Standard Financial Statement

Industry Standard Financial Statement
This Statement is for use in the MARP
Section This section asks for?
Tick when completed
Section A
My details
Details about your personal circumstances, your name, address, occupation and the number of people living in your household. [ ]
Section B
My mortgage
Details about your mortgage on your primary residence, that is, the residential property you occupy as your primary residence, or the only residential property you own. This section also helps you to better understand the key elements of your mortgage. [ ]
Section C
My monthly income
Details on all your monthly income. [ ]
Section D
My monthly household expenditure
Details of all your expenditure or outgoings, calculated on a monthly basis. Details of all expenses that may be incurred during the expected period of financial difficulty should be included in the SFS [ ]
Section E
My monthly debt payments
Details about monthly amounts of all your other debt repayments (other than your mortgage repayment on your primary residence). [ ]
Section F
My other properties
Details on properties you own which are not your primary residence. [ ]
Section G
My other assets
Details of all other assets you own, either on your own or with someone else for example savings, cars, and shares. [ ]

Section H
Summary of your SFS
This section will help you to review the figures you inputted in sections B, C, D and E. [ ]

Section A: My details
Borrower 1 Borrower 2
A1 Name
A2 Correspondence address
A3 Property address
(if different to correspondence Address)
Please indicate preferred contact method
A4 Home telephone
A5 Mobile
A6 E-mail
A7 Marital status
A8 Date of birth DD/MM/YYYY DD/MM/YYYY
A9 Total number of all persons in household
A10 No. and age of dependants
Dependant 1
Dependant 2
Dependant 3
Dependant 4
A11
Are any of these dependants in third level education? [Yes/No] If Yes, please provide the number of expected years remaining. A12 Are any of these dependants or persons living in the household without being a dependant financially contributing to the household on a monthly basis? [Yes/No] If Yes, please include the monthly contribution in field C8. A13 Do any of these dependants have medical or care needs that have an impact on your financial situation? [Yes/No] If Yes, please include the monthly cost of any related medical expenses in field D4. A14 Are you currently employed? [Yes/No] If you are self-employed, please provide details. A15 What is your current occupation? If you are unemployed or retired, please include your previous occupation. A16 Are you in permanent employment? [Yes/No] A17 Name of current employer and your length of service

A18
For what reason(s) are you having, difficulty meeting your mortgage and/or other debt repayments? Please select all that apply. [..] Unemployment [..] Reduced Income [..] Illness [..] Divorce/Separation [..] Bereavement [..] School/College Fees [..] Household bills [..] Other (Please specify) [..] Unemployment [..] Reduced Income [..] Illness [..] Divorce/Separation [..] Bereavement [..] School/College Fees [..] Household bills [..] Other (Please specify) A19 How long do you expect these difficulties to continue? (If you are not in a position to answer this question, please contact your mortgage provider to seek support on how to answer this question) [..] 0-3 months [..] 3-6 months [..] 6-12 months [..] 12+ months [..] 0-3 months [..] 3-6 months [..] 6-12 months [..] 12+ months

Section B: My mortgage
This section relates to the mortgage on your primary residence, that is, the residential property you occupy as your primary residence, or the only residential property in the State you own. B1 Mortgage provider B2 Mortgage Account Reference Number(s) B3 Account reference of any other mortgage account(s) on your primary residence (for example top-up account) B4 Total outstanding mortgage balance (€) (do not include arrears) This total should include the balances of B2 and B3 (if applicable) B5 Estimated current value of primary residence (€) B6 Monthly mortgage repayments due (€) H4 B7 Monthly mortgage repayments being paid (€) B8 Remaining term of mortgage B9 Current Interest Rate (%) Is this rate fixed, or variable? Please select Variable for tracker rate.  Fixed  Variable  Part fixed and part variable B10 Arrears balance (€) (if applicable) B11 Is your mortgage currently restructured? [Yes/No] B12 Do you have a Payment Protection Insurance policy? [Yes/No]

Section C: My monthly income
If you face seasonal or irregular income, please engage with your mortgage provider for further assistance on completing this section. Please consult the SFS consumer Guide on how to calculate monthly income. Borrower 1 Borrower 2 TOTAL € C1 Gross monthly salary (for self-employed please refer to Revenue Form 11) C2 Net monthly salary (for self-employed please refer to Revenue Form 11) C3 Monthly social welfare benefits Please list under rows C3 a, b and c. C3 (a) Benefit (please specify) C3 (b) Benefit (please specify) C3 (c) Benefit (please specify) C4 Child Benefit C5 Mortgage Interest Supplement C6 Working Family Payment C7 Maintenance received C8 Other (please specify) C9 Monthly rental income (from other properties) (report figure from F5) C10 Monthly income from non￾property assets (report figure from G7) C11 Total monthly income (sum of C2 to C10) H1

Section D: My monthly household expenditure – Guidance
The figures you include in section D are based on your household’s individual circumstances. When calculating the average monthly cost for each of the expenses, you should seek to include the examples of items listed below in your figure for ‘average monthly cost’. To calculate your monthly average costs consult the SFS Guide [here]. You only need to include costs that are relevant to your household. Expense Examples of items to include in average monthly cost figure D1 Food Groceries, takeaways and eating out (restaurants, cafés, canteens) D2 Clothing Clothes and footwear D3 Personal care Personal hygiene, baby/infant costs and grooming items D4 Health Medicines and medical visits and appointments D5 Household goods Furniture, appliances, cleaning products D6 Household services Bin charges, household repairs and maintenance, local property tax, management fees, TV licence, TV channels and streaming services, bank charges or fees D7 Communications Phone (mobile and landline) and internet D8 Education Uniforms, books, school/college/course fees and contributions, extracurricular activities and costs linked to 3rd level accommodation. D9 Transport Petrol, motor tax, NCT, vehicle repairs and maintenance, parking and tolls, public transport costs (including school transport), taxis, rental costs D10 Household Energy Electricity and home heating D11 Insurance and Pension Any type of insurance, including motor, home, health, mortgage protection, payment protection, income protection, life assurance, pension contribution, where not deducted from salary at source. D12 Savings D13 Social inclusion and participation Social events, sports and hobbies, special occasions such as Christmas or any religious holidays and birthdays, and other events or activities D14 Childcare D15 Rent For example, in the case of separated borrowers, where one borrower is not living in the household and is paying rent for other accommodation. D16 Other Any other expenses not already captured. May include maintenance paid to spouse/child, costs associated with another property, elderly care, nursing home fees, carer fees, legal costs, children’s/ teenagers’ pocket money.

Section D: My monthly household expenditure
Please read the guidance above before you fill in this section.
Average
Monthly Cost €
Arrears
(where applicable) €
D1 Food
D2 Clothing
D3 Personal care
D4 Health
D5 Household goods
D6 Household services
D7 Communications
D8 Education
D9 Transport
D10 Household energy
D11 Insurance and pension
D12 Savings
D13 Social inclusion and participation
D14 Childcare
D15 Rent
D16 Other (please specify)
D17
Total Monthly Expenditure (sum of D1 to
D16)
H2
If there is any additional information not captured above that may impact your monthly expenditure, please include here [you may also use this text box to explain a high level of costs for certain items above]

Section E: My monthly debt payments
Debt type
Monthly repayments Remainin g term
Total outstandin g balance€
Arrears balance
€
Provider Purpose of loan/debt
Is this debt secured
[Yes/No]
Is this debt currently restructured?
[Yes/No]
Due € Being paid €
E1
Court mandated debt (Please specify)
E2 Credit union loan
E3 Personal bank loan
E4 Moneylending loan
E5 Loans from family/friends
E6 Hire purchase/PCP agreement
E7 Credit card
E8
Mortgage repayments on other properties
(see F5)
E9 Revenue Debt
E10 Other debt (please specify)
E11 Other debt (please specify)
E12 Other debt (please specify)
E13 Total (sum of E1 to E12)
H5

Section F: My other properties (other than primary residence)
This section relates to properties you own or partially own which are not your primary residence. When completing this section, please ensure the following:
 The figures for monthly rental income and monthly expenditure should also be included in Sections C (My Monthly Income) and D (My Monthly Expenditure)  The figures for monthly mortgage repayments due and being paid should also be included in Section E (My Monthly Debt Payments) Property (include details below) Property type Ownership type Estimated current value € Loan balance € Arrears balance € Monthly rental income € Monthly expenditure Is this debt currently restructured? [Yes/No] Monthly mortgage repayments Mortgage provider Is this property currently for sale? [Yes/No] Due € Being paid€ F1 1 F2 2 F3 3 F4 4 F5 Total C9 E16 My other properties (other than primary residence) Property Address Date of purchase 1 2 3 4

Section G: My other assets
Asset Type Original cost/ value €
Estimated current value €
Net monthly income
Please give any relevant details
G1 Savings/deposits/current account
G2 Shares
G3 Redundancy payment(s)
G4 Long-term investment (s)
(for example, a pension fund)
G5 Other investment(s)
G6 Other assets (for example, vehicles, stock, machinery) G7 Total (sum of G1 to G6) C10 Please list all other liabilities, for example any guarantees given with respect to company borrowing or borrowing by a family member.

Section H: Summary of financial situation (to be completed by the borrower)
H1 Total Monthly Income (C11)
H2 Total Monthly Expenditure (D17)
−
H3 Sub-Total (H1 minus H2)
=
H4 Monthly Mortgage Repayments Due (B6)
−
H5 Other Monthly Debt Repayments Due (E13)
−
H6 Total Surplus/Deficit (Take away H4 and H5 from H3) =

Signature Page
All regulated entities must ensure that the signature page of the Standard Financial Statement (SFS) is compliant with applicable Irish and/or EU law. Data protection law and requirements:
All regulated entities must include information for the borrower on the regulated entity’s obligations under applicable data protection law, for example, relating to the collection, processing and holding of the borrower’s information. Consent requirements:
A regulated entity cannot deem a Standard Financial Statement to be incomplete where any optional consents have not been signed by the borrower. It is the responsibility of a regulated entity to ensure that the signature page of the Standard Financial Statement includes any wording or requests for consent necessary to comply with applicable Irish and/or EU law. Borrower’s declaration:
All regulated entities must request a declaration from the borrower confirming the accuracy of the information provided in the Standard Financial Statement.

Appendix 1 - Glossary
Please find below useful guidance (terms explained and examples) to help you to complete your SFS.
Section A My details
A2 Correspondence address This address will be used for all correspondence relating to this SFS. A10 Dependant A person who financially relies on you.
Section B My mortgage
B11 Restructured
Select Yes if you have previously agreed with your mortgage provider to change the terms and conditions of your mortgage due to financial difficulties - for example reduced monthly payments.
Section C My monthly income
C1 Gross monthly salary Before tax and any other deductions at source C2 Net monthly salary If you have a deduction from your salary at source for example for health insurance, pension, credit union or Revenue payments do not include them again. C5 Mortgage Interest Supplement If you were previously eligible for and receiving this payment under the Mortgage Interest Supplement scheme, you should now receive it as part of the Supplementary Welfare Scheme. C8 Other For example pension, room rent (for primary residence), grants, financial contribution from dependants. Please do not repeat any monthly income already covered under previous headings.
Section E My monthly debt payments
Secured Select yes if a security for example a property, a vehicle or a guarantee is attached to the debt. Restructured Select yes if you have previously agreed with your loan provider to change the terms and conditions of your loan due to financial difficulties for example reduced monthly payments. E1 Court mandated debt For example, fines, instalment orders, judgements. E4 Moneylending loan Typically small loans at a high rate of interest over a short period of time.

E6 Hire purchase/PCP agreement
Type of credit, often associated with car financing. Under a hire purchase (HP) agreement, you hire the car, pay an agreed amount usually in monthly repayments, and only become the legal owner of the car at the end of the agreement. The legal owner of the car is the finance company that gave you the money to buy the car and you cannot sell the car without the finance company’s permission. E7 Credit cards Including credit cards linked to shops. E9 Revenue Debt For example all arrangements you may have in place with the Revenue to pay taxes you were not in a position to pay fully. E10 E11 E12 Other Debt For example additional loans or credit cards, overdrafts, payment of arrears on utilities, Buy Now Pay Later or shop credit.
Section F My other properties(other than primary residence)
Ownership Type
For example, sole or joint ownership. Where you do not 100% own a property, please state the % of the property that you do own. Monthly Expenditure For example, upkeep, maintenance, property tax. Restructured Select yes if you have previously agreed with your mortgage provider to change the terms and conditions of your mortgage due to financial difficulties for example reduced monthly payments.
Section G My other assets
G2 Shares For example, credit union shares, bank shares, employee share schemes.

Appendix 2
Please see below list of all documents needed to support your SFS. Please note we may request additional documentation if needed to assess your financial circumstances
Section
Documentation needed to complete this section (You only need to provide the documents relevant to your individual situation with your completed SFS) Tick when completed
Section A
My details
No document required to complete this section [ ]
Section B
My mortgage
Your annual mortgage statement
A statement from your mortgage provider showing the total left to pay on your mortgage A statement of mortgage payments or confirmation from your mortgage provider of the amount of monthly mortgage payment Your mortgage provider should be in a position to give you with all the above information, so please engage with your mortgage provider. Print out showing current estimated value of your property [ ]
Section C
My monthly income
Employee: proof of income in the form of recent payslips Self-employed: audited or certified accounts, business account statements, personal tax return or tax balancing statement, Revenue Form 11 Unemployed: most recent social welfare receipt for each social welfare payment received Retired: proof of receipt and amount of monthly pensions Proof of receipt of maintenance payments Proof of other income (see also Section F and Section G) [ ]

Proof of monthly financial contribution received from dependants and/or non-dependants living in the household (for example bank statements).
Section D
My monthly household expenditure
Recent Bills (electricity, gas/oil, internet, phone, mobile) Documents proving the amount spent on childcare and/or elderly care Proof of insurance (including motor, home, health, mortgage protection, payment protection, income protection, life assurance) and pension payments (pension contribution not deducted from salary at source) Proof of maintenance payments Proof of rent paid [ ]
Section E
My monthly debt payments
Proof of any court payment due
Statement related to any loans you have (credit unions, personal loans, credit cards, overdrafts, PCP/hire purchases) Statements should include the amount outstanding, the payments being made, the time left on each loan, the arrears balance, the reason for the loan [ ]
Section F
My other properties
Print outs showing estimated value of your properties Statement from your mortgage provider showing the full amount left to pay on each mortgage Statement of arrears on your mortgage accounts Proof of rental income Statement of mortgage payments or confirmation from your mortgage provider(s) of the amount of monthly mortgage payment [ ]
Section G
My other assets
Receipts and/or statements of purchase price for any asset Statement of current estimated value [ ]