On-line application Form

Please complete the on-line form below

In order that we may begin assisting you with your enquiry please fill out our on-line application form. This form enable us to begin dealing with your case and aslo allows us decide at an early stage whether we can help you.

Please note that even if we are able to assist you, you are under no obligation to continue your application. You will be contacted within 48 hours of you submitting your on-line application form.

ABOUT YOU

Email Address:

Title:

Surname:

Forename(s):

Date of Birth:

(dd/mm/yyyy) *

Marital Status:

Number of Children living with you:

Address:

Living Arrangements:

If Homeowner:

Mortgage Amount

Estimated Current Value

Home Phone Number:

Work Phone Number:

Mobile Phone Number:

Most convenient time to contact you:

Do you live on your own?:

If Yes, is your partner or whoever you may live with aware of the difficulties?:

If they are not aware, who do you live with or who may answer the telephone?:

Can we leave messages with them?:

Can we discuss your situation fully with them?:

May we contact you at work?:

How long have you lived at your present address?

Do you have any children?

If Yes please give details of the child(ren):

Name(s) of your Child(ren)	DOB (dd/mm/yyyy)	Parents

Are any of the children who live with you in employment?:

Is there a CSA Assessment pending?:

Do you receive maintenance from an Ex-partner?:

If Yes, how much per month is received?:

Do you own a car?

If Yes, please give details of vehicle(s)

Vehicle 1:

Value
Make/Model
Age

Vehicle 2:

Value
Make/Model
Age

ABOUT YOUR EMPLOYMENT
Job Description:
Company:
Date of Commencement:	dd/mm/yyyy
Gross Salary:

ABOUT YOUR PARTNERS EMPLOYMENT
Job Description:
Company:
Date of Commencement:	dd/mm/yyyy
Gross Salary:

ABOUT YOUR INCOME
Your Income	(calendar monthly)
Your take home pay (including regular overtime):	£
Partner's take home pay (including regular overtime):	£
Other regular income (Child benefit/CSA/maintenance/pension/other benefits):	£

ABOUT YOUR EXPENDITURE
Your Expenditure	(calendar monthly)
Mortgage: £
or Rent: £
Council Tax: £
Water Rates: £
Electricity: £
Gas: £
Telephone: £
Telephone - (Mobile: £
Car Expenses (include petrol, servicing, insurance & Road Tax: £
Secured Car Loan / Car H.P.: £
Public Transport: £
Household Expenses: £
Smoking: £
Maintenance / CSA payments: £
TV Licence: £
TV / VCR Rental:
Endowment Policies / Pension: £
Life Insurance: £
Home Insurance:
Other Insurances (Medical , Health, ASU, Pet, Travel): £
	£
	£
	£

ABOUT YOUR CREDITORS
Name of Creditor	Total Amount Owing £'s	Account No.

REASONS FOR YOUR CURRENT DEBT
State what has caused your problems. How these problems have been incurred. The cost of these problems. Any losses which were uninsured. Any third party guarantees that have been called upon. Credit Card debts. Legal Actions lost and why. Any loss of income.

HOW DID YOU HEAR ABOUT US?
Existing client
Professional contact
Internet search
Other

ADDITIONAL COMMENTS
If you have any comments you'd like to make or questions you'd like to ask, please enter them here.

	I authorise you to pass my information to third parties to enable the debt management service to be provided.
Once you have completed the form, press Send to submit it to us so that we can conduct a Personal Credit Review. Alternatively, press Reset to clear everything.

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ENQUIRY FORM

Name

House Name or No.

Postcode

Email address

Telephone

Mobile

Best time to call

Amount of debt

Employment Status

Are you a home owner?
Yes | No

Other Info

We will get back to you soon!

IVA's

The IVA Guide
The UK Insolvency Helpline has put together an IVA Guide based on the enquiries and questions that we receive at our helpline offices.

In the guide we cover such subjects as IVA Approval, early settlment of your IVA, missed IVA payments, IVA failure, additional debt claims and much more.
[click here for IVA Guide]

What is an IVA?
The IVA is an extremely powerful tool enabling you to clear your debt and return to a clean financial bill of health. Visit The UK Insolvency Helpline's Guide to Individual Voluntary Arrangements (IVAs).
[more...]

The UK Insolvency Helpline

FREEPHONE 0800 074 6918

CALL 0800 074 6918

On-line application Form

Please complete the on-line form below

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ENQUIRY FORM

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