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10Form 13.1: Financial Statement (Property and
(page 6)
Court File Number
Support Claims)
PART 4(c): BANK ACCOUNTS, SAVINGS, SECURITIES AND PENSIONS
Show the items owned on the dates in each of the columns below by category, for example, cash, accounts in financial institutions, pensions,
registered retirement or other savings plans, deposit receipts, any other savings, bonds, warrants, options, notes and other securities. Give your
best estimate of the market value of the securities if the items were to be sold on the open market.
Amount/Estimated Market Value
INSTITUTION
Account
(including location)/
Category
on date of
on valuation
DESCRIPTION
number
(including issuer and date)
today
marriage
date
$
$
$
17. TOTAL VALUE OF ACCOUNTS, SAVINGS, SECURITIES AND PENSIONS $
$
PART 4(d): LIFE AND DISABILITY INSURANCE
List all policies in existence on the dates in each of the columns below.
Cash Surrender Value
Company, Type & Policy No.
Owner
Beneficiary
Face Amount
on date of
on valuation
today
marriage
date
$
$
$
18. TOTAL CASH SURRENDER VALUE OF INSURANCE POLICIES $
$
PART 4(e): BUSINESS INTERESTS
Show any interest in an unincorporated business owned on the dates in each of the columns below. An interest in an incorporated business may
be shown here or under “BANK ACCOUNTS, SAVINGS, SECURITIES, AND PENSIONS” in Part 4(c). Give your best estimate of the market
value of your interest.
Estimated Market Value of YOUR Interest
Name of Firm or Company
Interest
on date of
on valuation
today
marriage
date
$
$
$
19. TOTAL VALUE OF BUSINESS INTERESTS $
$
Page 6 of 10
FLR-13.1-E (2015/01)
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