You must have JavaScript enabled to use this form. Repayment plan request form If you are already experiencing or expect to experience temporary payment difficulties as a result of the current rising cost of living and wish to arrange a short-term repayment plan with us, please complete this form. Please note, if you hold multiple agreements with us, you will be required to complete a form for each individual agreement you require support with. Important: A repayment plan will be reported to the Credit Reference Agencies for any active agreements as ‘in an arrangement’, along with late payment arrears markers which other lenders may review when making future lending decisions. Whilst no additional interest will be applied to your repayment plan, a reduced repayment plan will increase your monthly payment in subsequent months. You should therefore consider this increased monthly cost carefully before entering a plan. Please note that if your next scheduled payment is due in the next 5 working days we may not be able to set up your plan until the following months rental. Please do not cancel your direct debit. Please complete the form accurately in order to avoid any delays with your request being processed. Your details First name Last name Email address Date of birth Contact telephone number Agreement information Agreement number Vehicle registration Agreement end date Payment Information Nature of temporary difficulty - Select -Current impacts of cost of livingLoss of jobReduction in incomeOther For how many months, up to a max of 3 months, do you require support in the form of reduced payments? - Select -123 Current monthly payment Alternative monthly payment (upto a maximum of 50% reduction, subject to review) Preferred payment method for plan - Select -Existing Direct DebitManual Payment Last four digits of bank account used for current direct debit Assessing Your Affordability As responsible lenders, it is important that we only agree a temporary repayment plan for you after assessing that the alternative amount is affordable for you. The quickest and most convenient way to assess your income and expenditure is through the use of Open Banking. Open Banking is provided via NEOS, a Credit Reference Agency and Open Banking provider, regulated by the Financial Conduct Authority (FCA). Open Banking allows a ‘one-time’ snapshot of your bank account and has no impact on your credit score. Using this method of assessing your affordability removes the need for you to gather the important financial information required to complete a manual Income and Expenditure review. Please indicate below how you would like to complete your Income & Expenditure review. Please indicate below how you would like to complete your Income & Expenditure review. Open Banking Click here to receive a link via email Open Banking Click here to receive a link via sms Manual Income & Expenditure Click here to complete the below details before submitting your plan request form. Affordability Marital status - Select -Married/Civil PartnershipDivorcedSingleWidowed Residential status - Select -CohabitingOwner OccupierCouncil TenantJoint OwnerLiving with ParentsTenant FurnishedTenant UnfurnishedOther TenantOther Number of dependent children under the age of 14 - Select -0123455+ Number of dependent children over the age of 14 - Select -0123455+ Number of vehicles in the household - Select -123455+ Employment status - Select -Employed Full-time Self-Employed non-professionalNon-workingSelf-Employed ProfessionalEmployed Part-timeRetired Occupation Employer/Company name Time with Employer Town/City located Your Monthly Income Salary or wages (after tax and any pension contributions) Other salary or wages (after tax / pension contributions) Pension Borders, Lodgers, rentals Maintenance or child support Investments/Interest Benefit(s) (e.g. disability, jobseeker) Other Income (e.g. from partner) Total Monthly Income Your Monthly Expenditure Council Tax Health Insurance Gas, Coal, Oil Life Insurance Other Insurance(s) (not car) Electricity Petcare (Insurance, vets, food) Food Housekeeping Childcare Adult care Child Maintenance (CSA) School fees/expenses Home telephone/Internet Mobile Phone Essential hire purchase costs TV License Satellite/Other entertainment Hobbies/Sport Health (e.g. Dentist, optician) Payments to other creditors Personal Grooming Gifts (e.g. Birthdays) Home repairs/maintenance Other Spending Vehicle Expenses for all vehicles in household Fuel Vehicle Tax Insurance Maintenance Breakdown Cover Parking Other travel expenses for household Public Transport Holidays Other Travel costs Total Monthly Expenditure Difference between total income and monthly expenditure Customer declaration: I am the customer named on the agreement. I am experiencing or expect to experience temporary payment difficulties as a result of the current rising cost of living. I have read the explanatory wording, ‘Our Repayment Plans explained’ on this website. We confirm that: a Repayment Plan to reduce your current monthly repayment to us may be available for a specified number of monthly payments, depending on your circumstances and will increase your subsequent monthly payments to us once the plan period has ended, you can stop the plan at any time by repaying any arrears to bring your agreement up to date, free and impartial debt advice is available to you which may help you decide if a payment plan is the right option for you. Please see the ‘Our Repayment Plans explained’ page on this website for details. 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