Questionnaire

So that we can assess whether we will be able to help you, please complete this questionnaire.

NOTE: All information will be kept confidential and will not be disclosed to any third parties.

What is the your name?*
What is your address?*
Married or Single?	Married Single Divorced
Have you any dependants?	Please list their names, ages and relationship:
Contact telephone number?*
Mobile number?
Contact fax?
Contact email address?
Employment status	Employed Self employed Company director
What is your job title?
Details of pressing creditors	Please include details of the amounts, contact details, reference numbers.
Have you received demands or threats of Court action?	Yes No If yes,from whom?
Have you received any County Court Judgements?	Yes No
Are there any Statutory Demands?	Yes No
Has anyone Distrained?	Yes No If yes, whom?
Do you own your own home?	Yes No
Do you have a mortgage?	Yes No If yes, please state amount outstanding and with who?
Please list any assets, savings, shares or other?
What is your monthly income?
Please list your monthly expenditure?
* I confirm that I am a UK resident or was a UK resident in the preceding 3 years

*Mandatory