Form I - Financial Information (Page 2 of 9) in pdf

Form I - Financial Information Page 2

I am the beneficiary under a trust.

(YYYY/MM/DD)

I have attached the trust settlement agreement and the trust’s three most recent financial statements

are attached.

I am a partner in a partnership.

(YYYY/MM/DD)

I have attached confirmation of my income including my draw from, and any capital in, the partnership

for its three most recent taxation years.

I control a corporation.

(YYYY/MM/DD)

I have attached the financial statements of the corporation and its subsidiaries for the three most

recent taxation years, and statement showing a breakdown of all salaries, wages, management fees,

or other payments or benefits paid to, or on behalf of, persons or corporations with which the

corporation, and every related corporation, does not deal at arm’s length, for the three most recent

taxation year.

I have made an assignment in bankruptcy and have attached documents relating to my bankruptcy.

Other (specify) :

Additional page(s) attached

I am unable to provide supporting documentation for any or all of the above income sources. The

explanation for this is:

Additional page(s) attached

All or part of my income is not subject to income tax (portion exempt, and reason, if required):

Additional page(s) attached

3. Proof of my previous income

I have attached the following information:

a complete copy of my filed income tax return for the last three years; or

an explanation (on a separate page) detailing why all documents have not been included.

First previous tax year (

)

I have attached a complete copy of my filed income tax return and a copy of my notice of assessment (and

re-assessment, if appropriate).

I have NOT attached a complete copy of my filed income tax return and a copy of my notice of

assessment (and re-assessment if appropriate). Please provide an explanation why:

Additional page(s) attached

Form I

Financial Statement

Page 2

Form I - Financial Information Page 2