IVA or Individual Voluntary Arrangement STATEMENT

Please spend a small amount of time filing in our form and we will contact you on receipt of your application details. (* required fields)

Debtor 1

Name

Address

Home Telephone Number*

Work Telephone Number*

Mobile Telephone Number*

Date of Birth

Marital Status

Occupation

Employer
(name and address)

Years service

Current Salary (yearly)

Current Salary (Net monthly figure)

No of Dependants

Age of Dependants

Debtor 2

Name

Address

Home Telephone Number*

Work Telephone Number*

Mobile Telephone Number*

Date of Birth

Marital Status

Occupation

Employer
(name and address)

Years service

Current Salary (yearly)

Current Salary (Net monthly figure)

No of Dependants

Age of Dependants

Personal details continued

History
please detail the reasons for your current financial position.

Other
Any other information you believe is relevant please detail

Assets

House

Address

Value (GBP) £

Yes No
if yes with whom

Is the property is in joint names

Mortgage Lender
(name and address)

Reference No

Type of Mortgage
(ie Endownment/repayment)

Amount of current mortgage outstanding

Yes No

Do you have arrears

Monthly Payment
(without arrears)

Monthly Payment
(with arrears)

No. of years at Property

Yes No
if yes please give details

Are there any other charges on the property

Car(s)

Car 1

Make & Registration

Value

Yes No

Finance Yes/No

If yes Finance Company
(name and address and policy No.)

Amount outstanding

Monthly payment

Completion date

Car 2

Make & Registration

Value

Yes No

Finance Yes/No

If yes Finance Company
(name and address and policy No.)

Amount outstanding

Monthly payment

Completion date

Assets (continued)

Endowment/Insurance Policies

Yes No

Do you have endowment/insurance policies

If yes...

Policy 1

Name and Address of Insurance Company

Policy No.

Date Commenced

Date of Completion

Monthly Payments

Current Value

Value at Completion

Yes No

Can it be surrendered

If yes, current surrender value

Yes No

Is it secured against a loan/mortgage

If yes, current surrender value

Policy 2

Name and Address of Insurance Company

Policy No.

Date Commenced

Date of Completion

Monthly Payments

Current Value

Value at Completion

Yes No

Can it be surrendered

If yes, current surrender value

Yes No

Is it secured against a loan/mortgage

If yes, current surrender value

Any other information

Assets (continued)

Bank Accounts

Current bankers
(name and address)

Account no

Current balance

Type of Account

Yes No

Do you have a Savings account(s)

Name and Address of Bank/Building Society

Account no

Current balance

Other Assets

Yes No

Do you have a Pension

If yes...

Debtor 1

Name and Address of Pension Company

Policy No.

Monthly Payments

Current Value

Type of Pension
(i.e. occupational/personal)

Debtor 2

Name and Address of Pension Company

Policy No.

Monthly Payments

Current Value

Type of Pension
(i.e. occupational/personal)

Assets (continued)

Any other assets please detail below, ie, antiques, timeshare, shares, debtors

Creditors

Please list below all creditors, including the following information

Name and Address

Account No

Current Balance

Details of any debt collection agencies / solicitors

Details of any county court summons/judgements

Details of any joint and several guarantees given on other debts

(PLEASE INCLUDE COPIES OF THE LATEST STATEMENTS, CORRESPONDENCE, COURT DOCUMENTS)

IMPORTANT NOTE: Please ensure you detail all creditors. Any creditors not notified of the voluntary arrangement will not be bound by the arrangement and can take separate legal action against you.

Creditors (continued)

Name and Address

Account No

Current Balance

Monthly Income and Expenditure details

Income

Salary (1)

Salary (2)

Other Income - ie child allowance

Expenditure

Mortgage

Electricity

Gas

House Insurance

Water Rates

Council Tax

Telephone

Travel/Petrol

Food and general household expenses

TV Licence

Others (please state,ie, car payment insurance)

Total Expenditure

Available Income

Monthly voluntary contribution

Surplus Income

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