two-minute survey

 

Name *


Address *


Email *


Telephone *


Date of Birth * (DD/MM/YYYY)


Marital Status *
married single divorced

Job Status *
employed self-employed partnership

Children (under 18) *
none 1 2 3 4 or more

Home Owner *
yes no

Do you rent? *
yes no

Estimated market value *


Mortgage *
joint name sole name

Value of outstanding mortgage *


Mortgage payment arrears *
yes no

Unsecured debt
(credit cards, hire purchase, etc) *


Total value of current assets
(savings, investments, cars, etc) *


Monthly income *
< £500 £500 - £1000 £1000 - £1500 £1500 - £2000 £2000 - £2500 > £2500

Previously bankrupt *
yes no

Brief description of advice required *

Offices at:

29 Lemon Street, Truro, Cornwall TR1 2LS | Tel. 01872 276363 | Fax 01872 276364
Sydney House, 44 South Street, St Austell, Cornwall PL25 5BN
Tel. 01726 68111 | Fax 01726 61433

email: info@brainssolicitors.co.uk

brains solicitors are authorised and regulated
by the Solicitors Regulation Authority (No. 47578)

 

Martyn J Evans is authorised to act as a Licensed Insolvency
Practitioner by the Solicitors Regulation Authority (No. 134695)