Fife Trading Standards Money Advice Service
Client Appraisal Form

How did you hear about our Service?
Name:
Partner's Name:
Address:
Postcode:
Tel:
Email:

You		Your Partner
Date of birth		Date of birth
Nat. Ins. No.		Nat. Ins. No.
How many hours worked per week?		How many hours worked per week?
Type of work		Type of work
Were you in the military?		Were you in the military?
Have you been bankrupt or signed a Trust Deed?		Have you been bankrupt or signed a Trust Deed?
Date of discharge from bankruptcy/ Trust Deed?		Date of discharge from bankruptcy/ Trust Deed?

Housing
Is your home rented?		If so from whom?
Is your home bought?		How much equity do you have in your home?

Dependants
Name/Relationship (e.g. Jane/daughter)		Date of birth
Name/Relationship		Date of birth
Name/Relationship		Date of birth
Name/Relationship		Date of birth
Name/Relationship		Date of birth
Name/Relationship		Date of birth
How many dependants live with you?		How many days per week?

Does anyone else live with you? (Give details)

Health
Does anyone in the household have any illnesses/disabilities? (Give brief details)

Income			Expenditure
	Amount	Frequency		Amount	Frequency
Client net wage			Rent/Mortgage
Partner net wage			Secured Loans (Homeowners only)
Income Support			Council Tax
Child Benefit			Life Insurance
Jobseekers Allowance			Contents Insurance
Working Tax Credit			Buildings Insurance
Child Tax Credit			Endowment Insurance
Pension Credits			Other Insurance
State Pension			Gas
Occupational Pension			Electricity
Incapacity Benefit			Housekeeping
Statutory Sick Pay			School Meals
DLA (Mobility Component)			TV Rental/Licence
DLA (Care component/AA)			Telephone (landline)
Maintenance			Telephone (mobile)
Board from lodger/children			Car Tax/Ins/MOT
Student Loan/Bursary			Petrol
Other (Detail)			Other Travel Costs
Other (Detail)			Clothing
Other (Detail)			Car Payments
Other (Detail)			Child Support
Other (Detail)			Childminder
Other (Detail)			Fines
Other (Detail)			Other (Detail)
Total			Total
Available Income

If your wages are being arrested or there is any money being deducted from your benefits, please tell us who is arresting or deducting money and how much. The above amounts should be before deductions.
Company:		Amount:

Equal Opportunities Monitoring

In order to check the effectiveness of our Equal Opportunities policy, we monitor a range of areas where people may experience discrimination. All information will be treated in strict confidence and names will not be shown in any statistics produced. Please tick the category that most closely indicates your cultural background.

White		Black African		Asian-Indian		Chinese		White European
Black Caribbean		Asian-Pakistani		Mixed Race		Irish		Black Other
Asian-Bangladeshi		Other

Creditor Information

Make sure that you are liable for the debts you tell us about on these next pages. If you are not sure if they are your debts, let us see the agreement you signed.

Creditor details (name/address/phone number)

Whose name is debt in?		Account number
Amount owed		Original payment
Is debt secured on your home?		Type of debt (loan/credit card/ catalogue etc)

Creditor details (name/address/phone number)

Whose name is debt in?		Account number
Amount owed		Original payment
Is debt secured on your home?		Type of debt (loan/credit card/ catalogue etc)

Creditor details (name/address/phone number)

Whose name is debt in?		Account number
Amount owed		Original payment
Is debt secured on your home?		Type of debt (loan/credit card/ catalogue etc)

Creditor details (name/address/phone number)

Whose name is debt in?		Account number
Amount owed		Original payment
Is debt secured on your home?		Type of debt (loan/credit card/ catalogue etc)

Creditor details (name/address/phone number)

Whose name is debt in?		Account number
Amount owed		Original payment
Is debt secured on your home?		Type of debt (loan/credit card/ catalogue etc)

Creditor details (name/address/phone number)

Whose name is debt in?		Account number
Amount owed		Original payment
Is debt secured on your home?		Type of debt (loan/credit card/ catalogue etc)

Creditor details (name/address/phone number)

Whose name is debt in?		Account number
Amount owed		Original payment
Is debt secured on your home?		Type of debt (loan/credit card/ catalogue etc)

Creditor details (name/address/phone number)

Whose name is debt in?		Account number
Amount owed		Original payment
Is debt secured on your home?		Type of debt (loan/credit card/ catalogue etc)

Please add any further relevant information you would like to provide us with.

Further information ...

For information and support, contact Trading Standards.

Trading Standards Money Advisors can be contacted on 01592 583123.

You can also visit the website at www.tradingstandards.gov.uk/fife or email us
at money.advice@fife.gov.uk.

Thank you.

Now click on the 'Post Form' button below.

Fife Council, Environmental Services, Trading Standards, Kingdom House, Kingdom Avenue, Glenrothes, KY7 5LY
Telephone: 08451 55 55 56.
Electronic Mail:  cds_TS@fife.gov.uk
Internet World Wide Web:  http://www.tradingstandards.gov.uk/fife

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