Helping Hands Application Form

Household Expenditure

Please complete the following for your household expenditure:

Do you make mortgage payments?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for rent (less Housing Benefit if applicable)?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay council tax (less Council Tax Benefit if applicable)?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for home buildings and/or contents insurance?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay a ground rent or service charge?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for water?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for gas and electricity?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for food (please include toiletries and cleaning products if you purchase these with your general grocery shopping)*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for clothing/shoes?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for a TV licence and/or TV packages eg Sky, Netflix, Now TV?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for Telephone (home landline) and/or broadband/internet costs?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for mobile telephones?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

How many mobile phones does this cover?*

Do you pay car running costs ie. MOT, tax, insurance, maintenance/repairs and fuel?*

Yes
No

Please enter monthly amount for MOT:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Please enter monthly amount for tax:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Please enter monthly amount for insurance:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Please enter monthly amount for maintenance/repairs:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Please enter monthly amount for fuel:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

How many cars does this cover?*

Do you pay for car finance?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for any other transport costs ie. public transport or taxi?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you make monthly credit card repayments?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for any credit / loan agreements?*

Yes
No

Please specify name of credit / loan company:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other credit / loan agreements?*

Yes
No

Please specify name of credit / loan company:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other credit / loan agreements?*

Yes
No

Please specify name of credit / loan company:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other credit / loan agreements?*

Yes
No

Please specify name of credit / loan company:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other credit / loan agreements?*

Yes
No

Please specify name of credit / loan company:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other credit / loan agreements?*

Yes
No

Please specify name of credit / loan company:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other credit / loan agreements?*

Yes
No

Please specify name of credit / loan company:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other credit / loan agreements?*

Yes
No

Please specify name of credit / loan company:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other credit / loan agreements?*

Yes
No

Please specify name of credit / loan company:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other credit / loan agreements?*

Yes
No

Please specify name of credit / loan company:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for any life insurance?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for any funeral plans?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay any child maintenance ie. Child Support Agency (CSA); Child Maintenance Service (CMS) or payments directly to a former partner?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you pay for childcare and/or carer's costs?*

Yes
No

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other expenditure?*

Yes
No

Please specify what this is for:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other expenditure?*

Yes
No

Please specify what this is for:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other expenditure?*

Yes
No

Please specify what this is for:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other expenditure?*

Yes
No

Please specify what this is for:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have any other expenditure?*

Yes
No

Please specify what this is for:*

Please enter monthly amount:*

If this expenditure is weekly then please multiply this figure by 4.33 to get the monthly amount. If paid annually, then please divide the figure by 12 to get the monthly amount.

Do you have mortgage/rent arrears?*

Yes
No

Please enter amount:

Mortgage/rent arrears upload*

Please note you are required to provide any statements, letters or reminders in relation to this debt.

Do you have other arrears ie. council tax, water, gas, electricity?*

Yes
No

Please detail:*

Please enter amount of arrear:

Other arrears upload*

Please note you are required to provide any statements, letters or reminders in relation to this debt.

Do you have an outstanding credit card balance?*

Yes
No

How many cards does this balance cover?

Name of credit card/provider:*

Current balance on card:*

Credit card upload*

Please note you are required to provide any statements, letters or reminders in relation to this debt:

Do you have any other credit cards?*

Yes
No

Name of credit card/provider:*

Current balance on card:*

Credit card upload*

Please note you are required to provide any statements, letters or reminders in relation to this debt:

Do you have any other credit cards?*

Yes
No

Name of credit card/provider:*

Current balance on card:*

Credit card upload*

Please note you are required to provide any statements, letters or reminders in relation to this debt:

Do you have any other credit cards?*

Yes
No

Name of credit card/provider:*

Current balance on card:*

Credit card upload*

Please note you are required to provide any statements, letters or reminders in relation to this debt:

Do you have any other credit cards?*

Yes
No

Name of credit card/provider:*

Current balance on card:*

Credit card upload*

Please note you are required to provide any statements, letters or reminders in relation to this debt:

Do any of these cards have an interest rate of 0%?*

Yes
No

Please detail:*

Do you have any store cards?*

Yes
No

Please enter the total store card balance:*

How many cards does this balance cover?*

Store card upload*

Please note you are required to provide any statements, letters or reminders in relation to this debt:

Are you overdrawn in your bank account?*

Yes
No

How much is your current overdraft?

Overdraft upload*

Please note you are required to provide any statements, letters or reminders in relation to this debt.

Do you pay monthly charges on your overdraft?*

Yes
No

How much are your average monthly charges?

Do you have a bank loan?*

Yes
No

Initial loan agreement amount*

Approximate loan start date

Current balance*

How many months left to pay

Bank loan upload*

Please note you are required to provide any statements, letters or reminders in relation to this debt.

Do you have a car finance loan?*

Yes
No

Initial loan agreement amount*

Approximate loan start date

Current balance*

How many months left to pay

Car Finance upload*

Please note you are required to provide any statements, letters or reminders in relation to this debt.

Do you have any other loans?*

Yes
No

Initial loan agreement amount*

Approximate loan start date

Current balance*

How many months left to pay

Other loan upload*

Please note you are required to provide any statements, letters or reminders in relation to this debt.

Helping Hands Online Form

Eligibility

Previous applications

Personal Details

Employment Details

Company Pensioner (Ocean/Exel/DHL)

Why I need Helping Hand:

Household Income

Section Break

Section Break

Household Expenditure

Declaration, Data Protection & Privacy

Privacy and Use of Your Information:

Month and Year	Amount received