InDebted | Statement of Financial Position Form

Wage / Salary *

Frequency

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Adjusted monthly

Rental Income

Frequency

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Adjusted monthly

Pension / Superannuation Income (retirement payments)

Frequency

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Adjusted monthly

Investment Income (Dividends, Interest, Distributions)

Frequency

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Adjusted monthly

Government Benefits / Support Payments

Frequency

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Adjusted monthly

Total amount

Frequency

Adjusted monthly

Total amount *

Frequency

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Adjusted monthly

Yes No

Total amount

Frequency

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Start date

First-party

Third-party

Liquidity

Statement of Financial Position

Income & Expenses Details

Income (after tax)

Any Other Personal Income

Expenses

Your share (if any) of these expenses

Your share of other living expenses *

Do you have a Mortgage?

Do you pay Rent/Board?

Do you have any loans for personal, car or investment?

Student Loan Balance (e.g., HECS-HELP, NZ Student Loan)

Do you have any other non-Amex issued credit cards?

Any Other Expenses

Total Income: $ 0.00

Total Expenditure: $ 0.00

Customers Net Serviceability: $ 0.00

Proposed repayment schedule

Income & Expenses Details

Income (after tax)

Expenses

General operating costs *

Do you have any other non-Amex issued credit cards or business loans?

Any Other Expenses

Total Income: $ 0.00

Total Expenditure: $ 0.00

Customers Net Serviceability: $ 0.00

Proposed repayment schedule

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