BANKRUPTCY/PROPOSAL APPLICATION CHECKLIST
1.
Application
- complete all questions
- bring 2 pieces of identification when you sign up
(i.e. driver’s licence & birth certificate)
2.
Vehicles
- copy of vehicle registration(s)
- independent appraisals (two required, usually from
vehicle car lots)
3.
Real Estate
- market evaluations (2) (appraisal or valuation)
- copy of mortgage payout statement(s)
- copy of insurance on real estate
4.
Agreements
- debentures, mortgages, separation, alimony, child
support, leases, sales contracts, judgments, fines,
wage assignments, court orders
5.
Credit Cards
- all must be turned over to the Trustee, including
those with a nil balance
6.
Life Insurance
- copy of all policies
7.
RRSP’s/RESP’s/Bonds/Securities
- all pertinent documentation/statements
8.
Income Information
- most current pay stub available showing year to
date amounts, deductions, etc.
9.
Creditor Statements
- most recent statements from creditors & collection
agencies
10. Student Loans
- you may wish to verify your student loan status by
calling 1-888-815-4514
11. Tax Information
- copy of last return filed
- if you have not filed up to date, please provide
information for Trustee to file previous year (T4’s,
receipts, etc.)
- re: current year – a list of all employers with gross
earnings and deductions made for tax, CPP, EIC,
union dues and any maintenance/support payments
and spousal earnings
12. Initial filing fee to Bankruptcy Estate $____________ (by cash or money order only)
HAYES MCNEILL & PARTNERS LTD.
TRUSTEE IN BANKRUPTCY
CONFIDENTIAL DETAILED APPLICATION
Please answer to the best of your knowledge. When you have completed the application please deliver it to our office. We will contact you to make arrangements for a meeting to sign the prepared legal documents.
PERSONAL INFORMATION (Full Legal Name Required)
Last Name: _______________________ First Name: ________________ Middle Name(s): ____________ Address:
Street City Province Postal Code
Mailing address (if different from above) ______________________________________________________ Resided at above address since: Year _____ Month _____ Day _____
Phone #: ___________________ __________________ _______________________
Home Cell Business
Email address _____________________________
S.I.N. ________________________________ Birth date: Year _____ Month _____ Day ____ Highest Level of Education:
Some High School ___ High School ___ Some Post-Secondary ___Post Secondary ___ University Degree___
Occupation:
Marital Status: Single ____ Common Law ____ Married _____ Separated ______ as of __________ Divorced ____ as of _____________ Widowed ____ as of _____________
Spouse
’
s Full Name: ________________________ Spouse’
s Phone # ___________________ Address: __________________________________________________________________________Street City Province Postal Code
Spouse
’
s S.I.N. ______________ Spouse’
s Birth date Year _____ Month _____ Day _____ Spouse’
s Occupation ___________________________Nearest Relative:
Name, Address and ________________________________________________________________________ Phone Number _____________________ Relation
Number of Dependents who rely on you for financial support: _________ (list below) Name Income Since
January 1
DEBTS: List all debts, including secured debts and utilities (best estimate of balance
owing)
Creditors Name
Complete Address
Account Number
Estimated Amount
Owing
When listing all your debts please indicate if another person is also legally
ASSETS DESCRIPTION
BEST ESTIMATE OF PRESENT VALUE Cash on hand/In Bank
Household Furniture/Effects
(to calculate see last two pages of application)
Accounts Receivable (due to you)
(provide list showing names/address/ amount)
Cash Surrender Value of Insurance Policies
Pensions (Company, Plan #)
RRSP (Company, Plan #)
RESP (Registered Education Savings Plan)
Stocks/Credit Union Shares
Shares in Limited Company (Give # of shares, company name Cottage / Timeshare
(give address & legal description) House
(give address & legal description) Land
(give address & legal description) Automobile
(give year/model/VIN #) Motorcycle
(give year/model/VIN #)
Other Vehicles
Boat (model & size)
Motor (type & size)
Trailer
Recreational Equipment Other Assets
(e.g. inheritances/litigation/etc.)
Have you been self employed in the last 5 years? Yes ____ No ____
Business #1 Business #2 BUSINESS AND TRADE NAMES
Sole Proprietorship, Partnership or a Corporation.
Start Date / End Date (yr/mth/day) What Happened to Business? Where are Books & Records? Are they up to date?
Name(s) of Partner(s) Place of Business (City) Nature of Business
GST #
Are there any outstanding GST returns? For what periods?
Are the employees paid? Are the T4’s completed?
How many employees?
Are any of your debts directly related to your business? Yes _____ No ______ If yes, what percentage? ________%
Are you an Officer or a Director of a limited company? Yes _____ No ______ (If so you may need to resign as director)
If yes - Name of the Company _______________________________________
- Date you became a Director or Officer _______________________________________
- Is the company still operating? Yes _____ No ______
- Where are the books and records? _______________________________________ --- List all of your employers, showing dates started and terminated, for the past two years. If you had any periods when you were drawing EI benefits, show each period separately.
Employer`s Name Employer`s Full Address Date Job Commenced
Date Job Finished
REASONS FOR YOUR FINANCIAL PROBLEMS:
___ Over-extension of credit ___ Relationship Breakdown ___ Medical Issues
___ Business failure ___ Alcohol/Drugs/Gambling ___ Poor Financial Management Provide short description
PREVIOUS BANKRUPTCY, ETC:
Have you ever been bankrupt before? ______ If yes: Name bankruptcy was filed under Date of Bankruptcy___________ Name of Trustee/Prov.
Provide reasons for previous bankruptcy
Please supply a copy of Discharge Order.
Have you ever made a proposal or an arrangement with your creditors?_____ If yes, please detail
GENERAL:
1. Within the last twelve (12) months, have you sold, disposed of, or transferred any of your assets? Yes ___ No ___ (e.g. Vehicles, RRSP
’
s, Stocks/Bonds, Furniture) - If yes, provide details below.Description of Asset Date Disposed To Whom ie: Spouse/Relative/Other
Sale Price Where are the sale proceeds?
2. Within the last twelve (12) months, have you made payments in excess of regular payments to any creditor, or paid any one creditor’s debt in full? Yes ___ No ___
If yes, detail;
3. Within the last twelve (12) months, have you had any assets seized, garnished or repossessed by a creditor? (ie: paycheque, bank acct, vehicles, refunds) Yes ___ No ___
Asset Seized:
Date Seized: Value:
Name of party that seized:
Was party who made seizure a secured creditor? Yes ___ No ___
Form of security?
4. Within the last five (5) years, have you sold, disposed of, or transferred any real estate? Yes ___ No ___ Description and address
of Property
Date
Disposed To Whom Sale Price
Where are the sale proceeds?
5. Within the last five (5) years, have you made any gifts to relatives or other in excess of $500? Yes ___ No ___ If Yes, detail:
6. Have you made any arrangements to continue to pay any creditors in the future? Yes ___ No ___
If yes, detail:
7. Do you expect to receive any sums of money, or any other property within the next 12 months, which are not related to your normal income? Yes ___ No ____
If yes, detail:
8. Does anyone owe you any money? Yes ___ No ___ If yes, detail:
9. Are you related in any way to an individual that has used, or is using, the services of Hayes McNeill & Partners Ltd.? Name____________________ Relationship_____________ Bankrupt or proposal____________
10. Do you currently own any of the following?
(a) Collectibles (stamps, coin, art, antiques, etc) Yes _____ No _____ $
(b) Savings Bonds (owned presently or being purchased) Yes _____ No _____ $
(c) RRSP’s, GIC’s, LIRA’s Yes _____ No _____ $
(d) Shares (owned presently or being purchased) Yes _____ No _____ $
Please provide details :
(e) Personal Life Insurance Policies (include a copy) Yes _____ No _____ $
Please provide details :
11. Are you a beneficiary of a will or
will you receive an inheritance? Yes _____ No _____ $
Please provide details :
Please provide details
13. Do any of your debts arise from:
A fine or penalty imposed by court Yes _____ No _____ $ Alimony or maintenance payments Yes _____ No _____ $ Fraud, embezzlement, misappropriation Yes _____ No _____ $
Student Loans Yes _____ No _____ $
14. For which year did you file your last income tax return?
Did you receive a refund? Yes _____ No _____ $
Where are the proceeds?
15. Are you paying/receiving any alimony or maintenance? Yes _____ No _____
If yes, to/from whom ______________________ Amount since January 1st $_____________________ (Please provide a copy of the Court Order or separation agreement)
Have you co-signed or guaranteed any loans? __________ Amount of loan $ Borrower
’
s Name & Address:Lender
’
s Name & Address:Business or Personal Debt? Is party bankrupt?
INCOME SUMMARY (MONTHLY) PER MONTH
Net Salary (after deductions) $
Net Self Employment Earnings (after business expenses)
Pension/Annuities CPP $________ OAS $ _________ Other $ __________ Total
Other Pension Income (disability, union, etc.)
Net Earnings of Spouse (if living with you) Alimony Received
EI (Employment Insurance Benefits) Child Tax Benefit / UCCB
Social Assistance Rental Income
Other (specify) ____________________________
EXPENSE SUMMARY PER MONTH
Child support payments you pay $
Spousal support payments Child care (daycare)
Expenses associated with a medical condition (not including MSP premiums) Fines/penalties being paid
Employment-related expenses (If not reimbursed by employer) Debts where stay has been lifted
Rent _____ Mortgage ______ Room & Board _______ (Tick one) Property taxes
Heating
Telephone / Cellular Telephone Cable / Internet
Hydro Smoking Alcohol
Miscellaneous - Dining Out ____________ - Sports/Entertainment ____________ - Other ________________________ Food/Groceries Laundry Hygiene Products Clothing
Car or Truck Payments
Transportation costs (fuel/repairs & maintenance) Car insurance
Insurance on house/contents Life insurance
Payment being made to Trustee
Loan payments (to secured creditors) Details ________________________________
TOTAL MONTHLY EXPENSES $
Hayes McNeill & Partners Ltd. (“HMPLTD”)
Consent Under the Personal Information Protection Act (“PIPA”) of
British Columbia
I, the undersigned person, hereby consent to HMPLTD collecting, using, and disclosing any
personal information that I or any other party may give to HMPLTD about me for the purpose of
providing advice to me and/or in the performance of HMPLTD’s duties whether it is assisting
me in settlements with creditors or in the performance of HMPLTD’s duties as Trustee under a
Proposal or as Trustee in Bankruptcy under the Bankruptcy and Insolvency Act.
For example, I consent to the collection, use, and disclosure of personal information which may
be of a financial nature such as my personal assets and debts, personal income and expenses, and
any information related to my income tax returns and related information, and any other personal
information that I or others may provide to HMPLTD for the purpose of performing of its duties
under the Bankruptcy and Insolvency Act and as consultant where any engagement is not under
the Bankruptcy and Insolvency Act.
For example, I acknowledge that the disclosure of such personal information, which I or others
provide, may be provided to my creditors, Canada Revenue Agency, Superintendent of
Bankruptcy, the Official Receiver, other interested parties, and the Court, for the purpose of
fulfilling any engagement and your legal and professional obligations and I consent to such
disclosure.
I have been given a chance to ask any questions I have about the Privacy Policies and they have
been answered to my satisfaction.
I agree to HMPLTD collecting, using and disclosing personal information about me as set out
above and in the HSLCO’s Privacy Policy.
Dated at _____________, BC, this ________ day of __________, 20___.
Signature:__________________________________
INVENTORY OF ASSETS
HOUSEHOLD FURNISHINGS & APPLIANCES
(Best Estimate of Liquidation Value)
EXEMPT
LIVING ROOM
KITCHEN
STUDY
Sofa
$_______
Table
$
Desk
$
Chairs(s)
Chairs
Chair(s)
Lamps
Pots/Pans
Computer
Stereo Equip
Dishes
CD Player
Microwave
DINING ROOM
DVD Player
Freezer
Table
$
TV
Washer/Dryer
Chairs
VCR
Fridge
Cabinet
Stove
China/Silver
__________
BEDROOM #1
BEDROOM #2
BEDROOM #3
Bed
$_______
Bed
$
Bed
$
Dresser
________
Dresser
________
Dresser
Night Stand
Night Stand
________
Night Stand
CLOTHES
_________
$
TOTAL EXEMPT $_______________
NON-EXEMPT - (you may be required to pay for these or sell them)
JEWELLERY
OTHER
COLLECTIONS
Rings
$
Bike(s)
$
Coin
Watches
Ski Equipment
Stamp
Necklaces
Camping Equip
Plate
Sporting/Outdoors
Gun
TOTALNON-EXEMPT $_________________
I HEREBY CERTIFY THAT THIS IS A TRUE AND COMPLETE LIST OF ALL MY HOUSEHOLD AND PERSONAL
EFFECTS AND THAT THE ASSIGNED VALUES ARE THE TRUEST VALUES TO THE BEST OF MY BELIEF.
UNINCORPORATED TRADE AND BUSINESS ASSETS
Exempt Assets
Tools and Equipment (attach list)
Description
Location
Value
TOTAL
Other Non - Exempt Assets
Inventory (attach list)
$_____________
Accounts Receivable (attach list)
$_____________
I HEREBY CERTIFY THAT THIS IS A TRUE AND COMPLETE LIST OF ALL MY
TRADE AND BUSINESS ASSETS AND THAT THE ASSIGNED VALUES ARE THE
TRUEST VALUES TO THE BEST OF MY BELIEF.
Date:_______________ Signature:
