For Financial Mentors - Water Utility Consumer Assistance Trust

If you are assisting with an existing application or WaterCare customer and would like to share your applicants budget information with us, feel free to complete the form below and we’ll be in touch.

Please note: If you have already completed a budget with your applicant, you can upload the existing budget instead of completing the entire form below.

Applicant's details

Applicants name(Required)

Watercare account no.

Your name(Required)

Your email address(Required)

Your phone number

Your budgeting agency name(Required)

Your budgeting agency best contact detail (email or phone number)

I would like to(Required)

Upload a prepared budget document to support the mentioned applicant

Complete WUCAT’s online budget form

Budget files to upload

Drop files here or

Accepted file types: pdf, doc, docx, csv, xls, xlst, png, gif, Max. file size: 50 MB, Max. files: 6.

If you have already prepared supporting documentation or budgets with your application, please upload them here.

Information about income and outgoings

(This section is to be completed by a budget advisor)

Number of adults in household:(Required)

Number of dependent children in household:(Required)

Weekly household budget

Income

My take home pay (after tax and all other deducations)(Required)

Please enter a number greater than or equal to 0.

My income support payments (total)(Required)

Please enter a number greater than or equal to 0.

Partner/spouse’s take home pay(Required)

Please enter a number greater than or equal to 0.

Partner’s income support payments(Required)

Please enter a number greater than or equal to 0.

Board income(Required)

Please enter a number greater than or equal to 0.

Rental property income(Required)

Please enter a number greater than or equal to 0.

Other adult household contributions(Required)

Please enter a number greater than or equal to 0.

Other income (specify)(Required)

Please enter a number greater than or equal to 0.

TOTAL INCOME (TOTAL A)

Household costs

Mortgage(Required)

Please enter a number greater than or equal to 0.

Rent or board(Required)

Please enter a number greater than or equal to 0.

Groceries(Required)

Please enter a number greater than or equal to 0.

Electricity(Required)

Please enter a number greater than or equal to 0.

Gas(Required)

Please enter a number greater than or equal to 0.

Water and wastewater rates(Required)

Please enter a number greater than or equal to 0.

Land rates(Required)

Please enter a number greater than or equal to 0.

House maintenance(Required)

Please enter a number greater than or equal to 0.

Insurance – house/contents(Required)

Please enter a number greater than or equal to 0.

Phone (landline/mobile/internet)(Required)

Please enter a number greater than or equal to 0.

TOTAL HOUSEHOLD COSTS (TOTAL B)

Travel costs

Fares (e.g. bus, train, ferry)(Required)

Please enter a number greater than or equal to 0.

Petrol/fuel (own or borrowed vehicle)(Required)

Please enter a number greater than or equal to 0.

Car insurance(Required)

Please enter a number greater than or equal to 0.

Vehicle registration/warrant of fitness(Required)

Please enter a number greater than or equal to 0.

Vehicle maintenance/repairs(Required)

Please enter a number greater than or equal to 0.

Vehicle Road User charges(Required)

Please enter a number greater than or equal to 0.

Car loan repayments(Required)

Please enter a number greater than or equal to 0.

Fines(Required)

Please enter a number greater than or equal to 0.

Other (specify)(Required)

Please enter a number greater than or equal to 0.

TOTAL TRAVEL COSTS (TOTAL C)

Family costs

Child support payments(Required)

Please enter a number greater than or equal to 0.

School donations, fees, uniforms(Required)

Please enter a number greater than or equal to 0.

Child Care(Required)

Please enter a number greater than or equal to 0.

Medical/prescription/dental(Required)

Please enter a number greater than or equal to 0.

Clothing and shoes(Required)

Please enter a number greater than or equal to 0.

Pet registration/vet fees(Required)

Please enter a number greater than or equal to 0.

Holidays(Required)

Please enter a number greater than or equal to 0.

Gifts(Required)

Please enter a number greater than or equal to 0.

Life/health insurance(Required)

Please enter a number greater than or equal to 0.

Income protection insurance(Required)

Please enter a number greater than or equal to 0.

Donations/Koha(Required)

Please enter a number greater than or equal to 0.

Bank fees(Required)

Please enter a number greater than or equal to 0.

Hidden

Superannuation/Kiwi Saver

Please enter a number greater than or equal to 0.

Other (specify)(Required)

Please enter a number greater than or equal to 0.

TOTAL FAMILY COSTS (TOTAL D)

General costs

Hire purchase repayments(Required)

Please enter a number greater than or equal to 0.

Hidden

Student loan repayments

Please enter a number greater than or equal to 0.

Other repayments(Required)

Please enter a number greater than or equal to 0.

Tuition fees(Required)

Please enter a number greater than or equal to 0.

Sports fees/gym fees(Required)

Please enter a number greater than or equal to 0.

Subscriptions (magazines, newspapers)(Required)

Please enter a number greater than or equal to 0.

Personal (cigarettes, alcohol, gambling(Required)

Please enter a number greater than or equal to 0.

TOTAL GENERAL COSTS (TOTAL E)

SUMMARY OF COSTS

Household costs (B)

Travel costs (C)

Family costs (D )

General costs (E)

TOTAL INCOME (A)

TOTAL COSTS (B – E)

SURPLUS / SHORTFALL

Information about assets and liabilities

ASSETS: (What you own)

Value (approx.)

Total debt owing

Own home

Own home value(Required)

Please enter a number greater than or equal to 0.

Own home dept owing(Required)

Please enter a number greater than or equal to 0.

Motor vehicle/s

Motor vehicle/s value(Required)

Please enter a number greater than or equal to 0.

Motor vehicle/s dept owing(Required)

Please enter a number greater than or equal to 0.

Investments/shares etc

Boat/caravan/campervan etc value(Required)

Please enter a number greater than or equal to 0.

Boat/caravan/campervan etc dept owing(Required)

Please enter a number greater than or equal to 0.

Boat/caravan/campervan etc

Investments/shares etc value(Required)

Please enter a number greater than or equal to 0.

Investments/shares etc dept owing(Required)

Please enter a number greater than or equal to 0.

Other savings

Other savings value(Required)

Please enter a number greater than or equal to 0.

Other savings dept owing(Required)

Please enter a number greater than or equal to 0.

Other asset/s

Other asset/s value(Required)

Please enter a number greater than or equal to 0.

Other asset/s dept owing(Required)

Please enter a number greater than or equal to 0.

Other land/investment property/holiday home etc

Other land/investment property/holiday home etc value(Required)

Please enter a number greater than or equal to 0.

Other land/investment property/holiday home etc dept owing(Required)

Please enter a number greater than or equal to 0.

Address of other land/ property/holiday home etc(Required)

List(Required)

LIABILITIES: (Type of debt)

Who you owe (WINZ, fines, finance co. etc)

Amount owing

Repayment. Amount

Repayment. Frequency

Declaration

Name(Required)

Date(Required)

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