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Information Form

This form provides your Trustee with the information needed to prepare the legal documents for either a bankruptcy or a consumer proposal. The information you provide helps ensure your file is accurate. The form is submitted through a secure link, and your privacy is protected.

First Name*(Required)

Middle Name(s)

Surname*(Required)

Maiden Name(s) (if applicable)

S.I.N*(Required)

Birth Date*(Required)

Preferred Phone Number*(Required)

Address*(Required)

Street Address* Address Line 2 Town/City* Province* Postal Code*

Date moved to current address*(Required)

Date moved to B.C.*(Required)

Marital Status*(Required)

Marital Status – Last date of change (if single, use your birthday)*(Required)

Spouse / Common-Law Partner Section

Last Name*(Required)

Last

First Name*(Required)

First

Middle Name

Middle

Occupation

Employer

Birth Date*(Required)

S.I.N

Cell Phone*(Required)

Email*(Required)

Separated / Divorced Section

Last Name

Last

First Name

First

Middle Name

Middle

Occupation

Employer

Birth Date*(Required)

S.I.N

Cell Phone*(Required)

Email*(Required)

Dependent Information

Do you have any dependents who rely on you for financial support?*(Required)

First Name*(Required)

First

Middle Name

Middle

Last Name*(Required)

Last

Birth Date*(Required)

+ Add Dependent

Yes

First Name*(Required)

First

Middle Name

Middle

Last Name*(Required)

Last

Birth Date*(Required)

+ Add Dependent

Yes

First Name*(Required)

First

Middle Name

Middle

Last Name*(Required)

Last

Birth Date*(Required)

+ Add Dependent

Yes

First Name*(Required)

First

Middle Name

Middle

Last Name*(Required)

Last

Birth Date*(Required)

+ Add Dependent

Yes

First Name*(Required)

First

Middle Name

Middle

Last Name*(Required)

Last

Birth Date*(Required)

Employment Information (Past 2 Years)

Employment Status*(Required)

Current Employer Name*(Required)

Job Title*(Required)

Start Date*(Required)

Less than 2 years of employment

Employer Address*(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Most recent employer*(Required)

Most Recent Employer Address*(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job title*(Required)

End date of employment*(Required)

Additional Employment

Employer Name*(Required)

Job Title*(Required)

Start Date*(Required)

End Date*(Required)

Employer Address*(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add Another Employment?

Yes

Additional Employment

Employer Name*(Required)

Job Title*(Required)

Start Date*(Required)

End Date*(Required)

Employer Address*(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add Another Employment?

Yes

Additional Employment

Employer Name*(Required)

Job Title*(Required)

Start Date*(Required)

End Date*(Required)

Employer Address*(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Self Employment Information

Have you operated a business in the last five (5) years?(Required)

Business #1

Business #2

Business #3

Name

Business #1 Name

Business #2 Name

Business #3 Name

Proprietorship, Partnership or Limited Company

Business #1 – Proprietorship, Partnership or Limited Company

Business #2 – Proprietorship, Partnership or Limited Company

Business #3 – Proprietorship, Partnership or Limited Company

If Limited Company, are you an officer or director?

Business #1 – Are you an officer or director?

Business #2 – Are you an officer or director?

Business #3 – Are you an officer or director?

Period of Operation (start date and end date if no longer operating)

Business #1 – Period of Operation

Business #2 – Period of Operation

Business #3 – Period of Operation

Current status of business (e.g., actively operating, winding down, closed, etc.)

Business #1 – Current status of the business

Business #2 – Current status of the business

Business #3 – Current status of the business

Full address where the business records are held

Business #1 – Where are books and records of Company?

Business #2 – Where are books and records of Company?

Business #3 – Where are books and records of Company?

Full Address of Business

Business #1 – Address of Business

Business #2 – Address of Business

Business #3 – Address of Business

Nature of business

Business #1 – Nature of business

Business #2 – Nature of business

Business #3 – Nature of business

Percentage ownership of the business

Business #1 – Percentage ownership of the business

Please enter a number from 1 to 100.

Business #2 – Percentage ownership of the business

Please enter a number from 1 to 100.

Business #3 – Percentage ownership of the business

Please enter a number from 1 to 100.

Maximum number of employees in the past twelve (12) months

Business #1 – Maximum number of employees in the past twelve (12) months

Business #2 – Maximum number of employees in the past twelve (12) months

Business #3 – Maximum number of employees in the past twelve (12) months

Business number (eg. GST/Payroll)

Business #1 – Business number (eg. GST/Payroll)

Business #2 – Business number (eg. GST/Payroll)

Business #3 – Business number (eg. GST/Payroll)

Date of last return filed

Business #1 – Date of last return filed

Business #2 – Date of last return filed

Business #3 – Date of last return filed

Previous Insolvencies

Have you filed a Bankruptcy or Consumer Proposal before?*(Required)

Yes

Name of Trustee

Location

Reason for Financial Difficulties

Please briefly describe the circumstances that have led to your current financial difficulties.

Assets

Approximate Value

Description

Checking/Savings

Bank account – Approximate Value

Bank account – Description

RRSP

RRSP – Approximate Value

RRSP – Description

RESP

RESP – Approximate Value

RESP – Description

TFSA

TFSA – Approximate Value

TFSA – Description

Stocks/Shares

Stocks/Shares – Approximate Value

Stocks/Shares – Description

Crypto Currency

Crypto Currency – Approximate Value

Crypto Currency – Description

Insurance Policies

Insurance Policies – Approximate Value

Insurance Policies – Description

Vehicle(s)

Vehicle – Approximate Value

Vehicle – Description

Recreational Vehicle(s)

Recreational Vehicle – Approximate Value

Recreational Vehicle – Description

Real Estate (Home/Land)

Real estate (home/land) – Approximate Value

Real estate (home/land) – Description

Household Goods

Household goods – Approximate Value

Household goods – Description

Household Furniture

Household Furniture – Approximate Value

Household Furniture – Description

Jewelry

Jewelry – Approximate Value

Jewelry – Description

Clothing and Medical Aids

Clothing and Medical Aids – Approximate Value

Clothing and Medical Aids – Description

Tools of Trade

Tools of trade – Approximate Value

Tools of trade – Description

Other Investments

Other investments – Approximate Value

Other investments – Description

Other Assets

Other assets – Approximate Value

Other assets – Description

Please provide any relevant details regarding the assets you have listed.

Debts

Please list all of your known creditors

Creditor Name & Account #

Balance

Individual or Joint

Credit Card(s)

Credit card – Account #

Credit card – Balance

Credit card – Individual or Joint

Personal Loan(s)

Personal Loan – Account #

Personal Loan – Balance

Personal Loan – Individual or Joint

Line(s) of Credit

Line of credit – Account #

Line of credit – Balance

Line of credit – Individual or Joint

ICBC

ICBC – Account #

ICBC – Balance

ICBC – Individual or Joint

Spousal/Child support

Spousal/Child support – Account #

Spousal/Child support – Balance

Spousal/Child support – Individual or Joint

Payday Loan

Payday loan – Account #

Payday loan – Balance

Payday loan – Individual or Joint

Auto Loan/Lease

Auto loan/lease – Account #

Auto loan/lease – Balance

Auto loan/lease – Individual or Joint

Mortgage

Mortgage – Account #

Mortgage – Balance

Mortgage – Individual or Joint

Student Loan

Student loan – Account #

Student loan – Balance

Student loan – Individual or Joint

Tax Debt

Tax debt – Account #

Tax debt – Balance

Tax debt – Individual or Joint

Utilities/Other

Utilities/Other – Account #

Utilities/Other – Balance

Utilities/Other – Individual or Joint

Please provide any relevant details regarding the debts you have listed.

General Information

In the past 12 months, have you made any payments to creditors that were more than your regular required payments, either in Canada or elsewhere?*(Required)

Please provide the date, creditor, and amount paid.*(Required)

In the past 12 months, has any creditor seized your property or garnished your income, either in Canada or elsewhere?*(Required)

Please provide the date, creditor, property or income affected, and amount involved.*(Required)

In the next 12 months, do you expect to receive any money or property that is not part of your regular income? Examples include inheritances, gifts, damages, settlements, etc.*(Required)

Please explain the source or reason and provide the estimated value.*(Required)

In the past five years, have you sold, gifted, or otherwise transferred (in whole or in part) any assets or property, either in Canada or elsewhere? (Examples include TFSAs, RRSPs, and RESPs.)*(Required)

Please describe the asset, its location, the amount received, and how the proceeds were used.*(Required)

In the past 5 years, have you made any gifts over $1,000 to family members or others, either in Canada or elsewhere?*(Required)

Please state who received the gift, the amount, and the reason for the gift.*(Required)

Are your tax returns up to date?*(Required)

Are you paying or receiving child or spousal support?*(Required)

Please provide further details.*(Required)

Do you have student loan debt?*(Required)

Please provide your last date of studies*(Required)

Did your debt arise from EI overpayments or fraud allegations?*(Required)

Please provide details*(Required)

Monthly Income & Expenses

Income (Net)

Employment Income

Spouses Employment Income

Pensions / Annuities

Child Support Received

Child Tax Benefits

Spousal Support Received

Employment Insurance Benefits

Social Assistance Benefits

Self Employment Income

Non-Discretionary Expenses

Spousal Support

Child Support

Child Care Expenses

Medical Expenses

Discretionary Expenses

Rent/Mortgage

Property Tax / Strata Fees

Telephone / Cellular

Cable / Internet

Gas / Heating / Water

Smoking

Alcohol

Dining / Lunches / Restaurants

Entertainment / Sports

Other

Other Payments – Secured Creditor

Food / Grocery

Laundry / Dry-cleaning

Grooming / Toiletries

Clothing

Car Lease / Payments

Repairs / Maintenance / Gas

Public Transportation

Insurance – Vehicle

Insurance – House / Contents

Insurance – Disability / Life

Documents Upload

Drop files here or

Accepted file types: jpg, png, pdf, docx, xlsx, csv, Max. file size: 128 MB.

Please upload any documents relevant to your application to help us process your file as efficiently as possible. Examples include credit card or loan statements showing current balances, recent pay stubs, daycare receipts, vehicle registration, and RRSP statements.

Declaration / Signature Section

Declaration / Signature(Required)

By signing below and submitting this form, I confirm that the information provided is accurate and fully discloses all relevant details regarding my assets, liabilities, and financial affairs to the best of my knowledge.

Date*(Required)

First Name*(Required)

Middle Name(s)

Surname*(Required)

Maiden Name(s) (if applicable)

S.I.N*(Required)

Birth Date*(Required)

Preferred Phone Number*(Required)

Address*(Required)

Street Address* Address Line 2 Town/City* Province* Postal Code*

Date moved to current address*(Required)

Date moved to B.C.*(Required)

Marital Status*(Required)

Marital Status – Last date of change (if single, use your birthday)*(Required)

Spouse / Common-Law Partner Section

Last Name*(Required)

Last

First Name*(Required)

First

Middle Name

Middle

Occupation

Employer

Birth Date*(Required)

S.I.N

Cell Phone*(Required)

Email*(Required)

Separated / Divorced Section

Last Name

Last

First Name

First

Middle Name

Middle

Occupation

Employer

Birth Date*(Required)

S.I.N

Cell Phone*(Required)

Email*(Required)

Dependent Information

Do you have any dependents who rely on you for financial support?*(Required)

First Name*(Required)

First

Middle Name

Middle

Last Name*(Required)

Last

Birth Date*(Required)

+ Add Dependent

Yes

First Name*(Required)

First

Middle Name

Middle

Last Name*(Required)

Last

Birth Date*(Required)

+ Add Dependent

Yes

First Name*(Required)

First

Middle Name

Middle

Last Name*(Required)

Last

Birth Date*(Required)

+ Add Dependent

Yes

First Name*(Required)

First

Middle Name

Middle

Last Name*(Required)

Last

Birth Date*(Required)

+ Add Dependent

Yes

First Name*(Required)

First

Middle Name

Middle

Last Name*(Required)

Last

Birth Date*(Required)

Employment Information (Past 2 Years)

Employment Status*(Required)

Current Employer Name*(Required)

Job Title*(Required)

Start Date*(Required)

Less than 2 years of employment

Employer Address*(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Most recent employer*(Required)

Most Recent Employer Address*(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Job title*(Required)

End date of employment*(Required)

Additional Employment

Employer Name*(Required)

Job Title*(Required)

Start Date*(Required)

End Date*(Required)

Employer Address*(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add Another Employment?

Yes

Additional Employment

Employer Name*(Required)

Job Title*(Required)

Start Date*(Required)

End Date*(Required)

Employer Address*(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Add Another Employment?

Yes

Additional Employment

Employer Name*(Required)

Job Title*(Required)

Start Date*(Required)

End Date*(Required)

Employer Address*(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Self Employment Information

Have you operated a business in the last five (5) years?(Required)

Business #1

Business #1 Name

Business #1 – Proprietorship, Partnership or Limited Company

Business #1 – Are you an officer or director?

Business #1 – Period of Operation

Business #1 – Current status of the business

Business #1 – Where are books and records of Company?

Business #1 – Address of Business

Business #1 – Nature of business

Business #1 – Percentage ownership of the business

Please enter a number from 1 to 100.

Business #1 – Maximum number of employees in the past twelve (12) months

Business #1 – Business number (eg. GST/Payroll)

Business #1 – Date of last return filed

Business #2

Business #2 Name

Business #2 – Proprietorship, Partnership or Limited Company

Business #2 – Are you an officer or director?

Business #2 – Period of Operation

Business #2 – Current status of the business

Business #2 – Where are books and records of Company?

Business #2 – Address of Business

Business #2 – Nature of business

Business #2 – Percentage ownership of the business

Please enter a number from 1 to 100.

Business #2 – Maximum number of employees in the past twelve (12) months

Business #2 – Business number (eg. GST/Payroll)

Business #2 – Date of last return filed

Business #3

Business #3 Name

Business #3 – Proprietorship, Partnership or Limited Company

Business #3 – Are you an officer or director?

Business #3 – Period of Operation

Business #3 – Current status of the business

Business #3 – Where are books and records of Company?

Business #3 – Address of Business

Business #3 – Nature of business

Business #3 – Percentage ownership of the business

Please enter a number from 1 to 100.

Business #3 – Maximum number of employees in the past twelve (12) months

Business #3 – Business number (eg. GST/Payroll)

Business #3 – Date of last return filed

Previous Insolvencies

Have you filed a Bankruptcy or Consumer Proposal before?*(Required)

Yes

Name of Trustee

Location

Reason for Financial Difficulties

Please briefly describe the circumstances that have led to your current financial difficulties.

Assets

Please complete the fields that apply to you from the list of assets below.

Checking/Savings – Approximate Value

Checking/Savings – Description

RRSP – Approximate Value

RRSP – Description

RESP – Approximate Value

RESP – Description

TFSA – Approximate Value

TFSA – Description

Stocks/Shares – Approximate Value

Stocks/Shares – Description

Crypto Currency – Approximate Value

Crypto Currency – Description

Insurance Policies – Approximate Value

Insurance Policies – Description

Vehicle(s) – Approximate Value

Vehicle(s) – Description

Recreational Vehicle(s) – Approximate Value

Recreational Vehicle(s) – Description

Real Estate (Home/Land) – Approximate Value

Real Estate (Home/Land) – Description

Household Goods – Approximate Value

Household Goods – Description

Household Furniture – Approximate Value

Household Furniture – Description

Jewelry – Approximate Value

Jewelry – Description

Clothing and Medical Aids – Approximate Value

Clothing and Medical Aids – Description

Tools of Trade – Approximate Value

Tools of Trade – Description

Other Investments – Approximate Value

Other Investments – Description

Other Assets – Approximate Value

Other Assets – Description

Please provide any relevant details regarding the assets you have listed.

Debts

Please list all of your known creditors

Credit Card(s) – Creditor Name & Account #

Credit Card(s) – Balance

Credit Card(s) – Individual or Joint

Personal Loan(s) – Creditor Name & Account #

Personal Loan(s) – Balance

Personal Loan(s) – Individual or Joint

Line(s) of Credit – Creditor Name & Account #

Line(s) of Credit – Balance

Line(s) of Credit – Individual or Joint

ICBC – Creditor Name & Account #

ICBC – Balance

ICBC – Individual or Joint

Spousal/Child Support – Creditor Name & Account #

Spousal/Child Support – Balance

Spousal/Child Support – Individual or Joint

Payday Loan – Creditor Name & Account #

Payday Loan – Balance

Payday Loan – Individual or Joint

Auto Loan/Lease – Creditor Name & Account #

Auto Loan/Lease – Balance

Auto Loan/Lease – Individual or Joint

Mortgage – Creditor Name & Account #

Mortgage – Balance

Mortgage – Individual or Joint

Student Loan – Creditor Name & Account #

Student Loan – Balance

Student Loan – Individual or Joint

Tax Debt – Creditor Name & Account #

Tax Debt – Balance

Tax Debt – Individual or Joint

Utilities/Other – Creditor Name & Account #