Kelowna / Kamloops
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Contact Information:

Name:
 
Contact #:
 
Email Address:
 
Where do you live?
   

Please complete only what applies to you:

Number of people in your family?
 
What is your net monthly income (after taxes) from all income sources?
$ .00
 
What is your spouse's or common-law spouse's net monthly income from all sources?
$ .00
 

Debts

   
Your unsecured debt?
 $ .00
(Charge cards, overdraft or loans)
  
Spouse's unsecured debt?
$ .00
(Charge cards, overdraft or loans)
  
Bank loans and finance company loan in your name only?
$ .00
 
Bank loans and finance company loans in your spouse's name only?
$ .00
 
Revenue Canada - CRA for personal income taxes?
$ .00
 
Revenue Canada - CRA for spouse's income taxes?
$ .00
 

Assets

Market Value of property or principal residence including mobile home?
$ .00
 
Amount of all mortgages and loans secured by this asset?
$ .00
 
Amount in an RRSP?
$ .00
 
 
Amount in your spouse's RRSP?
$ .00
 
Were you bankrupt before?
YES NO
 
Has a creditor taken legal action against you?
YES NO
 

Additional Information

If you wish to add more information or ask questions, please indicate in the following box.

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