Balance Sheet For Household Income And Expenses
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1To：
Student Finance Office
Working Family and Student Financial Assistance Agency
Balance Sheet for Household Income and Expenses
(1.4.2015 to 31.3.2016)
/
School Number：
Pupil’s Name:
Class:
Application Form No.: ______________________
# Delete whichever is inapplicable
Average Monthly Income
Average Monthly Expenses
(1) Applicant
Occupation
:
#Rent/Mortgage repayment
: $
No. of working days per month*
:
work
days a month on average
Daily wages*
: $
Average monthly wages
Management fees
: $
(no. of working days x daily wages)*
: $
: $
Allowance
Other income
: $
Rates (per month)
: $
(e.g. contribution from relatives, pension,
profits, rental, backpay, bonus, year-end
double pay, etc.)
: $
: $
Total
Electricity charges (per
month)
(2) Spouse
Occupation
:
Water charges (per month)
: $
No. of working days per month*
: work
days a month on average
Daily wages *
: $
Fuel charges (per month)
: $
Average monthly wages
(e.g. town gas, LPG, etc.)
(no. of working days x daily wages)*
: $
Allowance
: $
: $
: $
Other income
Telephone
charges
(per
month)
(e.g. contribution from relatives, pension,
profits, rental, backpay, bonus, year-end
double pay, etc.)
Total
: $
Travelling expenses
: $
(3) Unmarried children residing with the family
: $
Occupation
:
Meal charges
No. of working days per month*
: work
days a month on average
Children’s education
: $
Daily wages *
: $
expenses
Average monthly wages
(e.g. tuition fee, payment for
(no. of working days x daily wages)*
: $
textbooks and stationery, etc.)
Allowance
: $
Other income
: $
Others
: $
(e.g. contribution from relatives, pension,
(e.g. personal expenses, pocket
profits, rental, backpay, bonus, year-end
money for children,
double pay, etc.)
entertainment expenses, medical
expenses, etc.)
: $
Total
*[For those without income proof (e.g. taxi-drivers, sam hong workers, decoration
workers, construction site labourers, casual workers, etc.), please provide
information on the number of working days per month and daily wages, and
calculate the average monthly wages by multiplying the number of working days
per month by daily wages.]
Average monthly income
Average monthly expenses
:
[(1)+(2)+(3)]
: $
$
Total annual income
Total annual expenses
:
(Average monthly income x12)
: $
(Average monthly expenses x 12)
$
If expenses are greater than income, please specify the source of money and
(1)
provide evidence (e.g. savings, pension, compensation, severance payment,
bank overdraft, loan, etc.):
Any necessary supplementary information may be provided on additional
(2)
sheets and returned to the Office together with this Balance Sheet.
My family # (is / is not) in receipt of CSSA from the Social Welfare Department.
Applicant’s Signature :
As it would take some time to process the information, please return this Balance Sheet
to the Office by fax or by mail as soon as possible. Thank you for your co-operation.
Applicant’s name
:
Fax No. 2598 5486, 2511 1148
Telephone No. : 2802 2345
Date
:
Room 713-714, 7/F, Kwai Hing Government Offices,
166-174 Hing Fong Road, Kwai Chung, N.T.
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