Income & Expenditure Form - Financial Statement

Income & Expenditure Form.

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Income & Expenditure Form

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Financial Statement Form
Customer Information

Step 1 out of 9

If you're experiencing financial difficulty, we're here to help you. Please complete an income and expenditure form so we can understand your financial situation. We'll then be able offer a solution that's best for you.

The form should take about half hour to complete. You can save your details at any point and come back to it later on.

It's useful to have the following information to hand so you can complete the form easily. You'll need the same information for each person named on the mortgage account.

Income (payslips, accounts)
Outgoings (debts)
Savings
Investments.

Mortgage details

Mortgage account number

Correspondence address

First name

Last name

Home phone no.

Mobile phone no.

Work phone no.

Email address

What's your intended retirement age (if applicable)?

How many people are named on the mortgage?

Unfortunately, as there are more than 2 people named on the mortgage you're unable to continue online. Please download/print a copy of the form to complete and send to us. If you're unable to this, please request a copy which we'll send by post. All those named on the mortgage will need to provide their details.

Paper form

Request a copy

Borrower 2 contact information

First name

Last name

Home phone no.

Mobile phone no.

Work phone no.

Email address

What's your intended retirement age (if applicable)?

There are errors in the form. Please fix them and submit again

You & Your Household

Step 2 out of 9

Tell us about your household and employment. Please provide a combined total for all borrowers whether you're living at the same address or not. E.g. dependants and vehicles may be shared by more than one borrower – you only need to tell us about each once.

Borrower 1

How many people live in your household?

How many dependants under the age of 14 do you support financially?

How many dependants aged 14 or over do you support financially?

How many vehicles are owned within your household?

Employment status

Employment details

Job title

How many hours do you normally work per week?

Borrower 2

Employment status

Employment details

Job title

How many hours are you contracted to do per week?

There are errors in the form. Please fix them and submit again

Household Income

Step 3 out of 9

Please tell us more about the monthly income received for each borrower named on the mortgage e.g. if you get paid every 4 weeks, multiply the amount by 13 and divide by 12:

Amount x 13

Borrower 1 income

Basic salary

Overtime/bonus

Total income from other work

Total income from private/State pension(s)

Maintenance/child support

Jobseeker's Allowance

Income Support

Working Tax Credit

Child Tax Credit

Child Benefit

Incapacity Benefit

Income from a contributing occupant(s) (not a lodger or boarder)

Board/Lodging payment

Rental income from investment property

Dividends

Carers/Attendance Allowance

Other - please specify

Other Income Total

Monthly income

Borrower 2 Income

Basic salary

Overtime/bonus

Total income from other work

Total income from private/State pension(s)

Maintenance/child support

Jobseeker's Allowance

Income Support

Working Tax Credit

Child Tax Credit

Child Benefit

Incapacity Benefit

Income from a contributing occupant(s) (not a lodger or boarder)

Board/Lodging payment

Rental income from investment property

Dividends

Carers/Attendance Allowance

Other - please specify

Other income total

Monthly income

Total monthly household income

There are errors in the form. Please fix them and submit again

Household Expenditure

Step 4 out of 9

Please provide details of all your household outgoings. These are the costs you pay to run your household and/or are not deemed as debt or credit finance.

Please provide monthly figures i.e. if you pay a bill annually, divide the amount due by 12.

Joint borrowers

You need to combine the outgoings for all borrowers named on the mortgage. If you live at different addresses, you'll need to include all the outgoings applicable for each property.

Essential Expenses

Mortgage payment

Endowment

Rent

Ground rent & service charge

Other secured loans (e.g. car loans)

Building/Contents insurance

Pension

Other insurance

Court fines

Maintenance/Child Support

Essential expenses total

Utilities

Council tax

Gas

Electricity

Water rates

Other fuel – coal, oil, etc..

TV licence

Utilities total

Travel

Road tax

Car insurance

Fuel

MOT/service/maintenance

Parking

Breakdown Recovery

Public transport

Travel total

Communications

Home phone

Mobile phone

Internet

Cable/satellite

Communication total

Living Costs

Food/toiletries/cleaning

Clothing/footwear

Child care

Nappies/baby items

School/work meals

Medical (prescription/dentist)

Pets (foods, vets, insurance)

Living costs total

Additional Expenditure

Health insurance

Repairs/property maintenance

Hair dressing/cut

Alcohol/cigarettes

Pocket money/school trips/clubs

Holiday/special occasions

Gifts

Charities

Additional expenditure total

Do you have any other outgoings not mentioned above? Please don't include any debt or credit commitments. We'll ask for these details in the next section

Other Expenditure

Other - please specify

Other expenditure total

Total monthly expenditure

There are errors in the form. Please fix them and submit again

Credit Commitments - Excluding Mortgages

Step 5 out of 9

Excluding mortgages, do you have any other credit commitments?

Please provide details of all the credit commitments (debts) registered against each borrower named on the mortgage.

Please enter the monthly amounts that are due. If the debt is in joint names, you only need to enter the details once.

Credit commitment {{$index + 1}}

Name of creditor

Outstanding balance

Expected/Minimum payment

End date

Have you arranged to make reduced payments?

Yes

!!!!Actual Payment

New arranged end date (if applicable)

Reduced payment

Credit commitment totals

Outstanding balance

Monthly payment due

There are errors in the form. Please fix them and submit again

Savings & Investment Plans/Policies

Step 6 out of 9

Please provide details of all the properties you own (and that of any other borrower), whether they're mortgaged or not. You should include any residential properties, Buy to Lets and holiday homes etc.

If you own a property outright, you only need to complete the fields that are applicable and enter 0 for the outstanding mortgage.
If you're completing this form for a Buy to Let mortgage and you don't own your main residence, please leave the main residence details blank.

Main residential property

Is your main residence mortgaged to Bank of Ireland?

Name of main borrower who owns this property?

Name of lender:

Estimated value of the property:

Outstanding mortgage balance:

Maturity date (DD/MM/YYYY):

Amount of equity:

Other properties

Do you (or any other borrower) own other properties i.e. Buy to Lets, holiday or second homes?

Other Properties

How many investment properties do you have?

Property {{$index + 1}}

Name of the borrower(s) who owns this property?

Name of lender:

Estimated value of the property

Outstanding mortgage balance:

Maturity date (DD/MM/YYYY):

Amount of equity:

Is the property owned with anyone else?

Yes

Borrower(s) percentage share of the property?

How many other owners are there?

Total outstanding mortgage balance across all other properties:

Total estimated across all other properties:

Total equity held across all other properties:

There are errors in the form. Please fix them and submit again

Savings & Investment Plans/Policies

Step 7 out of 9

Please provide us with the details of any savings and investment plans or policies held by all borrowers.

For multiple bank/building society accounts and stocks and shares investments, please enter

the details of the main account/investment
a combined total for all the accounts and policies held
any further details in the additional information section.

Savings and investments

Do you or any joint borrower have savings or investments that are held with a bank or building society?

Bank/Building society accounts

Name of the account/policy holder:

Name of bank/building society:

Total value of savings/investments held with all banks and building societies:

Maturity date, if applicable (DD/MM/YYYY):

Do you or any joint borrower own any stocks and shares?

Stocks and shares

Name of the account/policy holder:

Name of investment company:

Combined value of all stocks and shares owned:

Maturity date, if applicable (DD/MM/YYYY):

Total value of bank/building society/stocks and shares savings/investments:

Investment plans/endowments

Do you or any joint borrower have any investment plans or endowment policies?

Name of investment company {{$index + 1}}:

Name of the account/policy holder:

Type of investment e.g. endowment:

Is the investment easily accessible? E.g. are you able to draw funds within 30 days without penalty, is the authority of someone else needed?

Yes

Value of this investment:

Maturity date, if applicable (DD/MM/YYYY):

Is this investment an endowment which is linked to your property?

Yes

Total value of investment plans/endowments:

Other Investments

Do you or any joint borrower have other types of investment (excluding properties)?

Name of investment company {{$index + 1}}:

Name of the account/policy holder:

Type of investment:

Is the investment easily accessible? E.g. are you able to draw funds within 30 days without penalty, is the authority of someone else needed?

Yes

Value of this investment:

Maturity date, if applicable (DD/MM/YYYY):

Total Value of other investments:

There are errors in the form. Please fix them and submit again

Additional Information

Step 8 out of 9

Please provide any other information that may be important for us to know when reviewing your circumstances.

Options & advice

Please provide details of your current circumstances and why you need our help.

What are your repayment proposals?

Have you had any independent financial advice?

There are errors in the form. Please fix them and submit again

Review & Submit

Step 9

Please review the information below which provides an overview of what you've told us. When you're happy, just submit the form or you can go back to make amendments.

We'll send you an email to confirm we've received your information. Then we'll be in touch as soon as we can to talk through your options.

Income & expenditure overview

Customer Information

Mortgage account number:

Correspondence address:

First name:

Last name:

Home phone no.:

Mobile phone no.:

Work phone no.:

Email address:

What's your intended retirement age (if applicable)?:

How many people are named on the mortgage?:

Borrower 2 information

First name:

Last name:

Home phone no.:

Mobile phone no.:

Work phone no.:

Email address:

What's your intended retirement age (if applicable)?:

You and Your Household

How many people live in your household?

How many dependants under the age of 14 do you support financially?

How many dependants aged 14 or over do you support financially?

How many vehicles are owned within your household?

Employment status:

Job title:

How many hours do you normally work per week?

Borrower 2 job information

Employment status:

Job title:

How many hours do you normally work per week?

Household Income

Borrower 1 job information

Basic salary:

Overtime/bonus:

Total income from other work:

Total income from private/State pension(s)

Maintenance/child support:

Jobseeker's Allowance:

Income Support:

Working Tax Credit:

Child Tax Credit:

Child Benefit:

Incapacity Benefit:

Income from a contributing occupant(s):

Board/Lodging payment:

Rental income form investment property:

Dividends:

Carers/Attendance Allowance:

Other Income:

{{ $root.vm.contact.Borrower1_Income.CarersAttendanceAllowance }}

Monthly income

Borrower 2 job information

Basic salary:

Overtime/bonus:

Total income from other work:

Total income from private/State pension(s):

Maintenance/child support:

Jobseeker's Allowance:

Income Support:

Working Tax Credit:

Child Tax Credit:

Child Benefit:

Incapacity Benefit:

Income from a contributing occupant(s):

Board/Lodging payment:

Rental income form investment property:

Dividends::Carers/Attendance Allowance

Other income:

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{{ other['name'] }}:

Monthly income:

Total monthly household income:

Household Expenditure

Essential Expenses

Mortgage payment:

Endowment:

Rent:

Ground rent & service charge:

Other secured loans (e.g. car loans):

Building/Contents insurance:

Pension:

Other insurance:

Court fines:

Maintenance/Child Support:

Essential expenses total:

{{ $root.vm.contact.Expenses_List.Essential['MortgagePayment'] }}

{{ $root.vm.contact.Expenses_List.Essential['GroundRentServiceCharge'] }}

{{ $root.vm.contact.Expenses_List.Essential['OtherSecuredLoans'] }}

{{ $root.vm.contact.Expenses_List.Essential['BuildingContentsInsurance'] }}

{{ $root.vm.contact.Expenses_List.Essential['MaintenanceChildSupport'] }}

Utilities

Council tax:

Gas:

Electricity:

Water rates:

Other fuel – coal, oil, etc..:

TV licence:

Utilities total:

Travel

Road tax:

Car insurance:

Fuel:

MOT/service/maintenance:

Parking:

Breakdown/recovery:

Public transport:

Travel total:

{{ $root.vm.contact.Expenses_List.Travel['MOTServiceMaintenance'] }}

Communications

Home phone:

Mobile phone:

Internet:

Cable/satellite:

Communication total:

{{ $root.vm.contact.Expenses_List.Communications['MobilePhone'] }}

{{ $root.vm.contact.Expenses_List.Communications['CableSatellite'] }}

Living Costs

Food/toiletries/cleaning:

Clothing/footwear:

Child care:

Nappies/baby items:

School/work meals:

Medical (prescription/dentist):

Pets (foods, vets, insurance):

Living costs total:

{{ $root.vm.contact.Expenses_List.LivingCosts['FoodToiletriesCleaning'] }}

{{ $root.vm.contact.Expenses_List.LivingCosts['ClothingFootwear'] }}

{{ $root.vm.contact.Expenses_List.LivingCosts['NappiesBabyItems'] }}

{{ $root.vm.contact.Expenses_List.LivingCosts['SchoolWorkMeals'] }}

Additional Expenditure

Health insurance:

Repairs/property maintenance:

Hair dressing/cut:

Alcohol/cigarettes:

Pocket money/school trips/clubs:

Holiday/special occasions:

Gifts:

Charities:

Additional expenditure total:

{{ $root.vm.contact.Expenses_List.Additional['HealthInsurance'] }}

{{ $root.vm.contact.Expenses_List.Additional['RepairsPropertyMaintenance'] }}

{{ $root.vm.contact.Expenses_List.Additional['HairDressingCut'] }}

{{ $root.vm.contact.Expenses_List.Additional['AlcoholCigarettes'] }}

{{ $root.vm.contact.Expenses_List.Additional['PocketMoneySchoolTripsClubs'] }}

{{ $root.vm.contact.Expenses_List.Additional['HolidaySpecialOccasions'] }}

Other Expenditure

{{ other['name'] }}:

Other expenditure total:

Other ExpenditureTotal monthly expenditure:

Credit Commitments - Excluding Mortgages

Excluding mortgages, do you have any other credit commitments?

Credit commitment

Name of Creditor:

Outstanding Balance:

Expected/Minimum Payment:

End date (DD/MM/YYY):

Have you arranged to make reduced payments?

Reduced payment:

New arranged end date (if applicable):

Outstanding balance:

Monthly payment due:

Property Ownership

Main residential property

Is your main residence mortgaged to Bank of Ireland?

Name of main borrower who owns this property?

Name of lender:

Estimated value of the property:

Outstanding mortgage balance:

{{ $root.vm.contact.Residences_Main.outstandingMortgageBalance }}

Maturity date (DD/MM/YYYY):

Amount of equity:

Other properties

Do you (or any other borrower) own other properties i.e. Buy to Lets, holiday or second homes?

{{$root.vm.contact['Residences_Other_HasInvestmentProperties_Fixed']}}

How many other properties are owned?

Property {{$index}}

Name of main borrower who owns this property?

Name of lender:

Estimated value of the property:

Outstanding mortgage balance:

Maturity date (DD/MM/YYYY):

Amount of equity:

Is the property owned with anyone else?

How many other owners are there?

Borrower(s) percentage share of the property?

Total outstanding mortgage balance across all other properties:

Total equity held across all other properties:

Financial Savings & Investment Plans/Policies

Do you or any joint borrower have savings or investments that are held with a bank or building society?

Bank/Building society accounts:

Name of the account/policy holder:

Name of bank/building society:

Total value of savings/investments held with all banks and building societies:

Maturity date, if applicable (DD/MM/YYY):

Do you or any joint borrower own any stocks and shares?

Stocks and shares

Name of the account/policy holder:

Name of investment company:

Combined value of all stocks and shares owned:

Maturity date, if applicable (DD/MM/YYY):

Total value of bank/building society/stocks and shares savings/investments:

Investment plans/endowments:

Do you or any joint borrower have any investment plans or endowment policies?

Investment company {{$index}}

Name of investment company:

Name of the account/policy holder:

Type of investment:

Is the investment easily accessible? E.g. are you able to draw funds within 30 days without penalty, is the authority of someone else needed?

Value of this investment:

Maturity date, if applicable (DD/MM/YYY):

Is this investment an endowment which is linked to your property?

Other Investments:

Do you or any joint borrower have other types of investment (excluding properties)?

Investment company

Name of investment company:

Name of the account/policy holder:

Type of investment:

Is the investment easily accessible? E.g. are you able to draw funds within 30 days without penalty, is the authority of someone else needed?

Value of this investment:

Maturity date, if applicable (DD/MM/YYY):

Is this investment an endowment which is linked to your property?

Additional Information

Please provide details of your current circumstances and why you need our help:

What are your repayment proposals?

Have you had any independent financial advice?

{{$root.vm.contact['Additional_HasSoughtFinancialAdvice_Fixed']}}

Summary

Total monthly household income:

Total monthly household expenditure:

Total monthly disposable income:

We’ll be in touch within five working days to talk through your options. We may ask you for further information which will enable us to help you.

If you need to make any changes to your form once you’ve submitted it, please call us on 0800 169 9722. Lines are open 9am-5pm Monday to Friday. All calls are recorded for training and monitoring purposes.

Your personal information will only be used to contact you in regards to the information provided. If you would like to know more about how we ensure your privacy, how we handle your personal information and what your rights are, you will find more information in our Privacy Notice on bankofirelanduk.com/PrivacyNotice or by contacting us to ask for a copy.

Bank of Ireland Group provides mortgages in the UK either through “Bank of Ireland Mortgages” which is a trading name of the Governor and Company of the Bank of Ireland or “Bank of Ireland UK” which is a trading name of Bank of Ireland (UK) plc. If you are in any doubt as to your mortgage provider or have any queries relating to our UK mortgage products or services please contact our UK administration centre at:- Bank of Ireland (UK Mortgages), PO Box 3191, One Temple Quay, Bristol, BS1 9HY. Telephone: (0117) 979 2222. Fax: (0117) 929 3787. Website: www.bankofirelandmortgages.co.uk

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