Financial Statement (Property And Support Claims) Page 2
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9Form 13.1:
Financial Statement (Property and
(page 2)
Court File Number
Support Claims)
NOTE: When you show monthly income and expenses, give the current actual amount if you know it or can find out. To get a monthly
figure you must multiply any weekly income by 4.33 or divide any yearly income by 12.
PART 1: INCOME
for the 12 months from
to
(date)
(date)
Include all income and other money that you get from all sources, whether taxable or not. Show the gross amount here and show your
deductions in Part 3.
CATEGORY
Monthly
CATEGORY
Monthly
1.
9.
Pay, wages, salary, including overtime
Rent, board received
(before deductions)
10. Canada Child Tax Benefit
2.
Bonuses, fees, commissions
11. Support payments actually received
3.
Social assistance
12. Income received by children
4.
Employment insurance
13. G.S.T. refund
Workers’ compensation
5.
14. Payments from trust funds
6.
Pensions
15. Gifts received
7.
Dividends
16. Other
(Specify. If necessary, attach an
extra sheet.)
8.
Interest
17.
INCOME FROM ALL SOURCES
PART 2: OTHER BENEFITS
Show your non-cash benefits — such as the use of a company car, a club membership or room and board that your employer or
someone else provides for you or benefits that are charged through or written off by your business.
Monthly Market
ITEM
DETAILS
Value
18. TOTAL
19. GROSS MONTHLY INCOME AND BENEFITS
$
(Add [17] plus [18].)
PART 3: AUTOMATIC DEDUCTIONS FROM INCOME
for the 12 months from
to
(date)
(date)
TYPE OF EXPENSE
Monthly
TYPE OF EXPENSE
Monthly
20. Income tax deducted from pay
25. Group insurance
21. Canada Pension Plan
26. Other
(Specify. If necessary, attach an
extra sheet.)
22. Other pension plans
23. Employment insurance
24. Union or association dues
27.
TOTAL AUTOMATIC DEDUCTIONS
28.
NET MONTHLY INCOME
$
(Do the subtraction: [19] minus [27].)
FLR 13.1 (Rev. 04/03)
Page 2 of 9
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