Form E - Financial statement - Mediation in Divorce e.pdf · Financial statement • For a...

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Financial statement For a financial order under the Matrimonial Causes Act 1973/ Civil Partnership Act 2004 • For financial relief after an overseas divorce etc under Part 3 of the Matrimonial and Family Proceedings Act 1984/Schedule 7 to the Civil Partnership Act 2004 of The parties are and Form E Financial statement (04.12) (please tick appropriate boxes) Husband Wife Civil partner To be completed by the relevant party Name of court Case No. Name of Applicant Name of Respondent This form should only be completed in applications for a financial order (which can only be applied for as part of a divorce, dissolution, annulment or (judicial) separation in the High Court or county courts in England and Wales) or for applications for financial relief after an overseas divorce/dissolution etc. If the application is for any other financial remedy in the county court please complete Form E1. If the application is for a financial remedy in the magistrates’ court please complete Form E2. Please fill in this form fully and accurately. Where any box is not applicable, write ‘N/A’. You have a duty to the court to give a full, frank and clear disclosure of all your financial and other relevant circumstances. A failure to give full and accurate disclosure may result in any order the court makes being set aside. If you are found to have been deliberately untruthful, criminal proceedings may be brought against you for fraud under the Fraud Act 2006. The information given in this form must be confirmed by a statement of truth. Proceedings for contempt of court may be brought against a person who makes or causes to be made, a false statement in a document verified by a statement of truth. You must attach documents to the form where they are specifically sought and you may attach other documents where it is necessary to explain or clarify any of the information that you give. Essential documents that must accompany this statement are detailed in the form. If there is not enough room on the form for any particular piece of information, you may continue on an attached sheet of paper. If you are in doubt about how to complete any part of this form you should seek legal advice. This statement is filed by Name and address of solicitor Dated D D / M M / Y Y Y Y © Crown Copyright 2012 Who is the husband wife civil partner Petitioner Applicant Respondent in the divorce dissolution nullity (judicial) separation financial relief application Applicant in this matter Who is the husband wife civil partner Petitioner Applicant Respondent in the divorce dissolution nullity (judicial) separation financial relief application Respondent in this matter

Transcript of Form E - Financial statement - Mediation in Divorce e.pdf · Financial statement • For a...

Page 1: Form E - Financial statement - Mediation in Divorce e.pdf · Financial statement • For a financial order under the Matrimonial Causes Act 1973/ Civil Partnership Act 2004 • For

Financial statement•ForafinancialorderundertheMatrimonialCausesAct1973/CivilPartnershipAct2004

•ForfinancialreliefafteranoverseasdivorceetcunderPart3oftheMatrimonialandFamilyProceedingsAct1984/Schedule7totheCivilPartnershipAct2004

of

The parties are

and

Form E Financialstatement(04.12)

(pleasetickappropriateboxes)

Husband Wife Civilpartner

To be completed by the relevant party

Nameofcourt CaseNo.

NameofApplicant

NameofRespondent

This form should only be completed in applications for a financial order (which can only be applied for as part of a divorce, dissolution, annulment or (judicial) separation in the High Court or county courts in England and Wales) or for applications for financial relief after an overseas divorce/dissolution etc.IftheapplicationisforanyotherfinancialremedyinthecountycourtpleasecompleteFormE1.Iftheapplicationisforafinancialremedyinthemagistrates’courtpleasecompleteFormE2.

Pleasefillinthisformfullyandaccurately.Whereanyboxisnotapplicable,write‘N/A’.

Youhaveadutytothecourttogiveafull,frankandcleardisclosureofallyourfinancialandotherrelevantcircumstances.

Afailuretogivefullandaccuratedisclosuremayresultinanyorderthecourtmakesbeingsetaside.

Ifyouarefoundtohavebeendeliberatelyuntruthful,criminalproceedingsmaybebroughtagainstyouforfraudundertheFraudAct2006.

Theinformationgiveninthisformmustbeconfirmedbyastatementoftruth.Proceedings for contempt of court may be brought against a person who makes or causes to be made, a false statement in a document verified by a statement of truth.Youmustattachdocumentstotheformwheretheyarespecificallysoughtandyoumayattachotherdocumentswhereitisnecessarytoexplainorclarifyanyoftheinformationthatyougive.

Essentialdocumentsthatmustaccompanythisstatementaredetailedintheform.

Ifthereisnotenoughroomontheformforanyparticularpieceofinformation,youmaycontinueonanattachedsheetofpaper.

Ifyouareindoubtabouthowtocompleteanypartofthisformyoushouldseeklegaladvice.

Thisstatementisfiledby

Nameandaddressofsolicitor

Dated D D / M M / Y Y Y Y

©CrownCopyright2012

Whoisthe husband wife civilpartner Petitioner Applicant Respondentinthe divorce dissolution nullity (judicial)separation financialreliefapplication

Applicantinthismatter

Whoisthe husband wife civilpartner Petitioner Applicant Respondentinthe divorce dissolution nullity (judicial)separation financialreliefapplication

Respondentinthismatter

You are unable to save the form with filled-in form fields. Please have all your documentation to hand before completing and printing out this form. Click into the first field, type data and tab to the next field.
Page 2: Form E - Financial statement - Mediation in Divorce e.pdf · Financial statement • For a financial order under the Matrimonial Causes Act 1973/ Civil Partnership Act 2004 • For

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1.1 Fullname

Tickhereifnotapplicable

1.3 Dateofthemarriage/civilpartnership

1.4 Occupation

1.5 Dateofthe separation

1.7 Ifyouhavesubsequentlymarriedorformedacivilpartnership,orwilldoso,

statethedate

1 General Information

1.2 Dateofbirth

1.6 Dateofthe

1.10Detailsof anychildren

ofthefamily

1.11 Detailsofthestateofhealthofyourselfandthechildrenifyouthinkthisshouldbetakenintoaccount

1.8 Areyoulivingwithanewpartner?

1.9 Doyouintendtolivewithanewpartnerwithinthenextsixmonths?

Yes No

Yes No

Date Month Year Date Month Year

Date Month Year

Date Month Year

Petitionfordivorce/dissolution/nullity/(judicial)separation

Decreenisi/conditionalorder/

(judicial)separationorder

Decreeabsolute/finalorder

(ifapplicable)

Date Month Year Date Month Year Date Month Year

FullnamesDateofbirth

Withwhomdoesthechildlive?Date Month Year

Yourself Children

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1.12Detailsofthepresentandproposedfutureeducationalarrangementsforthechildren.

1.13Detailsofanychildsupportmaintenancecalculationoranymaintenanceorderoragreementmadeinrespectofanychildrenofthefamily.Ifnocalculation,orderoragreementhasbeenmade,giveanestimateoftheliabilityofthenon-residentparentinrespectofthechildrenofthefamilyundertheChildSupportAct1991.

1.14 Ifthisapplicationistovaryanorder,attachacopyoftheorderandgivedetailsofthepartthatistobevariedandthechangessought.Youmayneedtocontinueonaseparatesheet.

1.15Detailsofanyothercourtcasesbetweenyouandyourspouse/civilpartner,whetherinrelationtomoney,property,childrenoranythingelse.

1.16Yourpresentresidenceandtheoccupantsofitandonwhattermsyouoccupyit(e.g.tenant,owner-occupier).

Presentarrangements Futurearrangements

CaseNo Court Typeofproceedings

Address Occupants Termsofoccupation

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2 Financial Details Part 1 Real Property (land and buildings) and Personal Assets

2.1 Completethissectioninrespectofthefamilyhome(thelastfamilyhomeoccupiedbyyouandyourspouse/civilpartner)ifitremainsunsold.

Documentationrequiredforattachmenttothissection:a) Acopyofanyvaluationofthepropertyobtainedwithinthelastsixmonths.Ifyoucannot

providethisdocument,pleasegiveyourownrealisticestimateofthecurrentmarketvalueb) Arecentmortgagestatementconfirmingthesumoutstandingoneachmortgage

Propertynameandaddress

LandRegistrytitlenumber

Mortgagecompanyname(s)andaddress(es)andaccountnumber(s)

Typeofmortgage

Detailsofwhoownsthepropertyandtheextentofyourlegalandbeneficialinterestinit(i.e.stateifitisownedbyyousolelyorjointlyownedwithyourspouse/civilpartnerorwithothers)

IfyouconsiderthatthelegalownershipasrecordedattheLandRegistrydoesnotreflectthetrueposition,statewhy

Currentmarketvalueoftheproperty

Balance(s)outstandingonanymortgage(s)

Ifasaleatthisstagewouldresultinpenaltiespayableunderthemortgage,stateamount

Estimatethecostsofsaleoftheproperty

Totalequityintheproperty(i.e.marketvaluelessoutstandingmortgage(s),penaltiesifanyandthecostsofsale)

TOTALvalueofyourinterestinthefamilyhome:TotalA £

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2.2 Detailsofyourinterestinanyotherproperty,landorbuildings.Completeonepageforeachpropertyyouhaveaninterestin.

Documentationrequiredforattachmenttothissection:a) Acopyofanyvaluationofthepropertyobtainedwithinthelastsixmonths.Ifyoucannot

providethisdocument,pleasegiveyourownrealisticestimateofthecurrentmarketvalueb) Arecentmortgagestatementconfirmingthesumoutstandingoneachmortgage

Propertynameandaddress

LandRegistrytitlenumber

Mortgagecompanyname(s)andaddress(es)andaccountnumber(s)

Typeofmortgage

Detailsofwhoownsthepropertyandtheextentofyourlegalandbeneficialinterestinit(i.e.stateifitisownedbyyousolelyorjointlyownedwithyourspouse/civilpartnerorwithothers)IfyouconsiderthatthelegalownershipasrecordedattheLandRegistrydoesnotreflectthetrueposition,statewhy

Currentmarketvalueoftheproperty

Balanceoutstandingonanymortgage(s)

Ifasaleatthisstagewouldresultinpenaltiespayableunderthemortgage,stateamount

Estimatethecostsofsaleoftheproperty

Totalequityintheproperty(i.e.marketvaluelessoutstandingmortgage(s),penaltiesifanyandthecostsofsale)

Totalvalueofyourinterestinthisproperty

TOTALvalueofyourinterestinALLotherproperty:TotalB £

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2.3 Detailsofallpersonalbank,buildingsocietyandNationalSavingsAccountsthatyouholdorhaveheldatanytimeinthelasttwelvemonthsandwhichareorwereeitherinyourownnameorinwhichyouhaveorhavehadanyinterest.Thisapplieswhetheranysuchaccountisincreditorindebit.Forjointaccountsgiveyourinterestandthenameoftheotheraccountholder.Iftheaccountisoverdrawn,showaminusfigure.

Documentationrequiredforattachmenttothissection:Foreachaccountlisted,allstatementscoveringthelast12months.

2.4 Detailsofallinvestments,includingshares,PEPs,ISAs,TESSAs,NationalSavingsInvestments(otherthanalreadyshownabove),bonds,stocks,unittrusts,investmenttrusts,giltsandotherquotedsecuritiesthatyouholdorhaveaninterestin.(Donotincludedividendincomeasthiswillbedealtwithseparatelylateron.)

Documentationrequiredforattachmenttothissection:Lateststatementordividendcounterfoilrelatingtoeachinvestment.

Nameofbankorbuildingsociety,

includingbranchname

Typeofaccount(e.g.current)

Accountnumber

Nameofotheraccountholder(ifapplicable)

Balanceatthedateof

thisstatement

Totalcurrentvalueofyour

interest

TOTALvalueofyourinterestinALLaccounts:(C1) £

Name TypeofInvestment SizeofHolding Currentvalue

Nameofanyotheraccountholder(ifapplicable)

Totalcurrentvalueofyour

interest

TOTALvalueofyourinterestinALLholdings:(C2) £

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2.5 Detailsofalllifeinsurancepoliciesincludingendowmentpoliciesthatyouholdorhaveaninterestin.Includethosethatdonothaveasurrendervalue.Completeonepageforeachpolicy.

Documentationrequiredforattachmenttothissection:Asurrendervaluationofeachpolicythathasasurrendervalue.

2.6 DetailsofallmoniesthatareOWEDTOYOU.Donotincludesumsowedindirector’sorpartnershipaccountswhichshouldbeincludedatsection2.11.

Nameofcompany

Policytype

Policynumber

Ifpolicyisassigned,stateinwhosefavourandamountofcharge

Nameofanyotherownerandtheextentofyourinterestinthepolicy

Maturitydate(ifapplicable) Date Month Year

Currentsurrendervalue(ifapplicable)

Ifpolicyincludeslifeinsurance,theamountoftheinsuranceandthenameofthepersonwhoselifeisinsured

Totalcurrentsurrendervalueofyourinterestinthispolicy

TOTALvalueofyourinterestinALLpolicies:(C3) £

Briefdescriptionofmoneyowedandbywhom Balanceoutstanding

Totalcurrentvalueofyourinterest

TOTALvalueofyourinterestinALLdebtsowedtoyou:(C4) £

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2.7 Detailsofallcashsumsheldinexcessof£500.Youmuststatewhereitisheldandthecurrencyitisheldin.

2.8 Detailsofpersonalbelongingsindividuallyworthmorethan£500.INCLUDE:• Cars(grossvalue)• Collections,picturesandjewellery• Furnitureandhousecontents

Whereheld Amount Currency Totalcurrentvalueofyourinterest

TOTALvalueofyourinterestinALLcashsums:(C5) £

Briefdescriptionofitem Totalcurrentvalueofyourinterest

TOTALvalueofyourinterestinALLpersonalbelongings:(C6) £

AddtogetherallthefiguresinboxesC1toC6togivetheTOTALcurrentvalueofyourinterestinpersonalassets: TOTALC £

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2 Financial Details Part 2 Capital: Liabilities and Capital Gains Tax

2.9 Detailsofanyliabilitiesyouhave.EXCLUDEliabilitiesalreadyshownsuchas:• Mortgages• Anyoverdrawnbank,buildingsocietyorNationalSavingsaccountsINCLUDE:• Moneyowedoncreditcardsandstorecards• Bankloans• HirepurchaseagreementsListallcreditandstorecardsheldincludingthosewithanilorpositivebalance.Wheretheliabilityisnotsolelyyourown,givethename(s)oftheotheraccountholder(s)andtheamountofyourshareoftheliability.

2.10IfanyCapitalGainsTaxwouldbepayableonthedisposalnowofanyofyourrealpropertyorpersonalassets,giveyourestimateofthetaxliability.

Liability Name(s)ofotheraccountholder(s)(ifapplicable)

Totalliability Totalcurrentvalueofyourinterestin

theliability

TOTALvalueofyourinterestinALLliabilities:(D1) £

Asset TotalCapitalGainsTaxliability

TOTALvalueofALLyourpotentialCapitalGainsTaxliabilities:(D2) £

AddtogetherD1andD2togivetheTOTALvalueofyourliabilities: TOTALD £

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2 Financial Details Part 3 Capital: Business assets and directorships

2.11Detailsofallyourbusinessinterests.Completeonepageforeachbusinessyouhaveaninterestin.

Documentationrequiredforattachmenttothissection:a) Copiesofthebusinessaccountsforthelasttwofinancialyearsb) Anydocumentation,ifavailableatthisstage,uponwhichyouhavebasedyourestimateof

thecurrentvalueofyourinterestinthisbusiness,forexamplealetterfromanaccountantoraformalvaluation.Itisnotessentialtoobtainaformalvaluationatthisstage

Nameofthebusiness

Brieflydescribethenatureofthebusiness

Areyou (pleasetickappropriatebox)

Ifyouareapartnerorashareholder,statetheextentofyourinterestinthebusiness(i.e.partnershipshareortheextentofyourshareholdingcomparedtotheoverallsharesissued)

Statewhenyournextsetofaccountswillbeavailable

Ifanyofthefiguresinthelastaccountsarenotanaccuratereflectionofthecurrentposition,statewhy.Forexample,iftherehasbeenamaterialchangesincethelastaccounts,orifthevaluationsoftheassetsarenotatruereflectionoftheirvalue(e.g.becausepropertyorotherassetshavenotbeenre-valuedinrecentyearsorbecausetheyareshownatabookvalue)

Totalamountofanysumsowedtoyoubythebusinessbywayofadirector’sloanaccount,partnershipcapitalorcurrentaccountsorthelike.Identifywheretheseappearinthebusinessaccounts

Yourestimateofthecurrentvalueofyourbusinessinterest.Explainbrieflythebasisuponwhichyouhavereachedthatfigure

YourestimateofanyCapitalGainsTaxthatwouldbepayableifyouweretodisposeofyourbusinessnow

NetvalueofyourinterestinthisbusinessafteranyCapitalGainsTaxliability

TOTALvalueofALLyourinterestsinbusinessassets:TOTALE £

SoletraderPartnerinapartnershipwithothersShareholderinalimitedcompany

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2.12Listanydirectorshipsyouholdorhaveheldinthelast12months(otherthanthosealreadydisclosedinSection2.11).

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2 Financial Details Part 4 Capital: Pensions and Pension Protection Fund (PPF) Compensation

2.13GivedetailsofallyourpensionrightsandallPPFcompensationentitlements,includingprospectiveentitlements.CompleteaseparatepageforeachpensionorPPFcompensationentitlement.EXCLUDE:• BasicStatePensionINCLUDE(completeaseparatepageforeachone):• AdditionalStatePension(SERPSandStateSecondPension(S2P))• FreeStandingAdditionalVoluntaryContributionSchemes(FSAVC)separatefromthescheme

ofyouremployer• MembershipofALLpensionplansorschemes• PPFcompensationentitlementforeachschemeyouwereamemberofwhichhastransferredtoPPF

Documentationrequiredforattachmenttothissection:a) Arecentstatementshowingthecashequivalent(CE)providedbythetrusteesormanagersof

eachpensionarrangement;fortheadditionalstatepension,avaluationoftheserightsorforPPFavaluationofPPFcompensationentitlement

b) Ifanyvaluationisnotavailable,givetheestimateddatewhenitwillbeavailableandattachacopyofyourlettertothepensioncompany,administrators,orPPFBoardfromwhomtheinformationwassoughtand/orstatethedateonwhichanapplicationforavaluationofanAdditionalStatePensionwassubmittedtotheDepartmentofWorkandPensions

Yes No

NameandaddressofpensionarrangementorPPFBoard

YourNationalInsuranceNumber

NumberofpensionarrangementorreferencenumberorPPFcompensationreferencenumber

Typeofschemee.g.occupationalorpersonal,finalsalary,moneypurchase,additionalstatepension,PPForother(ifother,pleasegivedetails)

DatetheCE,PPFcompensationoradditionalstatepensionwascalculated

Date Month Year

Isthepensioninpaymentordrawdown?(pleaseanswerYesorNo)

StatetheCEquotation,theadditionalstatepensionvaluationorPPFvaluationofthoserights

IfthearrangementisanoccupationalpensionarrangementthatispayingreducedCEs,pleasequotewhattheCEwouldhavebeenifnotreduced.Ifthisisnotpossible,pleaseindicateiftheCEquotedisareducedCE

IsthePPFcompensationcapped?(pleaseanswerYesorNo)

TOTALvalueofALLyourpensionassets:TOTALF £

Yes No

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2 Financial Details Part 5 Capital: Other assets

2.14GivedetailsofanyotherassetsnotlistedinParts1to4above.INCLUDE(thefollowinglistisnotexhaustive):• Anypersonalorbusinessassetsnotyetdisclosed• Unrealisableassets• Shareoptionschemes,statingtheestimatednetsaleproceedsofthesharesiftheoptions

werecapableofexercisenow,andwhetherCapitalGainsTaxorincometaxwouldbepayable• Businessexpansionschemes• Futures• Commodities• Trustinterests(includinginterestsunderadiscretionarytrust),statingyourestimateofthe

valueoftheinterestandwhenitislikelytobecomerealisable.Ifyousayitwillneverberealisable,orhasnovalue,giveyourreasons

• Anyassetthatislikelytobereceivedintheforeseeablefuture• Anyassetheldonyourbehalfbyathirdparty• AnyassetnotdisclosedelsewhereonthisformevenifheldoutsideEnglandandWalesYouareremindedofyourobligationtodiscloseallyourfinancialassetsandinterestsofANYnature.

Typeofasset Value TotalNETvalueofyourinterest

TOTALvalueofALLyourotherassets:TOTALG £

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2 Financial Details Part 6 Income: Earned income from employment

2.15Detailsofearnedincomefromemployment.Completeonepageforeachemployment.

Documentationrequiredforattachmenttothissection:a) P60forthelastfinancialyear(youshouldhavereceivedthisfromyouremployershortlyafterthe

last5thApril)b) Yourlastthreepayslipsc) YourlastFormP11Difyouhavebeenissuedwithone

Nameandaddressofyouremployer

Jobtitleandbriefdetailsofthetypeofworkyoudo

Hoursworkedperweekinthisemployment

Howlonghaveyoubeenwiththisemployer?

Explainthebasisofyourincomei.e.statewhetheritisbasedonanannualsalaryoranhourlyrateofpayandwhetheritincludescommissionsorbonuses

GrossincomeforthelastfinancialyearasshownonyourP60

Netincomeforthelastfinancialyeari.e.grossincomelessincometaxandnationalinsurance

Averagenetincomeforthelastthreemonthsi.e.totalincomelessincometaxandnationalinsurancedividedbythree

Brieflyexplainanyotherentriesontheattachedpayslipsotherthanbasicincome,incometaxandnationalinsurance

Ifthepayslipsattachedforthelastthreemonthsarenotanaccuratereflectionofyournormalincomebrieflyexplainwhy

Detailsandvalueofanybonusesorotheroccasionalpaymentsthatyoureceivefromthisemploymentnototherwisealreadyshown,includingthebasisuponwhichtheyarepaid

Detailsandvalueofanybenefitsinkind,perksorotherremunerationreceivedfromthisemployerinthelastyear(e.g.provisionofacar,paymentoftravel,accommodation,mealexpenses,etc.)

Yourestimateofyournetincomefromthisemploymentforthenext12months.Ifthisdifferssignificantlyfromyourcurrentincomeexplainwhyinbox4.1.2

EstimatedTOTALofALLnetearnedincomefromemploymentforthenext12months: TOTALH £

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2 Financial Details Part 7 Income: Income from self-employment or partnership

2.16Youwillhavealreadygivendetailsofyourbusinessandprovidedthelasttwoyearsaccountsatsection2.11.Completethissectiongivingdetailsofyourincomefromyourbusiness.Completeonepageforeachbusiness.

Documentationrequiredforattachmenttothissection:a) Acopyofyourlasttaxassessmentor,ifthatisnotavailable,aletterfromyouraccountant

confirmingyourtaxliabilityb) Ifnetincomefromthelastfinancialyearandestimatednetincomeforthenext12monthsis

significantlydifferent,acopyofmanagementaccountsfortheperiodsinceyourlastaccount

Nameofthebusiness

Datetowhichyourlastaccountswerecompleted

Yourshareofgrossbusinessprofitfromthelastcompletedaccounts

Incometaxandnationalinsurancepayableonyourshareofgrossbusinessprofitabove

Netincomeforthatyear(usingthetwofiguresdirectlyabove,grossbusinessprofitlessincometaxandnationalinsurancepayable)

Detailsandvalueofanybenefitsinkind,perksorotherremunerationreceivedfromthisbusinessinthelastyeare.g.provisionofacar,paymentoftravel,accommodation,mealexpenses,etc.

Amountofanyregularmonthlyorotherdrawingsthatyoutakefromthisbusiness

Iftheestimatedfiguredirectlybelowisdifferentfromthenetincomeasattheenddateofthelastcompletedaccounts,brieflyexplainthereason(s)

Yourestimateofyournetannualincomeforthenext12months

EstimatedTOTALofALLnetincomefromself-employmentorpartnershipforthenext12months: TOTALI £

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2 Financial Details Part 8 Income: Income from investments e.g. dividends, interest or rental income

2.17Detailsofincomereceivedinthelastfinancialyear(theyearendedlast5thApril),andyourestimateofyourincomeforthecurrentfinancialyear.Indicatewhethertheincomewaspaidgrossornetofincometax.Youarenotrequiredtocalculateanytaxpayablethatmayarise.

Natureofincomeandtheassetfromwhichitderived Paidgrossornet

Incomereceivedinthelastfinancial

year

Estimatedincomeforthenext12months

EstimatedTOTALinvestmentincomeforthenext12months:TOTALJ £

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2 Financial Details Part 9 Income: Income from state benefits (including state pension and child benefit)

2.18Detailsofallstatebenefitsthatyouarecurrentlyreceiving.

Nameofbenefit AmountpaidFrequencyofpayment

Estimatedincomeforthenext12months

EstimatedTOTALbenefitincomeforthenext12months:TOTALK £

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2 Financial Details Part 10 Income: Any other income

2.19Detailsofanyotherincomenotdisclosedabove.INCLUDE:AnysourceincludingaPension(excludingStatePension),andPensionProtectionFund(PPF)compensation• fromwhichincomehasbeenreceivedduringthelast12months(evenifithasnowceased)• fromwhichincomeislikelytobereceivedduringthenext12monthsYouareremindedofyourobligationtogivefulldisclosureofyourfinancialcircumstances

Natureofincome PaidgrossornetIncomereceivedinthelastfinancial

year

Estimatedincomeforthenext12months

EstimatedTOTALotherincomeforthenext12months:TOTALL £

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2 Financial Details Summaries

2.20Summaryofyourcapital(Parts1to5).

2.21Summaryofyourestimatedincomeforthenext12months(Parts6to10).

DescriptionReferenceofthesectiononthisstatement

Value

Currentvalueofyourinterestinthefamilyhome A

Currentvalueofyourinterestinallotherproperty B

Currentvalueofyourinterestinpersonalassets C

Currentvalueofyourliabilities D

Currentvalueofyourinterestinbusinessassets E

CurrentvalueofyourpensionandPPFcompensationassets F

Currentvalueofallyourotherassets G

TOTALvalueofyourassets(TotalsAtoGlessD): £

DescriptionReferenceofthesectiononthisstatement

Value

Estimatednettotalofincomefromemployment H

Estimatednettotalofincomefromself-employmentorpartnership I

Estimatednettotalofinvestmentincome J

Estimatedstatebenefitreceipts K

Estimatednettotalofallotherincome L

EstimatedTOTALincomeforthenext12months(TotalsHtoL): £

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3 Financial Requirements Part 1 Income needs

3.1 Incomeneedsforyourselfandforanychildrenlivingwithyouorprovidedforbyyou.ALLfiguresshouldbeannual,monthlyorweekly(statewhich).Youmust notuseacombinationoftheseperiods.Stateyourcurrentincomeneedsand,ifthesearelikelytochangeinthenearfuture,explaintheanticipatedchangeandgiveanestimateofthefuturecost.

3.1.1Incomeneedsforyourself.INCLUDE:• Allincomeneedsforyourself• Incomeneedsforanychildrenlivingwithyouorprovidedforbyyouonlyiftheseform

partofyourtotalincomeneeds(e.g.housing,fuel,carexpenses,holidays,etc)

3.1.2Incomeneedsforchildrenlivingwithyouorprovidedforbyyou.INCLUDE:• Onlythoseincomeneedsthataredifferenttothoseofyourhouseholdshownabove

Theincomeneedsbeloware:(deletethosenotapplicable)

Weekly Monthly Annual

Ianticipatemyincomeneedsaregoingtochangebecause

ItemCurrentcost Estimatedfuture

cost

SUB-TOTALyourincomeneeds £

ItemCurrentcost Estimatedfuture

cost

SUB-TOTALchildren’sincomeneeds: £

TOTALofALLincomeneeds: £

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3 Financial Requirements Part 2 Capital needs

3.2 Setoutbelowthereasonablefuturecapitalneedsforyourselfandforanychildrenlivingwithyouorprovidedforbyyou.

3.2.1Capitalneedsforyourself.INCLUDE:• Allcapitalneedsforyourself• Capitalneedsforanychildrenlivingwithyouorprovidedforbyyouonlyiftheseformpartof

yourtotalcapitalneeds(e.g.housing,car,etc.)

3.2.2Capitalneedsforchildrenlivingwithyouorprovidedforbyyou.INCLUDE:• Onlythosecapitalneedsthataredifferenttothoseofyourhouseholdshownabove

Item Cost

SUB-TOTALyourcapitalneeds: £

Item Cost

SUB-TOTALyourchildren’scapitalneeds £

TOTALofALLcapitalneeds: £

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4 Other Information

4.1 Detailsofanysignificantchangesinyourassetsorincome.Atbothsections4.1.1and4.1.2,INCLUDE:• ALLassetsheldbothwithinandoutsideEnglandandWales• Thedisposalofanyasset

4.1.1SignificantchangesinassetsorincomeduringtheLAST12months.

4.1.2SignificantchangesinassetsorincomelikelytooccurduringtheNEXT12months.

4.2 Briefdetailsofthestandardoflivingenjoyedbyyouandyourspouse/civilpartnerduringthemarriage/civilpartnership.

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4.3 Arethereanyparticularcontributionstothefamilypropertyandassetsoroutgoings,ortofamilylife,orthewelfareofthefamilythathavebeenmadebyyou,yourpartneroranyoneelsethatyouthinkshouldbetakenintoaccount?Ifthereareanysuchitems,brieflydescribethecontributionandstatetheamount,whenitwasmadeandbywhom.INCLUDE:• Contributionsalreadymade• Contributionsthatwillbemadeintheforeseeablefuture

4.4 Badbehaviourorconductbytheotherpartywillonlybetakenintoaccountinveryexceptionalcircumstanceswhendecidinghowassetsshouldbesharedafterdivorce/dissolution.Ifyoufeelitshouldbetakenintoaccountinyourcase,identifythenatureofthebehaviourorconductbelow.

4.5 Givedetailsofanyothercircumstancesthatyouconsidercouldsignificantlyaffecttheextentofthefinancialprovisiontobemadebyorforyouoranychildofthefamily.INCLUDE(thefollowinglistisnotexhaustive):• Earningcapacity• Disability• Inheritanceprospects• Redundancy• Retirement• Anyagreementmadebetweenyouandyourspouse/civilpartnerbeforeorafteryour

marriage/civilpartnershipstatingwhetherornotyourelyupontheagreementgivingyourreasons

• Anyplanstomarry,formacivilpartnershiporlivewithanewpartner• Anycontingentliabilities

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4.6 Ifyouhavesubsequentlymarriedorformedacivilpartnership(orintendto)orarelivingwithanotherperson(orintendto),givebriefdetails,sofarastheyareknowntoyou,ofhisorherincome,assetsandliabilities.

AnnualIncome AssetsandLiabilities

Natureofincome Value(ifknown,statewhether

grossornet)

Item Value(ifknown)

Totalincome: £ Totalassets/liabilities: £

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5 Order Sought

5.1 Ifyouareableatthisstage,specifywhatkindofordersyouareaskingthecourttomake.Evenifyoucannotbespecificatthisstage,ifyouareabletodoso,indicate:a) Ifthefamilyhomeisstillowned,whetheryouareaskingforittobetransferredtoyourselfor

yourspouse/civilpartnerorwhetheryouaresayingitshouldbesold

5.2 Ifyouareseekingavariationofanante-nuptialorpost-nuptialsettlementorarelevantsettlementmadeduring,orinanticipationof,acivilpartnership,identifythesettlement,bywhomitwasmade,itstrusteesandbeneficiariesandstatewhyyouallegeitisasettlementwhichthecourtcanvary.

5.3 Ifyouareseekinganavoidanceofdispositionorder,orifyouhavealreadyappliedforsuchanorder,identifythepropertytowhichthedispositionrelatesandthepersonorbodyinwhosefavourthedispositionisallegedtohavebeenmade.

b) Whetheryouconsiderthisisacaseforcontinuingspousalmaintenance/maintenanceforyourcivilpartnerorwhetheryouseethecaseasbeingappropriatefora‘cleanbreak’(A ‘clean break’ means a settlement or order which provides amongst other things, that neither you nor your spouse/civil partner will have any further claim against the income or capital of the other party. A ‘clean break’ does not terminate the responsibility of a parent to a child.)

c) Whetheryouareseekingai) pensionsharingorderii) pensionattachmentorderiii)pensioncompensationsharingorderiv)pensioncompensationattachmentorder

d) Ifyouareseekingatransferorsettlementofanypropertyorassets,identifythepropertyorassetsinquestion

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AddressallcommunicationstotheCourtManageroftheCourtandquotethecasenumber.Ifyoudonotquotethisnumber,yourcorrespondencemaybereturned.

Signed Dated

Printfullname

Addressforservice

Proceedings for contempt of court may be brought against a person who makes or causes to be made, a false statement in a document verified by a statement of truth.

D D / M M / Y Y Y Y

*deleteasappropriate

*[Ibelieve][theApplicant/Respondentbelieves]thatthefactsstatedinthisstatementaretrue

*IamdulyauthorisedbytheApplicant/Respondenttosignthisstatement

andconfirmthattheinformationgivenaboveisafull,frank,clearandaccuratedisclosureofmyfinancialandotherrelevantcircumstances.

Postcode

NameofApplicant’s/Respondent’ssolicitor’sfirm

*(Applicant/Respondent)(Litigationfriend)*(Applicant’s/Respondent’ssolicitor)

Positionorofficeheld(ifsigningonbehalfoffirmorcompany)

Statement of Truth

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FormEparagraph

Document PleasetickAttached Not

applicableTo

follow

1.14 Application to vary an order: ifapplicable,attachacopyoftherelevantorder.

2.1 Matrimonial home valuation: acopyofanyvaluationrelatingtothematrimonialhomethathasbeenobtainedinthelastsixmonths.

2.1 Matrimonial home mortgage(s): arecentmortgagestatementinrespectofeachmortgageonthematrimonialhomeconfirmingtheamountoutstanding.

2.2 Any other property:acopyofanyvaluationrelatingtoeachotherpropertydisclosedthathasbeenobtainedinthelastsixmonths.

2.2 Any other property:arecentmortgagestatementinrespectofeachmortgageoneachotherpropertydisclosedconfirmingtheamountoutstanding.

2.3 Personal bank, building society and National Savings accounts:copiesofstatementsforthelast12monthsforeachaccountthathasbeenheldinthelasttwelvemonths,eitherinyourownnameorinwhichyouhaveorhavehadanyinterest.

2.4 Other investments: thelateststatementordividendcounterfoilrelatingtoeachinvestmentasdisclosedinparagraph2.4.

2.5 Life insurance (including endowment) policies:asurrendervaluationforeachpolicythathasasurrendervalueasdisclosedunderparagraph2.5.

2.11 Business interests: acopyofthebusinessaccountsforthelasttwofinancialyearsforeachbusinessinterestdisclosed.

2.11 Business interests: anydocumentationthatisavailabletoconfirmtheestimateofthecurrentvalueofthebusiness,forexample,aletterfromanaccountantorformalvaluationifthathasbeenobtained.

2.13 Pension and PPF compensation:arecentstatementshowingthecashequivalent(CE)providedbythetrusteesormanagersofeachpensionarrangementorvaluationofeachPPFentitlementprovidedbythePPFBoardthatyouhavedisclosed(or,inthecaseoftheadditionalstatepension,avaluationoftheserights).Ifnotyetavailable,attachacopyofthelettersenttothepensioncompany,administratorsorthePPFBoardrequestingtheinformation.

2.15 Employment income: yourP60forthelastfinancialyearinrespectofeachemploymentthatyouhave.

2.15 Employment income: yourlastthreepayslipsinrespectofeachemploymentthatyouhave.

2.15 Employment income: yourlastformP11Difyouhavebeenissuedwithone.

2.16 Self-employment or partnership income: acopyofyourlasttaxassessmentorifthatisnotavailable,aletterfromyouraccountantconfirmingyourtaxliability.

2.16 Self-employment or partnership income: ifnetincomefromthelastfinancialyearandtheestimatedincomeforthenexttwelvemonthsissignificantlydifferent,acopyofthemanagementaccountsfortheperiodsinceyourlastaccounts.

State relevant Form E paragraph

Descriptionofotherdocumentsattached:

Schedule of Documents to accompany Form EThefollowinglistshowsthedocumentsyoumustattachtoyourFormEifapplicable.YoumayattachotherdocumentswhereitisnecessarytoexplainorclarifyanyoftheinformationthatyougiveintheFormE.

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Form E Financialstatement(04.12) ©CrownCopyright2012