Mandurah/Peel Financial Counselling Service

Mandurah/Peel Financial Counselling Service

Welcome to Finucare Financial Counselling Services. We look forward to working with you.
IF COMPLETING THE BELOW FORM, Please view the authority forms available on our website (You will be required to sign these during your appointment).
Below are opportunities for you to provide information, which will help us, in assisting you. There is also information which we hope will help guide you in what information to bring with you. We understand that sometimes information is difficult to get. Our financial counsellors are here to help, so please let them know anything you need help with. Please note that appointments with our financial counsellors will generally take about one hour.
Section 1

1.1 Personal Information - General
Name

First Name Last Name
Date of Birth

Month Day Year
Date Date Picker Icon
Partner/Spouse Name

First Name Last Name
Partner Date of Birth

Month Day Year
Date Date Picker Icon

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mobile Number

Area Code Phone Number
Work Phone

Area Code Phone Number
Home Phone

Area Code Phone Number
Email
1.2 Have you and/or your partner/spouse visited Finucare previously?
1.3 Are you aware of any persons whom you have/had a personal (eg. a relationship break-up ) or legal issue with, attending our services?
1.4 Are you currently appointed as any of the following:

Community Treatment Order Guardian Public Trustee Centrelink Money Management Voluntary Centrelink Money Management Involuntary
1.5 Are there any adults over 18 living in the house?
If yes and you are applying for debts related to Household expenses such as electricity, gas, water or rent you must complete details of other Adults living in the house.

Other Adults (over 18) Living in the House - Complete this section if you answered yes to the above

	Name	DOB	Relationship to Applicant
1
2
3

Section 3

Please fill in the below income and expenditure to the best of your ability. If a field does not apply, leave it blank. Please leave the TOTAL fields blank.

FORTNIGHTLY Income and Expenditure

	$
HOUSING TOTAL
Rent
1st Mortage
2nd Mortgage
Water Rates
Home & Contents Insurance
House Repairs
Strata Levels
MEDICAL TOTAL
Medical Insurance
Doctor
Dentist
Chemist
PERSONAL TOTAL
Grooming and Cosmetics
Entertainment
Club Fees
Holidays
Gifts
Pocket Money - Children
Alcoholic Drinks
Cigarettes/Tobacco
Donations/ Other
DVDS/Videos/Movies
Pool/Gardening
UTILITIES TOTAL
Electricity
Heating - wood/oil
Gas
Water
Mobile Phone
Internet/Foxtel
Telephone

Section 3 Continued

FORTNIGHTLY Income and Expenditure Continued.

	$
FOOD TOTAL
Groceries
Fruit and Vegetables
Lunches
Takeaway and Eating Out
EDUCATION TOTAL
School Fees & Books
Uniforms
Self-Education
School Excursions
Pre-School
Child Care / Child Minding
OTHER TOTAL
Superannuation
Life/Income Insurance
Professional Fees
Savings
Pet Vet Fees
Pet Food
Other Expenditure
TRANSPORT TOTAL
Petrol
Repairs
Registration
Fines
Insurance
License
Fares
EXTRAS TOTAL
Extra 1
Extra 2
Extra 3
Extra 4
Extra 5
Extra 6
Extra 7
Extra 8

Section 3 Continued

FORTNIGHTLY Income and Expenditure DEBTS

	Creditor Name	Fortnightly Payment	Balance Owing
Creditor 1
Creditor 2
Creditor 3
Creditor 4
Creditor 5
Creditor 6
Creditor 7
Creditor 8
Creditor 9
Creditor 10
Creditor 11
Creditor 12

Fortnightly Expenditure

	$
Living Expenses Total
Creditors/Loan Expenses
Total

Fortnightly Income

	$
Your Income
Partner/Spouse Income
Pension/Benefit
Family Payment
Child Support
Investments
Other
Other
TOTAL

Fortnightly Difference

	$
Fortnightly Income Minus Fortnightly Expenditure

Paperwork Checklist for Appointment

(Having as many of these with you as you can, will help us in assisting you. The minimum required for utility help is Bank Statements, Payslips/Centrelink Income and Asset Statement, copy of bill.)
- 3 months of current, bank account statements (from today back).
- Latest loan account statement for each of the following; Credit cards, Store Cards, Mortgages, Personal Loans, Hock Shop, Pay Day Loans or other debt you may have.
- Rent or Mortgage payment receipts if not on bank statement.
- 3 most current pay slips (if working).
- Centrelink Detailed Income and Asset Statement (including all benefits and deductions).
- Copies of Utility Bills ( Alinta, Synergy, Kleenheat, Origin or Other).
If Self-Employed additional documents which would be helpful are:
- 3 months of current, bank transaction statements from all accounts. Personal and Business accounts (from today back).
- 3 BAS Statements if monthly or 1 BAS statement if lodged quarterly
- Profit and Loss Statement (if available) or last tax return.
Additional Paperwork Required For Other Debts
- Proof of any other income (as listed at 2.6)
- Ensure ALL debts are listed, even those you are not sure are still current, including fines (These can be added to the above Income and Expenditure Statement).
- If you are applying for Grants related to household expenses such as gas, electricity, water or rent, please supply income and bank statements for ALL adults in the house.
If you are having trouble obtaining these items, contact our office to discuss ASAP.

We are able to photocopy these documents in our office, however there may be a short wait time. If you need to discuss anything, require assistance with completion of these forms or obtaining your documents, please phone or visit our office to discuss.

Address: 2 Tuart Avenue, MANDURAH WA 6210 (In front of Mandurah Library on Pinjarra Road)

Our office hours open to public are:

Monday______9.00am-4.00pm

Tuesday______9.00am-4.00pm

Wednesday___9.00am-4.00pm

Thursday_____Closed

Friday________Closed

Office times are subject to change according to staff availability. If we are not available, please feel free to leave us a message on 9581 1281, and we will return your call as soon as possible.
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	Name	DOB
Child 1
Child 2
Child 3
Child 4
Child 5