Find out if you qualify

You need to complete the sections below to give details of all household income for example; wages, benefits, Tax credits and pensions and also give details of your usual expenditure


Wages / Salary

Your Take Home Pay: None

Partner's Take Home Pay: None

Benefits / Tax Credits

Housing Benefit: None

Council Tax Support: None

Support for mortgage interest: None

Jobseeker's Allowance: None

Universal Credit: None

Income Support: None

Child Benefit: None

Child Tax Credit: None

Working Tax Credit: None

Maternity Pay / Allowance: None

Bereavement Benefits: None

Incapacity Benefit: None

Employment and Support Allowance: None

Statutory Sick Pay: None

Disability Living Allowance (Care): None

Personal Independent Payment (Daily living): None

Disability Living Allowance (Mobility): None

Personal Independent Payment (Mobility): None

Carer's Allowance: None

Severe Disablement Allowance: None

Attendance Allowance: None

Industrial Disablement Benefit: None


Retirement Pension: None

Pension Credit: None

Private Pension: None

Occupational Pension: None

Partner's Pension: None

Other Pension - Please Specify: None

Other Income

Maintenance: None

Student Grant / Loan: None

Income from Lodgers or Property: None

Son's / Daughter's Contribution: None

What (if any) savings do you have?: None

Other Income - Please Specify: None

Your total income is £0.00 per week


Tell us all of your usual payments for household bills and living expenses. Please make sure you include ALL payments that you are making towards arrears/debts here. You will NOT be able to include them later

Housing Costs

Rent: None

Mortgage: None

Secured Loans / 2nd Mortgage: None

Council Tax: None

Building / Contents Insurance: None

Other Housing Cost - Please Specify: None


Water / Sewerage: None

Gas: None

Electricity: None

Coal and Other Fuels: None


Food & General Housekeeping: None

Clothing: None


Child Care: None

School Meals etc.: None

Maintenance: None


Car - including fuel/insurance/road tax: None

Fares - Trains / Bus / Taxi: None

Motability Car: None


Care Costs / Special Needs: None

Other Outgoings

TV Licence: None

Sky / Cable: None

Appliance Rental: None

Telephone (inc. mobiles): None

Loans (inc. store cards, catalogues & HP): None

Other Outgoings - Please Specify: None

Your total expenditure is £0.00 per week

Amount left over

The above figures calculate that you have £0.00 left over each week after all your expenditure.
If this is not correct, please check the figures again.

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