Debt Relief Worksheet Page 5
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10Debt Relief Worksheet
Page 5
ASSETS
Description/Location
Estimated
Exempt
Secured
(Serial #, License #, Account #)
Value
(Y/N)
(Y/N)
Cash On Hand/In Bank
Stocks, Bonds, Investments (provide current
statements)
RRSP’S, RRIF’S, GIC’S, RESP’S (provide
current statements)
Pension Plans (provide current statements)
Surrender Value of Insurance Policies (PROVIDE
POLICY DOCUMENTATION)
Household Furnishings
Personal Effect
Real Estate (in Canada or elsewhere) PLEASE
COMPLETE AND RETURN SCHEDULE “A”
FOR EACH PROPERTY OWNED
House
Land / Cottage / Time Share
Rental/Business Properties
Motorized Vehicles PLEASE COMPLETE AND
RETURN SCHEDULE “B” FOR EACH
VEHICLE OWNED
Cars
Truck(s)/Van(s)
Recreational Vehicle(s)
Mobile Home
Tools of Trade
Other Assets of Value
Farming Assets (Use Separate Page)
FOR WHICH YEAR WAS YOUR LAST TAX RETURN FILED?
Refund Received
$________________
(You will be required to bring tax filings up to date)
Amount Owing
$________________
Refund to Come
$________________
ALL EMPLOYERS FOR THE LAST YEAR
Employer’s Name
Address
Date Started
Date Ended
IF YOU HAVE BORROWED MONEY OR PLEDGED ANY OF THESE ASSETS AS SECURITY, SHOW DETAILS BELOW
Creditor’s Name & Address
Asset Pledged
Amount of Loan
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Parent category: Business