Personal i&e Form

P

Personal Income and Expenditure Form – {Click here to download the forms}

Name – Email –

Cel No. –

Family Description –

A: INCOME                                                                           Actual                              Notes

1 Gross Salary  – Self
2 Gross Salary – Spouse
3 Other – Maintenance Received
4 Other –
5 Other –
GROSS INCOME

B: DEDUCTIONS OFF SALARY                                          Actual                                 Notes

1 Paye – Provision
2 Uif
3 Pension
4 Other –
TOTAL DEDUCTIONS
NETT INCOME

C: MONTHLY NECESSARY EXPENSES                    O/P    Actual                                 Notes

1 Groceries – Meat/ milk/veges/bread – Total
2 Bond Repayment/Rent
3 Water & Electricity/Rates & Taxes
4 Vehicle Lease
5 Vehicle / Household Insurance
6 Vehicle Maintenance
7 Petrol / Transport
8 Child / Parent Maintenance –
9 Medical Aid
10 Telephone – Cel / Landline
11 School Fees
12 Doctor / Dentist
13 Chemist
14 Clothing / Shoes – School & other
15 Home Maintenance
16 Creche / After Care / Day Mother
17 Housekeeper
18 Retirement Annuity
19 Life / Household Insurance
20 Bank Charges / Interest on Overdraft
21 Extraordinary Expense – this month
22 Any unrecorded expense – last month
23 Priority Creditor/Expense 1 – this month
24 Other 1 – A-Creditor Arrears:
25 Other 2 – A-Creditor Arrears:
26 Other 3 –
27 Other 4 –
TOTAL EXPENSES
NETT EXCESS (SHORTFALL)

D: CREDITORS                                                      A/B     Outs Balance  Instalment       Notes

1 Creditor Name:
2 Creditor Name:
3 Creditor Name:
4 Creditor Name:
5 Creditor Name:
6 Creditor Name:
7 Creditor Name:
8 Creditor Name:
9 Creditor Name:

E: ASSETS                                                                     Value          Outst Bal     Instalment       Notes

1 House –
2 Vehicle –
3 Household Goods –
4 Other –
5 Other –

Extra Notes: