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STRAIGHTALKDEBT.COM - A trading name of GRIFFIN & KING Ltd Call Free 0800 731 2205

Please complete all the details below and click the Submit Button at the bottom of the form when ready.

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Personal Information
* compulsory fields
    
   
Mr. Mrs. Ms. Miss.
Surname * :
First names: :
Date of Birth :
Age :
With which bank is your current account? :
Are you :
Single Married separated Divorced Widowed
     

If you are Married or living with a partner please fill in this section, otherwise go on to the next section
Spouse's/Partner's full name :
Spouse's/Partner's Date of Birth  
Spouse's/Partner's Occupation :
   
Full Time Part Time
     

YOUR DEPENDENTS
How many dependent children under 16 OR in full time education do you have? :
Do you have any children not living at home to whom you provide financial assistance? :
Yes No
If YES, how much do you pay each month for child maintenance? :
Is this amount set :
By Agreement By the CSA
How many adult dependents (e.g elderly parents/relatives) do you have? :
     

WHERE YOU LIVE
Address * :

Postcode :
Home phone number * :
Mobile phone number :
Are you :
The Home Owner A Tenant Living with parents
Rental Accommodation
     

If you are the Home Owner, please fill in this section, otherwise, go on to the next Section
if your property is jointly owned please give the name of the co-owner :
What is the approximate value of your property? :
What is the approximate amount outstanding on your mortgage? :
Do you have any other loans secured against your house :
Yes No
If Yes, please give details below    
Name of lender :
Amount owed: :
Name of lender :
Amount owed: :
     

YOUR WORK AND INCOME
Are you :
Employed Self Employed
What is your occupation :
  :
Full Time Part Time
What is your monthly income (after tax and national insurance)? :
Are there any other deductions from your income (eg CSA)? :
Do you receive a pension? :
Yes No
If Yes, how much is your monthly pension? :
Do you receive any benefits? :
Yes No

If Yes, please fill in the details below, otherwise go on to the next section
Type of benefit amount per month e.g. Child Benefit, Working tax credit...

 :
Spouse's/Partner's monthly income
(after tax and national insurance)		 :
     

DETAILS OF YOUR CREDITORS

Please fill in this section as accurately as possible as this will form the basis of who we write to notify them of your IVA

First secured lender or Mortgage
Name: :
Address :

Your account or reference number :
Total present amount interest
(The present amount due-including any interest):		 :
Is this debt owed jointly with someone else? :
Yes No
If Yes, who is the other partner in the debt? :
     

Second secured loan or mortgage lender
Name: :
Address :

Your account or reference number :
Total present amount interest
(The present amount due-including any interest):		 :
Is this debt owed jointly with someone else? :
Yes No
If Yes, who is the other partner in the debt? :
     

Other secured loan or mortgage company
Name: :
Address: :

Your account or reference number :
Total present amount interest
(The present amount due-including any interest):		 :
Is this debt owed jointly with someone else? :
Yes No
If Yes, who is the other partner in the debt? :
     

Finance or hire purchase (HP) creditor
Name :
Address :

Your account or reference number :
Total present amount interest
(The present amount due-including any interest)		 :
Is this debt owed jointly with someone else? :
Yes No
If Yes, who is the other partner in the debt? :
     
Name :
Address :

Your account or reference number :
Total present amount interest
(The present amount due-including any interest)		 :
Is this debt owed jointly with someone else? :
Yes No
If Yes, who is the other partner in the debt? :
     
Name :
Address :

Your account or reference number :
Total present amount interest
(The present amount due-including any interest)		 :
Is this debt owed jointly with someone else? :
Yes No
If Yes, who is the other partner in the debt? :
     
     
     

OTHER CREDITORS: CREDIT CARDS/STORE CARDS/LOANS/CATALOGES ETC:
Name: :
Address:* :

Your account or reference number :
Total present amount interest
(The present amount due-including any interest):		 :
Is this debt owed jointly with someone else? :
Yes No
If Yes, who is the other partner in the debt? :
     
Name: :
Address: :

Your account or reference number :
Total present amount interest
(The present amount due-including any interest):		 :
Is this debt owed jointly with someone else? :
Yes No
If Yes, who is the other partner in the debt? :
     
Name: :
Address: :

Your account or reference number :
Total present amount interest
(The present amount due-including any interest):		 :
Is this debt owed jointly with someone else? :
Yes No
If Yes, who is the other partner in the debt? :
     
Name: :
Address: :

Your account or reference number :
Total present amount interest
(The present amount due-including any interest):		 :
Is this debt owed jointly with someone else? :
Yes No
If Yes, who is the other partner in the debt? :
     
Name: :
Address: :

Your account or reference number :
Total present amount interest
(The present amount due-including any interest):		 :
Is this debt owed jointly with someone else? :
Yes No
If Yes, who is the other partner in the debt? :
     

YOUR DETAILED MONTHLY INCOME AND EXPENDITURE

How much do you pay each month for the following. Please make every effort to be as accurate as possible:

HOUSE MONTHLY SPEND
Mortgage or Rent :
Secured loan / second mortgage :
Council Tax :
Gas :
Electric :
Water :
Fixed phone line :
Internet connection :
Mobile phone :
Building insurance :
Home contents insurance :
House maintenance / DIY :
TV License :
Satellite / Cable TV :
Hire Purchase on household goods :
Car insurance :
Petrol :
Car tax :
Car maintenance :
MOT :
Parking :
AA / RAC membership :
Public transport or other travel :
Food :
Clothing :
Hire Purchase payments :
Life insurance :
Medical insurance :
Private pension :
Medical / Dental bills :
School fees :
Socialising :
Tobacco :
Fines / CCJs :
Child Support Agency :
Charity contributions :
Children's pocket money :
Other (please specify) :
   

 

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