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Online Assessment

Accounts and Amounts Owing - Please Read Instructions

Monthly Income

Assets

Investments

  • Basic Information
  • Debts
  • Income
  • Assets
  • Investments

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Your Name

Phone Number

Email Address

Spouse's Name

How did you hear about us?

Whos debt is it?

Marital Status

Postal Code

What province do you live in?

Additional Information

Do you have children under the age of 18? If so how many?

Do you have children over the age of 18? if so how many?

Are you financially supporting your children over the age of 18?

Have you declared bankruptcy before?

If yes, were you discharged from that bankruptcy?

Do you owe Revenue Canada (CRA) for back taxes? If so how much?

Have you filed taxes up to and including 2018?

Do you owe money to Family Maintenance Enforcement Program? If so how much?

Are your wages currently being garnished? If yes by who?

Do you pay child support? If so how much?

Do you pay alimony? If so how much?

Do you receive child support? If so how much?

Do you receive alimony? If so how much?

In this section you will list all of your unsecure debt. Your vehicle loans and mortgages are not listed here. Please follow the example below and DO NOT lump all of your debt together and make sure to list your creditors as well as the total amount owed Example: RBC Visa – $10,000.00

Are you up to date with your payments?

Debt #1 - Creditor and amount owing?

Debt #2 - Creditor and amount owing?

Debt #3 - Creditor and amount owing?

Debt #4 - Creditor and amount owing?

Debt #5 - Creditor and amount owing?

Debt #6 - Creditor and amount owing?

Debt #7 - Creditor and amount owing?

Debt #8 - Creditor and amount owing?

Debt #9 - Creditor and amount owing?

Debt #10 - Creditor and amount owing?

Debt #11 - Creditor and amount owing?

Debt #12 - Creditor and amount owing?

Debt #13 - Creditor and amount owing?

Debt #14 - Creditor and amount owing?

Debt #15 - Creditor and amount owing?

Your Income

Are you Self Employed? If so how much do you pay yourself (on average) per month (net)?

How often do you get paid?

What is your net pay (per check)?

If you have a spouse, how often do they get paid?

If your spouse has an income, what is their net take home pay (per check)?

If you receive child support, how much do you receive per month?

If you receive alimony, how much do you receive per month?

Do you receive tips or cash from your job? If so what is the average per month?

Do you have a part time job? If so what is your net take home pay per month?

Do you receive income from a rental property? if so how much?

Do you receive a disability income? If so how much?

Do you receive a pension income? If so how much?

Do you receive income from WCB? If so how much?

Do you receive income from social assistance? If so how much?

Do you receive Employment Insurance (E.I)? If so how much?

Do you receive Child Tax Credits? If so how much?

Property

Do you own property outside of Canada?

Do you own a home?

If you own a home, what is the current market value?

What is the oustanding mortgage on this property?

Do you have a second mortgage on this property? If so what is outstanding?

Do you have a third mortgage on this property? If so what is outstanding?

Do you have a secured line of credit on this property? If so what is outstanding?

How many people are on title for this property?

Do you own any other property other than the home listed above?

Other Assets

If you own a vehicle what is the year, make, and model?

Is there a loan outstanding on this vehicle? If so how much?

How many Kilometers are on the vehicle?

If you own a secondary vehicle what is the year, make, and model?

Is there a loan outstanding on the vehicle? If so how much?:

How many Kilometers are on this vehicle?:

Do you own any other vehicles?

If you own more than two vehicles please list any remaining vehicles here

Do you own recreational vehicles such as boats, campers, ATV's, snow mobiles?

If you said yes to the recreational vehicles please list all vehicles here.

If you own your home, is it rented out?

Investment Accounts

Do you contribute to RRSP's? If so what have you contributed in the last 12 months?

Do you contribute to RESP's? If so what is the current balance of that account?

Do you own Stocks? If so what is the current value?

Do you own Bonds? If so what is the current value ?

Do you own GIC's? If so what is the current value?

Do you own Mutual Funds? If so what is the current value?

Do you contribute to a Tax Free Savings account? If so what is the current value?

Do you have a Pension? If so what is the current value?

Do you have a LIRA Fund? If so what is the current value?