Income & expenditure for Council Tax liability

Regulation 36 of the Council Tax (Administration & Enforcement) Regulations 1992

If you’ve received a summons, but you are unable to pay the full amount before the court hearing date, please complete Section 2 of the on-line income & expenditure form. We will not agree a payment arrangement until we have these details.

If a Liability Order has been issued against you, but you cannot afford to pay in full immediately, please complete both Sections 1 and 2 of the on-line income & expenditure form.

You must supply the details requested on this section of the form, otherwise you may incur a Court Fine. If a Court Fine is incurred, your name may be entered on the PUBLIC REGISTER OF JUDGEMENTS, ORDERS AND FINES, which could seriously affect your ability to obtain credit (e.g. bank overdrafts, loans, credit cards, shop/catalogue credit, or a mortgage).

Personal Details (Section 1)

You

Your Partner

Title:

*First Name:

*Surname:

Daytime Telephone number:

*Address

*Email:

*Confirm Email:

*Council Tax Reference number

Employment

*Are you employed:

Yes No

If Yes, please supply - The name and address of your employer:

If No, please go to the next section called Other Income

Works Number / Pay Reference:

Average Net Earnings (take home pay):

Per

If an attachment of earnings order is currently in force, please give details:

Other Income

*Are you receiving Income Support or Jobseeker’s Allowance?

Yes No

If YES - please supply your National Insurance Number

If NO – if you are not employed, or receiving Income Support / Job Seekers Allowance, please give details of how you obtain income (e.g. self-employed, Incapacity Benefit, Investments, Pension) and how much you receive

£ Per

Please supply the names of any other occupiers, over the age of 18, at this address and their relationship to you

Financial Details (Section 2)

You are not legally obliged to supply the information below, but it will help us to agree a reasonable payment arrangement, rather than using other legal means of collecting the debt.

Vehicle Make:

Vehicle Model:

Vehicle Registration Number:

Year of Registration:

Number of adults in property:

Number of children in property:

Income

This Budget is:

Monthly Weekly Fortnightly

Income:

Partner's Income:

Pension:

Benefits:

Working families tax credit:

Maintenance:

Non-dependants contribution:

Child Benefit:

Other:

Total Income: £

Expenditure

	£		£
Rent		Mortgage
Second mortgage/Secured loan		Mortgage endowment
Current Council Tax		Ground rent
Service charges		Property repairs
Water charges		Electricity
Gas/other fuel		House contents insurance
Buildings insurance		Life assurance
Court fines		Maintenance/child support
Private pension		Car expenses
Travel expenses		Food/clothing
Childcare		Telephone
TV licence		Loan Repayments
TV rental		Mobile phone
Cigarettes		Alcohol
Entertainment		Store Cards
Other	Please supply details:

Total Expenditure: £

Amount Available: £

Offer of payment towards Council Tax arrears:

£ Per

* I declare that the information given here is true and correct. I understand that if I do not provide the information, WITHIN 14 DAYS of this request, I may be liable to a COURT FINE OF £500. Also, if I supply false information, I may be liable to a COURT FINE OF £1,000 AND A CRIMINAL RECORD.

*Required fields

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