Make or change an arrangement to pay your housing benefit overpayment 1Using the form2Declaration3About you4Your arrangement5Your income6Your work7Your outgoings8Loans and debts9Other information Complete this form if you would like to make or change an arrangement to pay your housing benefit overpayment by instalments. This form will ask you to provide your details your National Insurance number the Housing Benefit overpayment invoice number the amount you’re offering to pay how often you’re offering to pay this amount when you would like the payment to start. Depending on your answers, this form may also ask you to provide: if you work, information about your employer and employment if you don’t work, information about any benefits you receive details of your full income and outgoings details of any loans or debts you have. Please have this information ready as pages time-out after one hour. Do not use your browser back button – if you need to go to a previous page click on the previous button at the bottom of each page. Privacy Statement Dover District Council is a Data Controller under GDPR. In submitting this form we will collect and process your personal data. For information about your rights and how the Council uses your data, please view our Corporate and relevant service privacy notice which can be found on our Privacy page. DeclarationPlease check the box below to confirm that you have read, understand and agree to the following statements before completing this form: I confirm the details I will give on this form will be correct and true. I confirm that I will notify you of any relevant changes straight away. I understand that if I give information that is false this could lead to a penalty or legal proceedings being taken against me. I understand my data may be shared with other departments as permitted by law. Declaration(Required) I understand and accept the above declaration About youTitle (for example Mr, Mrs, Ms, Miss)(Required)First name(Required)Last name(s)(Required)Contact phone number(Required)Email address(Required)We will use your email address to send the receipt of your form, including the form reference number. This may include personal data. We will also use your email address to contact you about your benefit claim and Council Tax account. Enter email address Confirm email address Would you like to receive your Housing Benefit, Council Tax Support notifications and Council Tax bills by email?(Required)You can receive your Housing Benefit, Council Tax Support notifications and Council Tax bills by email rather than post. We will send all future Housing Benefit and Council Tax Support notification letters and Council Tax bills to the email address you have given above. If you change your email address you must let us know straight away. You can opt out of this at any time at dover.gov.uk/paperless Yes No Housing Benefit or Council Tax Support reference number(Required)National Insurance number(Required)About your addressAddress(Required) Address line 1 Address line 2 Town or city Postcode Your arrangementAre you requesting a new arrangement or a change to an existing arrangement?(Required) New arrangement Change to an existing arrangement Invoice reference number(Required)Total amount you owe (amount on the invoice)(Required)How much are you offering to pay?(Required)Every(Required) Week Two weeks Four weeks Month When would you like this payment to start from?(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920This field is hidden when viewing the formPaid in 6 months calculation(Required)This field is hidden when viewing the formPaid in 6 months calculation final(Required) About your incomePlease list all the money coming into the household and select how often. This includes any income you and your partner receive and if any other adults living in the property contribute any money towards the household. If you get any income not listed, please give amounts using the ‘other income’ option.Income typePlease select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmountHow oftenPlease select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthWould you like to add another type of income?(Required) Yes No Income type(Required)Please select…Attendance AllowanceCarer's AllowanceChild BenefitChild MaintenanceChild Tax CreditDisability Living AllowanceEmployment and Support AllowanceIncapacity BenefitIncome SupportJobseeker's AllowanceMoney paid to you by any other adults who live with you (not your partner)Personal Independence PaymentSevere Disability AllowanceWages or salaryWorking Tax CreditUniversal CreditOther incomeAmount(Required)How often(Required)Please select…Every weekEvery two weeksEvery four weeksEvery monthIf you have included 'other income' as an option above, please give details about this other incomeDo you work?(Required) Yes No About your workEmployer's name(Required)Employer's address(Required) Address line 1 Address line 2 Town or city Postcode Employer's phone number(Required)Payroll number About workDo you work?(Required) Yes No About your workName of employer(Required)Address of employer(Required) Address line 1 Address line 2 Town or city Postcode Phone number of employer(Required)Payroll numberWages/salary (after tax and National Insurance contributions)(Required)How often are you paid?(Required) Weekly Two-weekly Four-weekly Monthly About your incomeWhat benefit(s) do you claim?(Required) Disability Living Allowance (DLA) Employment and Support Allowance Housing Benefit Income Support Jobseeker’s Allowance Pension Credit guarantee credit Personal Independence Payment (PIP) None of the above If you and your partner claim benefit jointly, which of you receives payment?(Required) You Your partner Total amount of any other income you get(Required)How often do you get paid this income?(Required) Weekly Two-weekly Four-weekly Monthly About your outgoingsPlease list all of your household outgoings and select how often. If you have any outgoings not listed, please give amounts using the ‘other expense’ option.Priority outgoingsType of outgoingPlease select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmountHow often?Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another priority outgoing?(Required) Yes No Type of outgoing(Required)Please select…Broadband / home phoneChild maintenanceCouncil TaxElectricityGasRentTV licenceWater ratesAmount(Required)How often?(Required)Please select…Every weekEvery monthNormal household expensesType of outgoingPlease select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmountHow often?Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another normal household expense?(Required) Yes No Type of outgoing(Required)Please select…Childcare costsClothingFood (including household products and toiletries)Insurance – homeInsurance – lifeInsurance – vehicleInsurance – otherMobile phonePetrol or dieselPrescription costsPublic transportSchool mealsVehicle expensesAmount(Required)How often?(Required)Please select…Every weekEvery monthNon-essential costsType of outgoingPlease select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmountHow often?Please select…Every weekEvery monthAdd another non-essential cost?(Required) Yes No Type of outgoing(Required)Please select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another non-essential cost?(Required) Yes No Type of outgoing(Required)Please select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another non-essential cost?(Required) Yes No Type of outgoing(Required)Please select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another non-essential cost?(Required) Yes No Type of outgoing(Required)Please select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another non-essential cost?(Required) Yes No Type of outgoing(Required)Please select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmount(Required)How often?(Required)Please select…Every weekEvery monthAdd another non-essential cost?(Required) Yes No Type of outgoing(Required)Please select…Cable or Sky TVCigarettes or vape / alcoholEating outGamblingLeisure activitiesLotteryOther expenseAmount(Required)How often?(Required)Please select…Every weekEvery monthIf you have included 'insurance – other' as an option above or have any other outgoings, please give details about theseDo you have any outstanding loans or debts (including rent arrears)?(Required) Yes No About your loans and debtsPlease list all of your loans and debts including the amount payable per week and the total amount you owe.Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)Do you have another loan or debt?(Required) Yes No Type of loan or debt(Required)Please select…Catalogue(s)Credit card 1Credit card 2Credit card 3Court finesLoan 1Loan 2Loan 3Loans from friends / familyStore card(s)Utility (for example gas, water, electricity) arrearsRent arrearsOtherAmount payable(Required)How often?(Required)Please select…Every weekEvery monthTotal amount outstanding or owed(Required)What steps have you taken to reduce the amounts owed?(Required)Please upload proof of these debtsYou can upload up to five documents. Each document should be no bigger than 2MB. If you have more documents to upload, you can do so later in the form Drop files here or Select files Accepted file types: txt, pdf, doc, docx, rtf, jpg, jpeg, tif, tiff, bmp, png, xls, xlsx, Max. file size: 15 MB, Max. files: 5. Other informationPlease use this box to tell us any other informationIf you have no further information to give us, leave the box blank
