Solving Your Debt & Money Problems

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Solving Yo

ur

Debt

&

Money

Problems

PHONE: 705-726-6331

Please return your completed application form to one of our offices.

If you have any questions, please do not hesitate to call or visit our website at:

www.barriefinancialproblems.com

I choose to file a Bankruptcy .

OR

I choose to file a Proposal

.

For Office Use Only:

Bankruptcy Payment Terms – for bankruptcy (please make cheque or

money order out to BDO Canada)

Down payment: $___________ (cash, cheque or money order) Post Dated cheques ____ cheques at $___________per cheque;

TOTAL $___________

Proposal Payments Terms – for Consumer or Division I Proposal

Regular Payments ___________ of $___________ Lump sum $___________: on date ___________ Other ___________

TOTAL $ ___________

Ontario Lakeland Regional Offices

For all offices listed below, please contact: 855-510-DEBT(3328) 800-863-6082 Barrie 705-726-6331 barriefinancialproblems.com Alliston 705-726-6331 allistonmoneyproblems.com Bracebridge 705-325-7964 bracebridgemoneyproblems.com Huntsville 705-789-1079 huntsvillemoneyproblems.com Keswick 866-275-8836 keswickmoneyproblems.com Lindsay 866-588-7359 lindsaymoneyproblems.com Midland 705-325-7964 midlandmoneyproblems.com New Liskeard 705-495-2000 newliskeardmoneyproblems.com Newmarket 905-898-5950 newmarketmoneyproblems.com North Bay 705-495-2000 northbaymoneyproblems.com Orillia 705-325-7964 orilliamoneyproblems.com Parry Sound 705-774-9184 parrysoundmoneyproblems.com Peterborough 705-742-7560 peterboroughmoneyproblems.com Sault Ste. Marie

705-945-0990 saultstemariemoneyproblems.com Sudbury 705-671-3336 sudburymoneyproblems.com Timmins 705-268-3333 timminsmoneyproblems.com Uxbridge 866-275-8836

How Did You FIRST Learn About This BDO Office? Please check the one

that represents your initial source of information about BDO.

___ 1. Website

___ 2. Yellow Pages: online Yellow Pages or printed directory ___ 3. Newspaper: (please state which paper)

______________________________________

___ 4. Radio: (please state which station)

______________________________________

___ 5. Other: (please state: friend, banker, lawyer etc.)

______________________________________

What Source Did You Use To Get Our Telephone Number to Book a Free Consultation?

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Reminder Checklist

If applicable, please bring the following information listed below for initial consultation with BDO Canada.

1. Consultation Form

a) Ensure all questions are answered fully where relevant. b) Mailing addresses and account numbers for all creditors, including credit card statements and loan documents. c) Copy of any garnishee summons issued by a creditor.

Applicant _____ _____ _____ Spouse _____ _____ _____ BDO Use N/A _____ _____ _____ 2. Personal Identification

a) Copy of Birth Certificate. b) Copy of Driver’s License. c) Copy of Social Insurance Card.

d) Copy of Passport or Ontario Health Care Card.

_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____

3. Vehicles/motorcycles/boats, trucks etc

a) Copy of vehicle registration documents. b) Copy of vehicle Insurance.

c) Copy of lease agreements or finance sales contract. d) Appraisal. _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ 4. Real Estate

a) Copy of most recent mortgage statement.

b) Copy of current market, evaluation, opinion of value. c) Copy of land title if available and proof of insurance. d) Copy of mortgage documents if available.

_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ 5. RRSP, RESP

a) Copies of most recent plan statements.

b) Policy number and address for administrator. _____ _____ _____ _____ _____ _____

6. Pensions. LIRA, Life Insurance

a) Copies of all whole life insurance policies.

b) Policy numbers and address of insurance company. _____ _____ _____ _____ _____ _____

7. Stock/Bonds/Securities

a) All pertinent documentation/statements. _____ _____ _____

8. Matrimonial Agreements

a) Separation, alimony, child support, and property division

agreements. _____ _____ _____

9. Credit Cards

a) Bring all credit cards to Trustee, including those with a nil

balance. _____ _____ _____

10. Pay Stubs

a) Most current pay stub available showing year to date

income and/or bank statement if unemployed. _____ _____ _____

11. Tax Information

a) Copy of most recent tax return filed.

b) Copy of most recent tax notice of assessment. c) If prior years return is outstanding, all pertinent tax information slips (T4;s, receipts, etc.)

_____ _____ _____ _____ _____ _____ _____ _____ _____ 12. Payment to Trustee/Administrator

a) Deposit due on signing (first month payment). _____ _____ _____

13. Bank Account

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Solving Your

Debt

&

Money

Problems

Your Family Information

Day: Month: Year:

Full Name Relation Date of Birth (dd/mm/yyyy) Gender (m/f)

1. 2. 3. 4. 5.

Family Name (Last Name): First AND Middle Names:

(as printed on your birth

certificate /passport) AKA/Maiden Name: Date of Birth: SIN #: Marital Status: Since: Current Email: Telephone Number: Residential Address:

(Including Postal Code)

At this Address Since: If you use an alternative mailing address:

Information Form

Questions? Call: 705-726-6331

Home: Work: Cell:

______ Single ______ Married ______ Common Law ______ Separated ______ Divorced ______ Widowed

Day: Month: Year:

Applicant Spouse

Day: Month: Year:

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Employment Information for the Past Year Current Employer Applicant Spouse Employer Name: Address: City: Province Postal Code: Position: Start Date: End Date: Employee No: Attention: Fax: Phone:

Previous Employers since last tax return filed:

Applicant Spouse Employer Name: Address: City: Province: Postal Code: Position: Start Date: End Date: Employee No: Attention: Fax: Phone:

Self Employed Details

Are you currently Self Employed or operated a Business in the last 5 years? ____Yes ____ No (If yes, please complete below)

Name of Business:

Type of Ownership: ____ Incorporated ____ Partnership ____ Sole Proprietor Are you a Director: ____ Yes ____ No

Business Address (incl. Postal Code): Description of Business Activity: List Partners or Directors: Date Business Started (dd/mm/yyyy):

Date Business ended (dd/mm/yyyy): ____ Check here if business is still operating

Have you sold/closed a business in the past

5 years? ____ Yes ____ No

If “Yes,” what was the value of the assets, were the assets sold and how were funds distributed?

Is/was Business GST/HST Registered? ____ Yes ____ No If “Yes,” GST/HST Number:

Did/Does the Business have employees? _{____ Yes ____ No} If “Yes,” were all source deductions for employees remitted: ____ Yes ____ No

Can you produce books and financial

records for the Business? ____ Yes ____ No

If “No,” what happened to them?

Does the Business own any assets? ____ Yes ____ No If “Yes,” what is the value of all the assets? $

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Have you previously filed a Bankruptcy or Proposal in Canada or elsewhere? (Specify)

Applicant ____ Yes ____No Spouse ____ Yes ____No

Trustee’s Name Trustee’s Name

Bankruptcy Date Bankruptcy Date

Bankrupt Discharge Date Bankrupt Discharge Date

Estate No. Estate No.

Place Filed Place Filed

Result of Proposal Result of Proposal

Proposal Date Proposal Date

Highest Education Level Completed

___ 0-8 Years ___ Some High School

___ High School Graduate ___ Some Post

___ Post-Secondary ___ University Degree

___ Secondary ___ Certificate or Diploma

___ Both

Highest Education Level Completed

___ 0-8 Years ___ Some High School

___ High School Graduate ___ Some Post

___ Post-Secondary ___ University Degree

___ Secondary ___ Certificate or Diploma

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Property Information

Please answer question 1 through 7 by ticking yes or no and complete each section if applicable. Please use separate sheet for each property.

Mortgages/Other Charges on Property (i.e. Secured Line of Credit, Canada Revenue Agency Lien,

or Property Tax Arrears)

Name of Company Whose Debt Is It? Up to Date Statement Attached to Application Form? If “No,” please provide: Address Account # Amount Owed

1

st _{___ Yes ___ No}

_$

2

nd ___ Yes ___ No

$

3

rd ___ Yes ___ No

_$

Are the following payments current?

Mortgages: ____ Yes ____No If no, how much in arrears? ______________________ Property Taxes: ____ Yes ____No If no, how much in arrears? ______________________ Utilities: ____ Yes ____No If no, how much in arrears? ______________________ Insurance: ____ Yes ____No If no, how much in arrears? ______________________

Please advise your intention:

Intend to maintain payments on mortgages to keep the property ____ Yes ____No Intend to surrender the property back to the creditor ____ Yes ____No

1. Do you own any property/real estate?

_____ Yes

_____ No

If “yes” please complete this section, if “no,” please go to question 2.

Type of Property ____ House ____ Condo ____Cottage ____ Land _____ Time Share Property Address:

(incl. Postal/Zip Code) Person(s) holding title on deed

Date Property Purchased Purchase Price

Current Estimated Value $

$ Current Market Value by ______ Yes

Real Estate Agent Attached? ______ No

4

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Vehicles and Household Asset Information

2. Do you own or lease any vehicles? (include recreational vehicles i.e. trailers, boats etc)

____ Yes

____ No

If “yes,” please complete this section, if “no,” please go to question 3. Whose Name Is

Vehicle In? Name of Secured

Creditor

Amount

Owed Information Creditor

___ Applicant ___ Joint ___ Spouse Make: Model: Year: Value: VIN:

____________

____________ ____________ ____________ ____________ ___ Keeping ___ Surrender

$

Account Number: _________________ Address: _________________ ___ Applicant ___ Joint ___ Spouse Make: Model: Year: Value: VIN:

____________

$

____________

$

____________

$

____________

$

Account Number: _________________ Address: _________________

3. Please indicate the estimated liquidation value of your:

Household Goods Personal Effects

(i.e. Furniture, Appliances) (i.e. Jewellery, Clothing)

Please list any items included in the above totals that you believe to be worth over $500

4. Do you own a safety deposit box?

____ Yes

____ No

If yes, please describe the contents and value:

$ $

Item Value Item Value

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5. Do you own any other assets?

____ Yes

____ No

(i.e. RRSP’s, GIC’s, Mutual Funds, Life Insurance, Savings Bonds, Stocks, RESP’s, Pension)

Type of Asset

(i.e. RRSP) Company Name of Whose Name Is It In? Policy Number Total Value of Policy Contributions Estimated Made In The Last

12 Months 1. ____ Applicant ____ Spouse ____ Joint $ $ 2. ____ Applicant ____ Spouse ____ Joint $ $ 3. ____ Applicant ____ Spouse ____ Joint $ $ 4. ____ Applicant ____ Spouse ____ Joint $ $ 5. ____ Applicant ____ Spouse ____ Joint $ $

Please remember to attach to your application up-to-date statements of all your investments.

6. In the last 12 months, have you Sold, Transferred, Had Repossessed or Voluntarily

Surrendered any assets?

____ Yes

____ No

(Including Real Estate, Vehicles, RRSP’s, Life Insurance, Savings Bonds, Stocks, Shares, RESP’s?)

If Yes, please list below:

Asset Details

(if vehicle, put year/make/model) Received Amount Date Money Received

(dd/mm/yyyy)

What did you do with the money?

1. $

2. $

3. $

4. $

5. $

7. In the last five years, have you

Sold, Transferred, Had Repossessed or Voluntarily Surrendered

any assets?

____ Yes

____ No

If Yes, please list below:

Asset Details

(if property, put address including postal code)

Amount

Received Date Money Received

(dd/mm/yyyy)

What did you do with the money?

1. $

2. $

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Liabilities

Debt Information

List all of your debts, including credit cards, leases, secured debts, personal loans, bank overdraft, personal income taxes, etc.

Creditor Names and Addresses Balance Owing On: Comments

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Debt Information (continued)

Creditor Names and Addresses

Balance Owing On: Comments

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Monthly Income and Expense Statement

Please complete this statement of income and expenses as accurately as possible. If there are amounts that change from one month to the next (i.e. heating costs), enter the number that will demonstrate an average amount over a 12-month

period.

STATEMENT OF INCOME (MONTHLY)

Applicant Spouse Other Household

Salary or Wages – Net ______________ ______________ ______________

Self Employment – Net ______________ ______________ ______________

Social Assistance ______________ ______________ ______________ Employment Insurance ______________ ______________ ______________ Pension Income ______________ ______________ ______________ Worker’s Compensation ______________ ______________ ______________ Rental Income ______________ ______________ ______________ Support Received ______________ ______________ ______________

Child Tax Credit ______________ ______________ ______________

Other Income ______________ ______________ ______________

TOTAL INCOME ______________ ______________ ______________ TOTAL _____________ NON-DISCRETIONARY EXPENSES

Day Care/Child Care ________________ Fines/Penalties ________________

Support Payments ________________ Tax Installments ________________

Employment Expenses ________________ Other ________________

TOTAL _____________

NET INCOME BEFORE ORDINARY EXPENSES _____________

STATEMENT OF EXPENSES (MONTHLY)

Rent/Mortgage ________________ Medical/Dental ________________

Property Taxes ________________ Groceries ________________

Heating ________________ Laundry & Dry Cleaning ________________

Telephone ________________ Grooming & Toiletries ________________

Cable T.V. ________________ Clothing ________________

Electricity ________________ Diapers/Formula ________________

Water ________________ Car Payment ________________

Internet ________________ Vehicle Repairs ________________

Household Maintenance ________________ Gas & Oil ________________

Cigarettes ________________ Public Transportation ________________

Alcohol ________________ Vehicle Insurance ________________

Dining/Lunches out ________________ House Insurance/Contents ________________

Entertainment/Sports ________________ Life Insurance ________________

Gifts/Donations ________________ Secured Payments ________________

Allowances ________________ BDO Payment ________________

Pets ________________ Bank Charges ________________

Other (specify) ______________________________________________________________

TOTAL MONTHLY EXPENSES _____________

SURPLUS OR DEFICIT $ ___________

OFFICE USE ONLY

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General Information Questionnaire

1. Within the last 3 months, have you

a) used credit cards/credit lines for any purchases or cash advances? ____ Yes ____ No If “Yes,” how much was spent? ________________________________

When? (dd/mm/yyyy) ________________________________ From which creditor? ________________________________

b) applied for and received any loans/credit? ____ Yes ____ No If “Yes,” how much? ________________________________

When? (dd/mm/yyyy) ________________________________ From which creditor? ________________________________

2. Within the last 6 months, have you paid for advice regarding your financial situation?

____ Yes ____ No

If “yes,” how much? ________________________________ With whom? ________________________________ How much did you pay? ________________________________

3. Within the last 12 months, have you

a) made payments in excess of minimum payments to, or paid off in full, any creditor?

____ Yes ____ No

If “yes,” when? (mm/yyyy) ________________________________

How much? ________________________________

Which creditor’s? ________________________________

4. Within the last five years, have you

a) made any gifts to relatives or others in excess of $500? ____ Yes ____ No If “yes,” when? (mm/yyyy) ________________________________

How much? ________________________________

To whom? ________________________________

5. Have you made arrangements to continue to pay any creditors? ____ Yes ____ No ____ Mortgage ____ Car Loan ____ Car Lease ____ Other

6. Do you have any credit cards? (Must be given to the trustee) ____ Yes ____ No

7. Are there any writs, judgments, garnishments or wage assignments against you? ____ Yes ____ No

If “yes,” please ensure supporting documentation is provided so this can be stopped.

8. Do you expect to receive any lump sums of money in the next year? (i.e. inheritance)

____ Yes ____ No

9. Has anyone co-signed for any of your debts, or have you co-signed a debt for someone?

____ Yes ____ No

If “yes,” please provide details.

______________________________________________________________________________

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10. Have any of your debts been incurred as a result of gambling or drug/alcohol addiction?

____ Yes ____ No

11. Have you commenced or plan on commencing any legal action against another party?

____ Yes ____ No

12. Please briefly describe the circumstances that caused your financial difficulties.

____ Financial Mismanagement ____ Over-Extension of Credit ____ Marital Breakdown/Personal Problems ____ Health Related Problems

____ Business Failure ____ Unemployment or Adverse Employment Change ____ Other (please describe)

_________________________________________________________________________________________

13. Describe in your own words the reasons for your financial difficulty:

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Additional Questions (Part 1)

Please circle your response and if “Yes,” make detailed notes in the reference section below)

Applicant Co-Applicant 1. Have you ever applied for financial advice or assistance elsewhere? Yes/ No Yes/ No

(e.g. Government agency, lawyer, debt counselor, another trustee)

2. Are you bonded in your present position? Yes/ No Yes/ No 3. Does your spouse own any assets separately from you? Yes/ No Yes/ No 4. Did you sell or transfer anything you purchased on credit card before it

was fully paid off? Yes/ No Yes/ No

5. Have you returned goods to creditors that were purchased on credit

within the last 3 months? Yes/ No Yes/ No

6. Have you borrowed money, obtained a loan or used your credit

card for any purchases for a value of $1000 or more in the last 3 months? Yes/ No Yes/ No 7. Have you purchased any assets on a deferred payment plan such as

“buy now pay later” and the debt is still due? Yes/ No Yes/ No 8. In the last 12 months have you given security for any asset to any creditor? Yes/ No Yes/ No

(e.g. Taken out loan and pledged an asset as collateral in return)

9. Are any of your assets being held by someone else or in trust? Yes/ No Yes/ No 10. Are you in possession of any assets which do not belong to you and have

never belonged to you? Yes/ No Yes/ No

Detailed Notes: (Reference by question number above)

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Additional Questions (Part 2)

(Please circle your response and if “Yes,” make detailed notes in the reference section below)

Applicant Co-Applicant

11. Do you bank with a financial institution to which you owe money? Yes/ No Yes/ No (including overdraft)

Who? ________________________________ (If so, change banks) a) Are any creditors holding post dated cheques or directly debiting

your account? Yes/ No Yes/ No

12. Do you have any debts arising from the following:

a) Fine imposed by the court Yes/ No Yes/ No

b) Bail bond Yes/ No Yes/ No

c) Alimony Yes/ No Yes/ No

d) Maintenance order Yes/ No Yes/ No

e) Fraud Yes/ No Yes/ No

f) Embezzlement Yes/ No Yes/ No

g) Misappropriation Yes/ No Yes/ No

h) Theft of trust funds Yes/ No Yes/ No

i) Property by false pretense Yes/ No Yes/ No j) Student loans (Date you ceased being a student _____________) Yes/ No Yes/ No k) Employment insurance overpayment/CTB overpayment Yes/ No Yes/ No

Detailed Notes: (Reference by question number above)

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Estate No: __________________________

IN THE MATTER OF THE CONSUMER PROPOSAL OF

_______________________________________

ACKNOWLEDGEMENT RE: INCOME TAX ARREARS

I, _____________________________ (the “Debtor”), hereby acknowledge that BDO Canada Limited, has advised me of the following concerning my/our income tax arrears to my/our consumer proposal dated ____________________, 20 ______.

1. The Debtor is personally responsible for filing all outstanding income tax returns.

2. Failure by the Debtor to file all outstanding income tax returns may be deemed by Canada Revenue Agency as the Debtor’s failure to comply with the terms of the consumer proposal and as such, the Debtor may not obtain his/her certificate of full performance regarding his/her consumer proposal. 3. Failure by the Debtor to file all future income tax returns may be deemed by Canada Revenue

Agency as the Debtor’s failure to comply with the terms of the consumer proposal and as such, the Debtor may not obtain his/her certificate of full performance regarding his/her consumer proposal. 4. Any income tax owing from returns filed after the date of the consumer proposal are the

responsibility of the Debtor and do not form part of the consumer proposal.

______________________________ _____________________________

Signature of Debtor Date

______________________________ _____________________________

Signature of Witness Date

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NON-RELEASABLE STUDENT LOANS

I, _____________________________, hereby acknowledge that on ____________________, a licensed Trustee in Bankruptcy for BDO Canada Limited, has advised me that a discharge from bankruptcy or a certificate of completion of a consumer proposal does not release a full-time student from any student loans made under any federal or provincial statue if the student became a bankrupt or filed a consumer proposal before or within seven years after finishing the studies. I was further advised that the court may order that the student loan is discharged, at any time after five years of ceasing to be a student, if the court is satisfied that the bankrupt debtor has acted in good faith with regards to the student loan and the bankrupt debtor will continue to experience financial difficulty to such an extent that the bankrupt debtor will be unable to pay the student loan. I also understand that it is the bankrupt debtor’s responsibility to apply directly to the court and pay all costs relating to the application for a court order regarding the student loan.

______________________________ _____________________________

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DEBTS NOT RELEASED BY ORDER OF BANKRUPTCY OR PROPOSAL

1. Any fine or penalty imposed by the Court. 2. Any debt or liability for alimony.

3. Any debt or liability under a maintenance or affiliation order, or under an agreement for maintenance and support of a spouse or child living apart from the bankrupt.

4. Any debt or liability arising out of fraud, embezzlement, misappropriation or defalcation while acting in a fiduciary capacity. (i.e. Using credit cards when knowing you are insolvent)

5. Any debt or liability for obtaining property by false pretences or fraudulent misrepresentation.

6. Liability for the dividend that a creditor would have been entitled to receive on any provable claim not disclosed to the trustee, unless such creditor had notice or knowledge of the bankruptcy and failed to take reasonable action to prove his claim.

7. Student loans where the bankrupt was a full or part-time student at the date of bankruptcy or was a full or part-time student within seven years of the date of bankruptcy.

8. 407 ETR. The Ministry of Transportation can refuse to renew your sticker or drivers licence, unless this debt is paid in full.

Please note that if the Trustee has to oppose your discharge from bankruptcy for failure to comply with your duties as a bankrupt, there will be an additional fee of $1,000.00 added to your already existing fees. The additional fee must be paid in full prior to you obtaining your discharge. If you comply with the outstanding duties and you are still eligible for an automatic discharge, the Trustee will reduce the opposition fee to $500.00, which must be paid in full prior to your automatic discharge date. If you fail to attend one or both of your counselling sessions in the proper time frame, as per the Bankruptcy and Insolvency Act, you are no longer eligible for an automatic discharge and there will be an additional fee of $1,000.00 added to your fees, which must be paid in full prior to you obtaining your discharge.

There will be a $50.00 charge for every returned cheque; the fee must be paid in full prior to you obtaining your discharge or certificate of full performance.

I, _____________________________, have read and understand the above information.

I hereby certify that the information contained herein is a true, correct and complete statement that fully discloses the state of my assets and liabilities. I also acknowledge receiving a copy of this document on the date below.

I further acknowledge and authorize that the information collected in this document and throughout the insolvency process will be used to fully and properly administer the process as required by the Bankruptcy and Insolvency Act and other Acts associated with the administration.

______________________________ _____________________________

Thank you for completing this application form. Please refer to the first page of this application to locate the office closest to you or call the number found on page one of the application to arrange for a confidential complimentary assessment.

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Income Tax Information

Applicant Spouse

Last Income Tax Return Filed (Year): _________

Status? (Assessed, pending assessment) _________

Have you provided the Trustee with a copy of your last filed income tax return or Notice of Assessment? Yes / No Refund Received $_________ Amount Owing $ _________

Last Income Tax Return Filed (Year): _________

Status? (Assessed, pending assessment) _________

Have you provided the Trustee with a copy of your last filed income tax return or Notice of Assessment? Yes / No Refund Received $_________ Amount Owing $ _________

For more complex tax returns For more complex tax returns

Any commission income? Yes / No Any commission income? Yes / No

Any deductible business expenses? Yes / No Any deductible business expenses? Yes / No

Are all children residing with you? Yes / No Are all children residing with you? Yes / No

Do you claim equivalent to married amount? Yes / No Do you claim equivalent to married amount? Yes / No

Pay alimony/maintenance/child support? Yes / No Pay alimony/maintenance/child support? Yes / No

What amount paid LAST year? $ What amount paid LAST year? $

What amount paid THIS year? $ What amount paid THIS year? $

To whom is it paid? To whom is it paid?

SIN #: SIN #:

Does this include child support? Yes / No Does this include child support? Yes / No

Is the payment income tax deductible? Yes / No Is the payment income tax deductible? Yes / No

Have you provided the Trustee with a copy of your

separation Agreement? Yes / No

Receive alimony/maintenance/child support? Yes / No Receive alimony/maintenance/child support? Yes / No

Amount received: $ Amount received: $

Is the amount subject to income taxes? Yes / No Is the amount subject to income taxes? Yes / No

Deductible moving expenses? Yes / No Deductible moving expenses? Yes / No

If yes, what amount? $ If yes, what amount? $

Child care expenses? Yes / No Child care expenses? Yes / No

If yes, who paid to? If yes, who paid to?

SIN #: SIN #:

Do you claim northern living allowance? Yes / No Do you claim northern living allowance? Yes / No

Have you disposed of any RRSP’s since last January 1st_?

Yes / No

Have you disposed of any RRSP’s since last January 1st_?

Yes / No

_____ Initial

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Any further pertinent income tax information? (Note details below)

Child Activity Receipts Child Activity Receipts

DTC for self/dependants DTC for self/dependants

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