Section 6 Details of Applicant(s) Income – Please state the amounts you receive and how often you receive payment. All questions must be completed either with an amount or N/A (not applicable) please do not leave blank. – Applicant 1 Applicant 2 Frequency of Frequency of Income Amount Amount Payment Payment Basic Net Pay Bonuses/Overtime (Net Amount) Adoption Pay (Occupational & Statutory) Drawings / Dividend if Self Employed Employees Sick Pay (after deductions) Child Benefit Child Tax Credit Working Tax Credit Existing Adoption Allowances Maternity Allowance / Pay Paternity Allowance / Pay Job Seekers Allowance Income Support Incapacity Benefit Bereavement Benefit Severe Disablement Allowance State Retirement Pension State Pension Credit State Savings Credit Industrial Injuries(e.g. Byssinosis) Works Pension / Superannuation War / War Widows Pension Attendance Allowance Disability Living Allowance – Mobility / Care Component Any Other Source of Benefit or Income (e.g. lodgers, property
Section 6 – Details of Applicant(s) Income Please state the amounts you receive and how often you receive payment. All questions must be completed either with an amount or N/A (not applicable) – please do not leave blank. Applicant 1 Applicant 2 Income Amount Frequency of Payment Amount Frequency of Payment Basic Net Pay Bonuses/Overtime (Net Amount) Adoption Pay (Occupational & Statutory) Drawings / Dividend if Self Employed Employees Sick Pay (after deductions) Child Benefit Child Tax Credit Working Tax Credit Existing Adoption Allowances Maternity Allowance / Pay Paternity Allowance / Pay Job Seekers Allowance Income Support Incapacity Benefit Bereavement Benefit Severe Disablement Allowance State Retirement Pension State Pension Credit State Savings Credit Industrial Injuries(e.g. Byssinosis) Works Pension / Superannuation War / War Widows Pension Attendance Allowance Disability Living Allowance – Mobility / Care Component Any Other Source of Benefit or Income (e.g. lodgers, property
fin_assess_form.docx