Household type : --- Single person Household without children Household with 1 child Household with 2 children Household with 3 children Household with 4 children Household with 5 children Household with 6 children Household with 7 children Household with 8 children Household with 9 children Household with 10 children Household with 11 children Household with 12 children

Monthly net income and expenses

	Applicant A	Applicant B	Other person	Other person	Total
Income
Salaried occupation					0.00
Unemployment benefits					0.00
Revis supplement					0.00
RPGH supplement					0.00
FNS rental supplement					0.00
Pension/annuity					0.00
Personal alimony					0.00
Alimony for children					0.00
Other					0.00
Expenses
Paid personal alimony					0.00
Paid alimony for children					0.00
Total	0.00	0.00	0.00	0.00	0.00