Eurodebt Client Financial Planner

Franchisee’s Name

Legal Documents Enclosed

Advisor’s Name

Partner Unaware

Date

If different correspondence address to be used:

DMA

Client’s Name

Client’s Name

Financial Services Client Financial Planner

REV/10.05

1

Financial Services

APPLICANTS DETAILS Second applicant

First applicant

Title Mr/Mrs/Ms/Other Surname Forename(s) Date of Birth DD/MM/YY Present address Postcode Telephone numbers (include all)

Postcode Home

Home Work

Ext

Work

Mobile

Mobile

E-mail

E-mail

Postcode

Postcode

Ext

Previous address if at current address less than three years

PROOF

OF

I.D.

Passport Number Driving Licence Number Other (Specify)

EMPLOYMENT DETAILS Employers’s name Employer‘s address

Postcode

Postcode Length of service (Give dates) Position held/Job title Payment Method Payment Frequency

SELF EMPLOYED DETAILS Dates Occupation

BANK DETAILS Name - ie Yorkshire Bank Address Postcode

Postcode Accounts held

Current/Savings

Loan/Mortgage

Current/Savings

Loan/Mortgage

STATUS Marital Status

Single

Married

Single

Married

Separated

Divorced

Separated

Divorced

Widow/er

Living Together

Widow/er

Living Together

Number of Dependants and their ages Number of Dependants Living at Home and their ages

2

CAUSES/CIRCUMSTANCES LEADING MONTH/YEAR

TO

CURRENT SITUATION

EVENTS & CONSEQUENCES

MONTHLY INCOME Second applicant

First applicant Net Wages/Salary (Current Average)

£

p

£

p

Job Seekers Allowance

£

p

£

p

Child Benefit/Single Parent Benefit

£

p

£

p

Working Tax Credit

£

p

£

p

Child Tax Credit

£

p

£

p

CSA/Child Maintenance

£

p

£

p

Income Support

£

p

£

p

Maternity Benefit

£

p

£

p

Incapacity/Sickness Benefit

£

p

£

p

Attendance Allowance

£

p

£

p

Pension

£

p

£

p

Employed Children/Relatives/Lodger

£

p

£

p

Financial Support (Family/Friends)

£

p

£

p

Other

£

p

£

p

INDIVIDUAL TOTALS

£

p

(A) £

p

(B)

TOTAL FOR BOTH APPLICANTS

= (A) + (B)

=

£

p

(C)

3

MONTHLY HOUSEHOLD EXPENDITURE Property Rent/Lodgings

£

p

Rent Arrears

£

p

First Mortgage

£

p

Mortgage Arrears

£

Second Mortgage/Secured Borrowings

Arrears Outstanding

£

p

p

Arrears Outstanding

£

p

£

p

Arrears Outstanding

£

p

Other Secured Borrowings

£

p

Garage/Ground Rent

£

p

Council Tax

£

p

Council Tax Arrears

£

p

Arrears Outstanding

£

p

£

p

Water Rates (including arrears)

£

p

Arrears Outstanding

Electricity (including arrears)

£

p

Arrears Outstanding

£

p

Gas/Oil/Solid Fuel (including arrears)

£

p

Arrears Outstanding

£

p

Telephone

£

p

Telephone - Cell/Mobile

£

p

£

p

Vehicle Hire Purchase/Rental

£

p

£

p

Other Hire Purchase/Rental

£

p

£

p

Child Maintenance/CSA

£

p

£

p

Child Minding Fees

£

p

£

p

School/Nursery Fees

£

p

£

p

School/Nursery Meals & Travel

£

p

£

p

Pension Contribution

£

p

£

p

£

p

£

p

£

p

£

p

Term/Critical Illness Assurance

£

p

£

p

Payment Protection/ASU

£

p

Buildings and Contents Insurance

£

p

Pet Insurance

£

p

Vehicle Insurance

£

p

£

p

Vehicle Road Tax

£

p

£

p

NI Contributions

£

p

Union Fees

£

p

£

p

Opt/Dent/Med Expenses/Insurance

£

p

£

p

SUB TOTAL

£

p

£

p

List Finance Company Name in Notes below List Finance Company Name in Notes below

Endowment Assurance Whole Life Assurance

Mortgage Linked? Mortgage Linked? Mortgage Linked? Mortgage Linked?

Notes

4

MONTHLY HOUSEHOLD EXPENDITURE SUB TOTAL CARRIED FORWARD

£

p

TV Licence

£

p

Satellite/Cable Subscription

£

p

Internet

£

Other 1

(cont)

£

p

p

£

p

£

p

£

p

Other 2

£

p

£

p

Account Management Charge

£

p

SUB TOTAL

£

p

(D) £

p

Housekeeping - including Clothing

£

p

Child Visitations

£

p

£

p

Travel by Public Transport

£

p

£

p

Vehicle Fuel - Monthly Mileage

£

p

£

p

Vehicle Maintenance

£

p

£

p

Vehicle MOT

£

p

£

p

Prescriptions

£

p

£

p

Special Needs Expenses

£

p

Pet Food

£

p

Leisure/Tobacco (specify in notes below)

£

p

£

p

Contingency

£

p

IR/VAT (specify in notes below)

£

p

£

p

Court Fines

£

p

£

p

Other 1

£

p

£

p

Other 2

£

p

£

p

Other 3

£

p

£

p

Other 4

£

p

£

p

INDIVIDUAL TOTALS

£

p

(F) £

p

(G)

TOTAL FOR BOTH APPLICANTS

= (F) + (G)

=

£

p

(H)

£

p

(J)

ACCOUNT MANAGEMENT

£

p

MONTHLY PAYMENT TO EURODEBT

£

p

N ET M ONTHLY D ISPOSABLE I NCOME

£

(C)

(IF NOMINAL PAYMENT, DO NOT USE. ENTER PAYMENT ON NEXT PAGE)

Notes

5

MINUS

£

(H) =

(E)

CREDITORS Creditor

Action/ Hold/ Pending

Collector (if different)

Start Date MM/YY (Loans)

Current Balance

Contractual Monthly Amount

Next Monthly Payment Inc. Arrears

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. TOTALS

SPECIAL INSTRUCTIONS REGARDING SPECIFIC CREDITORS NO

CREDITOR

COURSE

OF

ACTION

TO BE

TAKEN

Monthly nominal amount clients can reasonably afford to offer their creditors. This amount will be calculated and offered to their creditors on a proportionate basis. (NOT TO BE USED IF THERE IS A MONTHLY DISPOSABLE INCOME) Nominal monthly Amount Offered 6

£

minimum £85.00 includes SPP fees

PROPERTY DETAILS Mortgage, Rented or Lodgings If Homeowners answer questions below Purchase Price

Date Purchased

£

Open Market Value

£

Forced Sale Value

£

Less 1st Mortgage Outstanding

Lender

£

Less 2nd Mortgage Outstanding

Lender

£

Less Secured Borrowings

Lender

£

Less any arrears on mortgages or borrowings

£

p

TOTAL PROPERTY ASSETS

£

p

VEHICLE DETAILS Make Model/Engine Year of Manufacture If Hire Purchase or Conditional Sale Name of Finance Company Trade Value

£

Less Total of Outstanding H-P payments

(£

INDIVIDUAL VEHICLE ASSETS

£

£ )

)

(£ £ £

TOTAL VEHICLE ASSETS

FULL

AND

FINAL SETTLEMENT OFFERS

Should funds be available to the client to enable an offer of Full and Final Settlement, please supply:Note: Should the client wish to proceed at any time, Head Office must be notified in writing.

The Source of Funding Amount of Funding

THIS SECTION

TO BE

SIGNED

BY

CLIENT(S) PRESENT

AT

MEETING

I/We confirm that the information provided by me/us is true and to the best of my knowledge. Full name (printed) Signature First applicant Second applicant Advisors Name

7

Date

CALL REPORT CHECK LIST Date of Meeting

1st Payment Due

Item

Enclosed

Seen

Checked on Bank Statement

To Follow

Payslips (1) Payslips (2) Gas Electric Water Council Tax

Telephone Number

Advisor

Mortgage Rent H.P. Agreements County Court P/W Current Creditors P/W

DMA Number

FEE

Initial

Initial

Payment

COMMENTS RE PAPERWORK:

DETAILS OF PAYMENT AS PER DMA:

Last Name

Last Name

DETAILS OF PAYMENT PROPOSAL AS PER DMA:

REMINDER: Please inform your clients that their file will be sent to Head Office for action. All enquiries/correspondence should be forwarded to Head Office direct.

MAKE SURE THAT YOUR CLIENT IS AWARE THAT CONTACTING YOU INSTEAD OF HEAD OFFICE COULD DELAY URGENT WORK ON THEIR CASE. 8