About this form
This form is issued when an Attachment of Earnings application has been made to the court. Completing it allows you to explain your financial situation and avoid further steps that could involve your employer. The form is one double-sided page—be sure to fill out both sides, sign it, and submit it.
What you’ll need
(1) Details of your income and any other sources of money.
(2) A list of your regular expenses (e.g., rent, bills, childcare).
(3) Any recent payslips or proof of income.
How long it will take
About 10-15 minutes.
Why complete this form?
By completing this form, you avoid your employer being contacted about your financial situation. It gives you the opportunity to explain what you can afford and ensures the court sets repayments at a manageable level. Acting early helps you stay in control of the process and keep it confidential.
If you don’t complete this form
If you do not complete and return the form, this could result in a County Court Bailiff visiting your home or you being summoned to a court hearing. Completing the form helps avoid these additional steps and keeps things simpler for you.