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Information questionnaire

Step 1 of 10

10%
  • Print version

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

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

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  • Address
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    If yes, tax refunds may be offset to family court.
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  • Monthly income

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  • Monthly non-discretionary expenses

  • Monthly discretionary expenses (family unit)

  • Housing expenses

  • Personal Expenses

  • Non recoverable medical expenses

  • Living expenses

  • Transportation expenses

  • Insurance expenses

  • Payments

  • other than mortgage or vehicle
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  • Debts

  • Secured creditors (mortgage, car loan, etc)

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  • Debts Unsecured Creditors

    (Credit Cards, Bank Overdrafts, Payday Loans, etc.)
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  • 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.

    (ie. credit cards, lines of credit)
  • Within the past 12 months, have you, either in Canada or elsewhere:

    (ie. credit cards, lines of credit)
    (ie. credit cards, lines of credit)
  • Within the past 5 years, have you, either in Canada or elsewhere:

    (ie. credit cards, lines of credit)
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  • 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

    (i.e. investments, Canada savings bonds)
  • RRSP's, savings plans

  • Property, cottage, house or land

  • Max. file size: 16 MB.
  • Vehicles

  • Boats, trailers, motors, recreational equipment, etc

  • Estimated tax refund to be received (for what year)

  • Other assets

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  • Description of furniture, appliances, household and personal effects

    Garage Sale Value
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  • Income tax information

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

  • Trustee's Fees:

    Trustee's fees for Summary Administration Bankruptcy (includes potential court fee) - $1200.00
    Disbursements - $100.00
    First and second counselling fee - $170.00
    Registration fee - $75.00
    G.S.T. on Trustee fee's, counselling fees and Disbursements - $74.30

    Total - $1619.30

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

  • Administrator Fee (Proposal’s)

    The Administrator’s fees and costs will be taken from proposal contributions and are taxed under a tariff pursuant to the BIA

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

  • 06/28/2022
  • IF YOU DO NOT PROCEED WITH FORMAL INSOLVENCY PROCEEDINGS WITHIN 60 DAYS AFTER THE RECEIPT OF THIS APPLICATION BY SMITH CAGEORGE BAIEY INC., WE WILL DESTROY THE APPLICATION PURSUANT TO THE PERSONAL INFORMATION PROTECTION AND ELECTRONIC DOCUMENTS ACT.

    *NOTICE TO BANKRUPT

    IT IS A CRIMINAL OFFENCE TO PROVIDE FALSE INFORMATION OR REFUSE OR KNOWINGLY NEGLECT TO PROVIDE INFORMATION THAT FULLY AND COMPLETELY REVEALS THE STATE OF YOUR AFFAIRS AS IT PERTAINS TO YOUR BANKRUPTCY. BE ADVISED THAT THIS INFORMATION CAN BE MADE AVAILABLE TO THE ROYAL CANADIAN MOUNTED POLICE IN THEIR CAPACITY AS THE ENFORCEMENT AGENCY OF THE SUPERINTENDENT OF BANKRUPTCY SHOULD AN ALLEGATION OF WRONGDOING MAY BE MADE THE THE TRUSTEE OR OFFICIAL RECEIVER.

  • This field is for validation purposes and should be left unchanged.
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Toll Free 1.877.806.2918
Tel: 403.261.7779
Fax: 403.452.8187

210, 617 – 11 Avenue SW
Calgary, AB
T2R 0E1

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