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8Form 13: Financial Statement (Support Claims)
(page 3)
Court file number
14. Other Benefits
Provide details of any non-cash benefits that your employer provides to you or are paid for by your business such as medical insurance
coverage, the use of a company car, or room and board.
Item
Details
Yearly Market Value
$
$
$
$
PART 2: EXPENSES
Expense
Monthly Amount
Expense
Monthly Amount
Automatic Deductions
Utilities, continued
CPP contributions
$
Telephone
$
EI premiums
$
Cell phone
$
Income taxes
$
Cable
$
Employee pension contributions
$
Internet
$
Union dues
$
SUBTOTAL
$
SUBTOTAL
$
Household Expenses
Housing
Groceries
$
Rent or mortgage
$
Household supplies
$
Property taxes
$
Meals outside the home
$
Property insurance
$
Pet care
$
Condominium fees
$
Laundry and Dry Cleaning
$
Repairs and maintenance
$
SUBTOTAL
$
SUBTOTAL
$
Childcare Costs
Utilities
Daycare expense
$
Water
$
Babysitting costs
$
Heat
$
SUBTOTAL
$
$
Electricity
FLR-13-E (2015/01)
Page 3 of 8
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