Revenue and expenditure account template

1. Copy and paste the following text into a word processor:

ASSET MANAGEMENT ACCOUNT FOR THE YEAR .............................

Management period from................... to .....................

File No. RG:

Cabinet:

I. - The protected person

Surname (by birth):

Usage name:

First name(s):

Date and place of birth:

Domicile:

Place of residence (if different from domicile):

Has the place of residence of the protected person changed since the last revenue and expenditure account (or since the inventory if it is the first revenue and expenditure account)?

□ Yes

□ No

Telephone:

E-mail address:

II. - The protective measure

Date of opening of the protection measure or date of last renewal of the measure:

Measure pronounced:

□ Guardianship

□ Enhanced Curatorship

□ Safeguarding justice with a special mandate

□ Future Protection Mandate

□ Judicial accompanying measure

Name and surname of the person in charge of the protection measure:

Date of appointment (date of judgment or date of order in case of subsequent designation):

Address:

Has the address of the person in charge of the protection measure changed since the last revenue and expenditure account (or since the inventory if it is the first revenue and expenditure account)?

□ Yes

□ No

Telephone:

E-mail address:

III. The management actions taken during the year

Existence of real estate assets:

□ Yes

□ No

If so, was the heritage changed during the year?

□ Yes

□ No

If yes, specify the nature of the transaction and attach a copy of the deed:

□ Sale

□ Acquisition

□ Succession

□ Donation

Location address of the building:

Existence of financial investments:

□ Yes

□ No

If so, were the financial investments changed during the year?

□ Yes

□ No

If yes, specify the reason for the changes:

□ Bank account consolidation

□ Sale of a share savings plan

□ Transfer of funds from one account to another

□ Plan expired

□ New investment following a sale or inheritance

□ Other reasons:

A. - Resources

Indicate the annual amount in euro for each type of resource.

1. Income

Salary:

Retirement pension:

Maintenance:

Compensatory benefit:

Life annuity:

Rental income:

Other (specify):

2. Allowances

Disabled adult allowance:

Family allowances:

Housing allowance:

Unemployment benefit:

Other (specify):

3. Movable income

Investment income (amount of interest or dividends paid into bank accounts):

Exceptional income (donation, inheritance, etc.):

Other (specify):

4. Other resources

Sale of real estate (e.g. apartment, house, etc.):

Sale of movable property (e.g. car, valuable furniture, etc.):

Refunds (CPAM, mutual, etc.):

Other (specify):

Total resources (A):

B. - Expenses

Indicate the annual amount in euro for each type of expenditure.

1. Expenses of daily living

Clothing:

Power supply:

Leisure-holidays:

Medical expenses:

Tuition fees:

Money of life:

Transport:

Other (specify):

2. Housing

Rent:

Accommodation costs:

Electricity:

Gas:

Water:

Telephone - internet:

Other (specify):

3. Taxes and charges

Income taxes:

Real estate wealth tax:

Property tax:

Other (specify):

4. Insurance costs

Housing:

Automobile:

Health (e.g. mutual health insurance):

Other (specify):

5. Home-support costs

Home help:

Other (specify):

6. Major purchases

Building (ex: apartment, house):

Automobile:

Furniture (e.g. wardrobe, bed, TV, etc.):

Other (specify):

7. Miscellaneous works and repairs

Real estate development works (e.g. renovation of building façade - painting):

Maintenance repairs (e.g. water leak):

Other (specify):

8. Investments

Movable investments (shares, SICAV, passbook, other):

9. Outstanding borrowing

Total amount of debt repaid over the year:

Other (specify):

10. Other expenditure

Remuneration of the person in charge of the protection measure (in the case of a legal representative for the protection of adults):

Cost of controlling revenue and expenditure accounts (if carried out by a qualified professional):

Other (specify):

Total expenditure (B):

C. Management balance of the year

Balance of previous year:

(For the deposit of the first revenue and expenditure account, enter the balance of the accounts on the day of the asset inventory. For subsequent years, enter the balance of the last revenue and expenditure account)

Total resources for the year (A):

Total expenditure for the year (B):

Balance (A - B):

D. - Situation of bank accounts and booklets

Important: the funds and securities of the protected person must be deposited in an account opened in his name and mentioning the protection measure. For each bank account, you must attach a copy of the last bank statement.

E. Outstanding debts

IV. - Observations of the person in charge of the protection measure on the assets mentioned in the revenue and expenditure account.

Please note: the elements relating to the protected adult's personal life (e.g. leisure, health, etc.) must be included in a separate document.

V. - Signatures

The person(s) in charge of the protection measure certify(s) this sincere and true revenue and expenditure account.

Does it

À

Signature(s)

2- Date and sign the management account

3- Send the completed revenue and expenditure account and the supporting documents necessary for its establishment to the person designated for the verification and approval of the revenue and expenditure account

All supporting documents (invoices, bank statements, credit agreement...) that allowed the establishment of the revenue and expenditure account