Income & Expenditure Form

Income & Expenditure Form

Income and Expenditure Form

Your Proposal

You must ensure all information supplied is accurate to the best of your knowledge and that you do not make an offer of payment that you cannot afford.

Please return your completed form by post or email as soon as possible to enable us to formerly submit your offer. Your first payment is required on the due date stated above, before the offer can be considered, and we may need evidence of your income and expenditure.

Please note that if you fail to keep up with payments this will invalidate your offer and further enforcement action may follow, possibly with additional costs for which you would be liable.

If you have any queries regarding your account, get into difficulties with making your payments, or if you would like to provide further information, please contact our office to discuss the matter on
0333 320 2540

I confirm that I understand the above and the information provided is accurate and correct, and give consent to share this information with the claimant

How to Pay

By telephone with a Debit or Credit Card on 0333 320 2540 (Calls from a landline will be charged at a local rate; Charges for calls from a mobile vary)

24/7 Automated Card Payment Line Telephone 0333 320 2541 (Calls from a landline will be charged at a local rate; Charges for calls from a mobile vary)

Payment by web at

Standing order using the details below or direct debit by contacting this office on 0333 320 2540


SORT CODE: 30-95-74

ACCOUNT: 00404802

Important note: Failure to quote your reference number when making a payment may result in your payment being delayed or in some cases, not being allocated to your account

You can seek free advice and information from

AdviceUK at

Citizens Advice at or for England call 03454 040506 / 03444 111444 for Wales call 03444 772020

National Debtline at or on 0808 808 4000

Money Advice Service at or on 0300 500 5000

Stepchange at or on 0800 138 1111 at

Other free advice is available

Personal Details



No. of dependants in household:

Monthly Income

Monthly Expenditure

Priority Debts Owed (Total Owed)

Priority Debts Owed (Monthly Payments)