Description
A financial statement (or financial report) is a formal record of the financial activities and position of a business, person, or other entity. Relevant financial information is presented in a structured manner and in a form easy to understand. They typically include basic financial statements, accompanied

Standard Financial Statement

Standard Financial Statement
This Statement is for use in the Mortgage Arrears Resolution Process

Section A: Borrower Information
Borrower 1
A1

Name

A2

Mortgage account reference no(s)

A3

Outstanding mortgage balance (€)

A4

Estimated current value of primary residence (€)

A5

Monthly mortgage repayments due (€)

A6

A7

Correspondence address

Line 1



Line 2



Line 3



Line 4



Line 5

Property address

Line 1

(if different to correspondence address)

Line 2



Line 3



Line 4



Line 5

Please indicate preferred contact method
A8

Home telephone

A9

Mobile

A10

Work telephone

Borrower 2

Standard Financial Statement

Section A: Borrower Information (cont.)
A11

Email

A12

Marital status

A13

Date of birth (please use DD/MM/YYYY format)
Date of birth of dependent children

Child 1

(including children over 18 in further education)

Child 2

/

/

/

/

Child 3
A14

Child 4
Child 5
Child 6

A15

Total number in household

A16

Employed Y/N; if self-employed give details
Occupation (if unemployed give previous occupation)

A17

A18

In permanent employment Y/N

A19 (A)

Name of employer

A19 (B)

Length of service
Reason(s) for review/arrears

A20

Years:



Months:

Years:



Months:

Standard Financial Statement

Section B: Your Monthly Income
Borrower 1
B1

Gross monthly salary (before tax and any other deductions at source)

B2

Net monthly salary (after tax and any other deductions at source)1

B3 (A)

B3 (B)

B3 (C)

Borrower 2

Total

Benefit (please specify below)

Benefit (please specify below)

Benefit (please specify below)

B4

Child benefit

B5

Mortgage interest supplement

B6

Family income support

B7

Maintenance

B8 (A)

Pension

B8 (B)

Room rent

B8 (C)

Grants
Other (please specify below)

B8 (D)

B9

Monthly income from property assets
(other than primary residence) (see E5)

B10

Monthly income from non-property assets (see F8)

B11

Total Monthly Income (sum of B2 to B10)

1 Do not include any deductions made from your salary at source (e.g., pension contribution, health insurance etc.) anywhere else on this form.

G1

Standard Financial Statement

Section C: Monthly Household Expenditure
Average Charge2
Utilities

C1

Electricity



C2

Gas/oil



C3

Phone (landline & internet)3



C4

TV/cable3



C5

Mobile phone



C6

Refuse charges



C7

TV licence

Household C8

Childcare



C9

Elderly care (e.g., carer, nursing home fees etc)



C10

Food/housekeeping/personal care



C11

Clothing and footwear



C12

Household repairs/maintenance

Transport C13

Petrol



C14

Motor insurance/tax/NCT



C15

Rail/bus/taxi costs (inc. school transport for children)



C16

Car maintenance/repairs



C17

Car parking and tolls

2 Average charge calculated by totaling last three utility bills and dividing by the number of months to get the average monthly cost.
3 Please identify if these bills are bundled.

Arrears (where applicable)

Standard Financial Statement

Section C: Monthly Household Expenditure (cont.)
Average Charge2
Mortgage C18

Mortgage protection/endowment premium



C19

Payment protection



C20

House insurance

Education C21

Books



C22

School/college fees



C23

Uniforms



C24

Extra curricular activities (school outings)



C25

Other (e.g. voluntary contributions)

Medical

C26

Medical expenses and prescription charges4



C27

Health insurance5

Social

C28

Lifestyle expenses (e.g. family events, Xmas, birthdays)



C29

Club membership



C30

Other (please specify below)

4 Medical expenses include dentist, optician and any other costs related to health.
5 Do not include if Health Insurance is deducted from your wages at source, (i.e., if it has already been deducted from B2).

Arrears (where applicable)

Standard Financial Statement

Section C: Monthly Household Expenditure (cont.)
Average Charge2
Other

C31

Life assurance



C32

Pension contribution6



C33

Maintenance paid to spouse/child (if applicable)



C34

Rent



C35 (A)



C35 (B)



C35 (C)



C36

Monthly expenditure on property assets (see E5)



C37

Monthly savings



C38

Total monthly expenditure (sum of C1 to C37)

Arrears (where applicable)

Property service/management charges
Other (please specify below)

Other (please specify below)

6 Do not include if Pension Contribution is deducted from your wages at source, (i.e., if it has already been deducted from B2).

G2

Standard Financial Statement

Section C: Monthly Household Expenditure (cont.)
Please provide details of any steps you have already taken to reduce your monthly expenditure and the savings you have achieved:

Please provide details of any steps you propose to take to reduce your monthly expenditure and the savings you expect to achieve:

Standard Financial Statement

Section D: Your Current Monthly Debt Payments
Monthly repayments

Remaining term

Debt Type
Due E
D1 Mortgage for
primary
residence

D2 Court mandated
debt (please
specify across7)

D3 Court mandated
debt (please
specify across)

D4 Credit union

D5 Credit union

D6 Overdraft

D7 Hire purchase

7 e.g. fines, instalment orders, judgements

Being paid E

Years

Months

Total
outstanding
balance E

Arrears
balance
E

Lender

Purpose
of loan

Secured
Y/N

Currently
restructured
Y/N

Payment
Protection
Insurance
Y/N

Standard Financial Statement

Section D: Your Current Monthly Debt Payments (cont.)
Monthly repayments

Remaining term

Debt Type
Due E
D8 Store card

D9 Catalogue debt

D10 Credit card 1

D11 Credit card 2

D12 Credit card 3

D13 Personal loan 1
(please specify
across)

D14 Personal loan 2
(please specify
across)

Being paid E

Years

Months

Total
outstanding
balance E

Arrears
balance
E

Lender

Purpose
of loan

Secured
Y/N

Currently
restructured
Y/N

Payment
Protection
Insurance
Y/N

Standard Financial Statement

Section D: Your Current Monthly Debt Payments (cont.)
Monthly repayments

Remaining term

Debt Type
Due E

Being paid E

Years

D15 Store card

D16 Loans from
family/friends

D17 Mortgage debt
on property other
than primary
residence (E5)
D18 Credit card 2

D19 Credit card 3

D20 Personal loan 1
(please specify
across)

D21 Personal loan 2
(please specify
across)

D22 Total
(sum of D2 to D21)

G5

Months

Total
outstanding
balance E

Arrears
balance
E

Lender

Purpose
of loan

Secured
Y/N

Currently
restructured
Y/N

Payment
Protection
Insurance
Y/N

Standard Financial Statement

Section E: Property Assets (other than Primary Residence)
Property
(give
details
below)

E1

1

E2

2

E3

3

E4

4

E5

Total

Property
type

(buy to let
etc.)

Ownership
type8

Current
value9
E

Loan
balance
E

Arrears
balance
E

Monthly
rental
income E

B9

Monthly
expenditure
(upkeep etc.)

Re-structured
Y/N

C36

8 For example, sole or joint ownership. Where a property/premises is not 100% owned by customer(s), please state the % amount that is owned.
9 Please provide a reasonable estimate of the current value of these assets.

Monthly repayments

Lender
Due E

Being paid E

D17

For
sale
Y/N

Standard Financial Statement

Section E: Property Assets (other than Primary Residence) (cont.)
Address

Property 1

Property 2

Property 3

Property 4

/

/

/

/

Line 1
Line 2
Line 3
Line 4
Line 5
DATE of
Purchase

/

/

/

Monthly income and expenditures related to property assets should also be included in Sections B and C respectively
Monthly mortgage repayments relating to property assets should be included in Section D

/

Standard Financial Statement

Section F: Non-Property Assets
Asset Type

Original cost/value e

Current estimated
value e

Net monthly income

F1 Savings/deposits
current account

F2 Shares

F3 Motor vehicle(s)

F4 Redundancy payment(s)

F5 Long-term investment(s)

F6 Other investment(s)

F7 Other Assets
(e.g. stock, machinery etc.)

F8 Total (sum of F1 to F7)

B10

Please give any relevant details

Standard Financial Statement

Please list all other liabilities, for example any guarantees given with
respect to company borrowing or borrowing by a family member.
Please provide any other information which you believe to be relevant to above:

Standard Financial Statement

I/we understand that the information provided will only be used for the purpose of assisting Mars Capital Ireland Limited to assess my/our financial situation under its Mortgage
Arrears Resolution Process.

Protecting Your Information
As your Lender we will keep your information confidential and will only use this information for the purpose of assisting you in accordance with our Mortgage Arrears Resolution
Process and in accordance with our obligations under the Data Protection Acts 1988 and 2003. For more information on your rights under the Data Protection Acts, see the Data
Protection Commissioner’s website at www.dataprotection.ie.
I/we declare that the information I/we have provided represents my/our financial situation, and commit to informing Mars Capital if my situation changes.

Signed
Borrower 1:

Date:

/

/

Signed
Borrower 2:

Date:

/

/

Standard Financial Statement

Section G: Financial Statement Summary (for office use only)
G1

Total Monthly Income (B11)

G2

Less Total Monthly Expenditure (C38)

G3

Sub-Total (G1 minus G2)

G4

(

)

Less Mortgage Repayments Due (D1)

(

)

G5

Less Other Monthly Debt Due (D22)

(

)

G6

Total Surplus/Deficit (subtract G4 and G5 from G3)

Standard Financial Statement

Guiding principles for completing the Standard Financial Statement
1

We are fully committed to working with customers who are in, or are facing, financial difficulties with their mortgage repayments in order that a mutually-acceptable
arrangement can be agreed. We will actively encourage contact with such customers through web sites, media and printed material.

2

We have specially-trained personnel in our offices, including specialised telephone contact points, to deal with customers facing or in financial difficulties.

3

This SFS is designed to assist you in setting out your current financial circumstances.

4

We consider that the completion of the SFS is a serious undertaking and we will work with you to ensure that the information is accurate, enabling us to work with
you to determine the most appropriate and viable option in each particular customer case.

5

The easiest way to see where you stand financially is to gather all the relevant information and documents so that you can write down all the money you have
coming in and going out each month and complete an SFS. (If your income is weekly, multiply it by 52 and divide the result by 12 to get your monthly income.)

6

In the SFS you will have to provide information on your current income, expenses and other amounts you owe and any assets you own. It is important that you
include all of your basic living expenses. You are also encouraged to ensure that you are maximising your income, including what social welfare entitlements you may
be eligible for such as Mortgage Interest Supplement (see www.keepingyourhome.ie).

7

It is important to fill out the SFS fully and accurately and to provide any relevant documentation that we may need to assess your situation; we will only seek
information that is relevant to this assessment.

8

Your completed SFS and other factors relating to your case will be assessed by our Arrears Support Unit which will decide whether or not an alternative repayment
arrangement is necessary and, if so, what type(s) of alternative repayment arrangement(s) appropriate to your circumstances can be made available.

9

If an alternative repayment arrangement is not offered to you, we will give you a reason for that decision in writing. You will have the right to appeal that decision.

10

If you require further information, you can avail of support material available through a number of sources including our website www.marscapital.ie or
www.keepingyourhome.ie. You can also seek independent advice from MABS (www.mabs.ie) or an appropriate alternative. If you give us your written consent
we will liaise with a third party, nominated by you, to act on your behalf.

Standard Financial Statement

Correspondence address
Please send all correspondence in respect of your Loan(s) to:
Mars Capital Ireland Limited, PO Box. 12546, Dublin 2.



doc_226273004.pdf
 

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