ࡱ> q` bjbjqPqP b::_%vvvGGG8Gd.H ](HI"&I&I&IJJJ\\\\\\\$1^h`\vMJ"JMM\&I&I\PPPMjl&Iv&I\PM\PPP J,v Q&IH ;G3NjQ4RT \0 ]Q}aN~}a Q Q8}avXQJ[K^PKLLJJJ\\PjJJJ ]MMMM-n3$n3   SHAPE \* MERGEFORMAT   Income & Expenditure StatementName:FCM Reference Number: Address:Home Tel:Mobile Tel:AIncome: MonthlyCGeneral Expenditure:MonthlyYour wagesMortgages (1st & 2nd)Your partners wagesRentCompany pensionCouncil TaxIncome SupportGas/Electric/WaterJobseekers AllowanceOther fuel or heating costsChild BenefitPhoneCarers allowanceInsurances (Life, Building etc)Other state benefitsGroceriesWorking Tax /Child Tax CreditsClothingIncapacity BenefitPension paymentsPension CreditTravelling expenses MaintenanceTV rental and licenceHousing BenefitToiletriesStudent loan/grantSchool meals and meals at workOtherPrescriptions, dentist and glassesOtherMaintenance paymentsOtherCourt fines, CCJs etc Total Income (A) Other BBank/Finance Debts:MonthlyName:O/S Bal:Continue overleaf if required Total Bank/Finance Debts (B)  Total General Expenditure (C)  Monthly Balance (A - B - C)  Please sign and date the declaration below and send it to First Credit Management Ltd, Fountain Court, Vale Park, Evesham, Worcs. WR11 1LS.  Declaration The information I have given is true and complete and I understand that you may check the information I have given on this form.  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