Finucare Financial Counselling Form/Paperwork Pack

MANDURAH/BYFORD FINANCIAL COUNSELLING SERVICE

Welcome to Finucare Financial Counselling Services. We look forward to working with you.
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
Full Name

First and Middle Name Last Name
Date of Birth

Month Day Year
Date
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mobile Number

Area Code Phone Number
Work Phone

Area Code Phone Number
Home Phone

Area Code Phone Number
Email
Partner:

YES NO
If attending with your partner, please complete a Client Partner Details Form (Also located on this website).
Partner/Spouse Full Name

First and Middle Name Last Name
Partner Date of Birth

Month Day Year
Date
Partner Phone Number

Area Code Phone Number
Partner Email
example@example.com
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

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

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 requiring help; 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 requiring help ( 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.

RECEPTION is available Monday to Wednesday

MANDURAH OFFICE

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

Our office hours are:

Monday______9.00am-4.00pm

Tuesday______9.00am-4.00pm

Wednesday___9.00am-4.00pm

Thursday_____Closed

Friday________Closed

BYFORD OFFICE

Address: Inside St Aidan's Anglican Church, 21 Clifton Street, BYFORD WA 6122

Our office hours are:

Monday_____Closed

Tuesday_____Closed

Wednesday__9.00am-3.30pm

Thursday____9.00am-3.30pm

Friday______9.00am-3.30pm

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.

MANDURAH/BYFORD FINANCIAL COUNSELLING SERVICE
I,
Name

First Name Last Name
, authorize FinUCAre Financial Counselling Service to act as my agent and advocate, as well as in seeking access to consumer/credit information about me from:-
Name of bank, creditor, utility etc.
I understand that this authorization remains in force until the matter which is the subject of this case is resolved or until I otherwise revoke this statement.
Signature

Clear
Name

First Name Last Name
Date of Birth

Month Day Year
Date
Date Signed

Month Day Year
Date

MANDURAH/BYFORD FINANCIAL COUNSELLING SERVICE

GENERAL RETAINER AND DISCLAIMER

To: FinUCAre Financial Counselling Service

I hereby authorize and request you to act on my behalf in regard to:
I authorize you to make enquiries and negotiate on my behalf to receive and hold relevant documentation and information and do such other things as are reasonably necessary to effectuating this retainer.

I understand and agree that neither the Financial Counsellor nor the FinUCAre Financial Counselling Service warrants, represents or give assurance to me that their information, advice or opinions are accurate or complete. Any information, advice, representation or assistance is given or performed without acceptance of responsibility on their part to me, members of my family, my partners and any other persons on whose behalf or for whose benefit I request assistance of the Financial Counsellor or the FinUCAre Financial Counselling Service.

In the event of any information or materials supplied by me or for me being inaccurate or incomplete, I hereby indemnify the Financial Counsellor or FinUCAre against any loss or liability arising from that inaccuracy of incompleteness.
Name

First Name Last Name
Signature

Clear
Date

Month Day Year
Date
Name

First Name Last Name
Signature

Clear
Date

Month Day Year
Date

MANDURAH/BYFORD FINANCIAL COUNSELLING SERVICE
Date

Month Day Year
Date
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
We note that you have consulted this service with a view to the service assisting you to assess your financial situation. In this letter we would like to set out briefly the sort of organization our service is, and the sort of work it does.

Our service is free and confidential and set up to assist consumers to deal with their finances in an effective way. We normally proceed by assisting clients to assess their financial situation realistically, to identify the options open to them to deal with their situation, and to weigh the advantages and disadvantages for them of those alternatives.

Our Agency does not provide legal or accounting advice or assistance and it does not lend money. Our aim overall is to assist you to manage your financial affairs effectively, and to work toward outcomes suitable for you.
Our Agency seeks to avoid any conflict of interest arising in its work. Normally we will only deal with a family or more than one person in a household if the interests of all of the people are the same. It is helpful in those circumstances if you can nominate a spokesperson to pass the family’s views and wishes to us, and to convey our suggestions or recommendations to the various members of the family. It is a condition of our acting for you that if it becomes evident that there is a difference of views or interests between family members of such a type as to create a potential conflict of interest, our Agency will cease to act for you. In that situation we shall endeavour to refer you to neighbouring counsellors who may be able to assist different members of the family separately.

While our service maintains the confidentiality of our clients and their files in all normal circumstances, it will disclose information if it is compelled by law to do so. Examples of such compulsion arise if our service is served with a Subpoena issued by a Court, or if a notice is received from Centrelink, Australian Taxation Office or the Child Support Agency. The laws which govern these departments give them the power to require the provision of information by persons or organizations who hold information relevant to their work. We are also required by our management and funding bodies to collect statistics, and report to funding bodies.

While our service is happy to work with you toward the outcomes you wish to achieve, we emphasise that we cannot guarantee a specific outcome for you. Rather, we offer to work with you towards realistic and achievable goals in the light of the alternatives open to you. In return, we request that you respond within a reasonable time to our letters or telephone calls to you. If we write to you, and do not hear from you within a month we will assume you no longer wish our service to act for you, and we will close your file.
When the matter about which you have consulted us is complete, or if we do not hear from you for more than a month we will close your file. This means that we cease to act on your behalf. We will make available for collection by you such documents that you have handed to us for the purpose of dealing with your matter. We shall retain for our own records copies of letters and documents we have prepared for you, and our diary and file notes which we make as the matter proceeds.

We retain files for a period of seven years after the file is closed. After this time, the file is destroyed or disposed of in such a way the privacy of the material is ensured.

In the course of the work we do with you it may be necessary for us to collect personal information from you, and pass it to third parties such as creditors and their representatives. If it is relevant to the outcomes you wish to achieve we may collect sensitive information concerning health or other factors which affect your ability to meet financial commitments.

If you wish us to deal with your matter in this way, we request that you sign and date this letter, and return it to this service.

Yours faithfully

On behalf of
Finucare Financial Counselling
Signature

Clear
Name

First Name Last Name
Date

Month Day Year
Date
Should be Empty:

MANDURAH/BYFORD FINANCIAL COUNSELLING SERVICE