Income and Expenditure Form

Written by Tony Webbstock.

              

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: