Submitting a Financial Budget

In order for us to fully understand your current financial status, we need to know more about your financial situation. As such please complete the following survey, filling in all possible details.

Once you have completed this survey we will send you an automated response to confirm we have received it. Once we have reviewed this survey we will be able to contact you to discuss the matter further.

If you would like to update your details after you have submitted this survey or have a question, feel free to contact us on 1300 799 511 quoting your reference.

Please try to answer all questions. If it does not apply to you, put N/A and the reason it does not apply.

Personal Details

First name

Last Name

Drivers License Number

Date of birth

Postal Address

Phone Numbers (At least one of these is required)

Home

Mobile

Work

Reference Number

Email Address (automated response will be sent here)

Your Assets

Do you own, rent or board at your current address?
RentBoardOwn

Name of landlord/real estate agent

Phone number of landlord/real estate agent

Address of landlord/real estate agent

Do you own or are you buying any land or building?
YesNo

Do you own or are you buying a motor vehicle?
YesNo

Are you owed any money?
YesNo

Are you an owner or do you have an interest in any business?
YesNo

Your Income

Are you employed?
You will be required to provide proof of your income e.g. a pay slip. This can be mailed to our office, attached below or sent via email to email@debtrecoveries.com.au with your reference number
YesNo

Will you be starting employment in the near future?
YesNo

Do you have a different source of income? If yes provide details

How much cash money do you have readily available?

Have you any personal property or assets not previously mentioned? If so, give details

If any of your assets or personal property are held with another person, provide the name and address of this person.

Your Expense

Give details of your expenses on a weekly basis.

Rent/Mortgage/Board

Food

Gas/Electricity

Clothing

House & Contents Insurance

Municipal & Water Rates

Telephone

Education Expenses

Medical/Dental/Pharmaceutical

Entertainment Expenses

Fuel Expenses

Car Expenses (Includes registration, insurance & maintenance)

Other Expenses

Loan Repayments (Give details of the loan and the balance owing, if multiple separate with ';')

Credit Card Repayments (Give details of each card and the balance owing, if multiple separate with ';')

Any other unpaid fines/debts against you (Give details of each and the outstanding balance, if multiple separate with ';')

Total

Family Details

Are you single/married/living in a de facto relationship?
SingleMarriedDe Facto

How many dependents do you have in your care?

What is their relationship to you and what are their ages? (if multiple, separate with ';')

Your Offer

We appreciate that you may not be able to pay the full amount in one payment. Please include your offer to pay this debt.

Lump Sum Your offer to pay off in one payment)

Other Comments

Terms and Conditions

I certify that I have read and accept the Terms and Conditions

Attach Proof of income here