FINANCIAL INFORMATION FORM

First Name *

Last Name

Phone Number

Email *

City/Town *

Province *

All Provinces Alberta British Columbia Manitoba Ontario Quebec Saskatchewan

Number of People in Your Household

Wage Earners          Dependants
         

Are you working?

Self                          Spouse
Yes/No Yes No             Yes/No Yes No

Is any creditor garnishing your income?

Self                          Spouse
Yes/No Yes No             Yes/No Yes No

Total Amount of Your Debts
(Not including mortgage and vehicle financing)

Self                          Spouse
           

Do Your Debts Include:

Credit Cards
Bank Loans
Student Loans
Child of Spousal Support Arrears
Income Taxes
Business GST
Judgments (e.g., motor vehicle, lawsuit, foreclosure, etc.)

Assets:

Self                          Spouse
Vehicle(s)           Vehicle(s)
House                House
RRSPs                RRSPs
Other                 Other

Are you currently operating a business?

Yes/No Yes No

Have you been in bankruptcy before?

Yes/No Yes No