Information questionnaire

Did you receive EI benefits this year or last?*

Yes
No

Date started*

Date ended*

Which office did you apply for EI benefits?

Address

What is your highest level of education?

Are you bonded in your present position?

Yes
No

Marital status:*

As of*

Spouses name

First Last

Spouses address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Spouses SIN:

Spouses birthdate

Number of persons in family household, including bankrupt*

Number of persons 17 years of age or less*

Name

First Last

Relationship

Date

Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

First Last

Relationship

Date

Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

First Last

Relationship

Date

Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Spouses occupation

Spouses employer

Do you pay alimony?

Yes
No

Amount

To whom?

Do you pay maintenance?

Yes
No

Amount

To whom?

Are you in arrears to pay alimony or maintenance?

Yes
No

If yes, tax refunds may be offset to family court.

Amount

Information questionnaire

Step 1 of 10

List all previous employers for this year and last if applicable.

List all previous employers for this year and last if other than above.

Monthly income

Monthly non-discretionary expenses

Monthly discretionary expenses (family unit)

Housing expenses

Personal Expenses

Non recoverable medical expenses

Living expenses

Transportation expenses

Insurance expenses

Payments

Debts

Secured creditors (mortgage, car loan, etc)

Debts Unsecured Creditors

Other liabilities

Have you had any debts arising from:

If you answered yes to any of the above, that debt may not be discharged by the bankruptcy process. It is advisable that you talk to an insolvency lawyer.

Within the past 12 months, have you, either in Canada or elsewhere:

Within the past 5 years, have you, either in Canada or elsewhere:

Assets

Cash (on hand, in chequing or savings account)

Furniture

Personal affects and jewelry

Loans owed to you, accounts receivable

Cash surrender value of insurance policies

Co-op stocks

Stocks, bonds, dividends

RRSP's, savings plans

Property, cottage, house or land

Vehicles

Boats, trailers, motors, recreational equipment, etc

Estimated tax refund to be received (for what year)

Other assets

Description of furniture, appliances, household and personal effects

Income tax information

Please list any income you have received from January 1 to the date of your completing this form

Trustee's Fees:

Note - Minimum $200 cash deposit required for first time bankrupt Minimum $250 cash deposit required for second time bankrupt

Administrator Fee (Proposal’s)

All credit cards in your possession must be turned over to the Trustee at the date of assignment

Note - Minimum $200 cash deposit required for first time bankrupt
Minimum $250 cash deposit required for second time bankrupt