Financial Health Summary (Condensed)

First Name: ______First Name: ______

Last Name: ______Last Name: ______

Age: ______Age:______

Contact Info

Phone (H/C/W): ______

Email: ______

Street: ______

City/Town: ______Prov.: ______Postal Code: ______

Family Status & Date:

___ Single____ Common-law____ Married____ Separated/ Divorced____ Widowed

Children/ Dependents:

# of kids living with you- ______

Age range of kids living with you- ______

Debts: Who do you owe money to?

Creditor Name / Type of loan
(credit card, mortgage, car loan, line of credit, etc. / Balance $ / Monthly payment

Do you have creditors calling you for late payments? Who? ______

What debts above are currently with a collection agency?:

Monthly Income and Expenses

Household Income: Earner / Income Type / Net Monthly Income
Non-Discretionary Expenses / Amount $
Medical Costs
Alimony
Child Support
Daycare
Total Monthly Non-Discretionary Expenses:

Household Discretionary Expenses:

Expense Type / $ Amount / Expense Type / $ Amount
Rent/ Mortgage / Food
Property taxes / Toiletries
Condo/ Lot Rent Fees / Grooming
Power/ Electricity / Clothing
Heat/ Oil/ Wood / Pets
Cable / Vehicle Loan/Lease Payment
Phone / Gas
Household Maintenance / Vehicle Insurance
Medical / Vehicle Maintenance
Dental / House/ Tenant Insurance
Vision/ Eye care / Life Insurance
Gifts- Holiday/ Birthday / Credit card payments
Activities / Personal loan payments
Lunches/ Eating Out / Line of Credit payments
Donation / Other:
Newspaper/ Magazines / Subtotal 1:
Sub- Total 1: / Total Monthly Expenses:

Household Net Income $______less N.D. Expenses $______Less Expenses $______= (+/-) $______

If you do not have enough income to cover your monthly expenses, call Rita Anderson & Associates Inc.

If you do not have enough income to cover your expenses every month, then you need to meet with Rita Anderson & Associates. We can help you towards living in better financial health.

If you are experiencing any of the following, you need to meet with Rita Anderson & Associates Inc:

-Creditors are calling you

-Wage garnishments

-Unable to make creditor minimum payments

-Need help to create a plan to pay off your creditors

-Considering a consolidation loan to combine all your payments into one

-Anxiety over financial situation

-Living pay check to paycheck with no plan.

58 Dorchester Street, Suite 201 · Sydney, NS · B1P 5Z1 · P (902) 539-8200 · T (855) 539-8200 · 1