Choose your statement:
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STATEMENT OF INCOME & EXPENSE FOR THE MONTH OF |
Instructions
Key data to the applicable disabled areas. The calculations are locked, and will automatically provide the totals.
General information
| Name: | |
| Business: |
Income
| Revenue - Cash Received (attach invoices and bank stmts) |
$
|
| GST & PST collected ( n/a if not applicable) |
$
|
Total Gross Sales Collected in Month
Expenses (just business Expenses)
| Accounting and legal fees |
$
|
| Bank Charges and interest |
$
|
| Insurance - liability, WCB, |
$
|
| Licenses and Dues |
$
|
| Materials, Product Costs, Purchases |
$
|
Vechicle Summary
|
Vechicle Fuel
Total
Business %
Amount
|
|
Vehicle Insurance
Total
Business %
Amount
|
|
Vehicle Repairs and Manintance
Total
Business %
Amount
|
| Supplies and Small Tools (<$100) |
$
|
| Office & Postage |
$
|
| Cell phone |
$
|
| Meals - Business only |
$
|
Office in Home Summary
|
Office - Rent
Total
Business %
Amount
|
|
Office - Utilities
Total
Business %
Amount
|
|
Office - Internet
Total
Business %
Amount
|
| Subcontract Wages - Cannot be Spouse |
$
|
| Wage Expense, including remittances to CRA |
$
|
| Other: |
$
|
| Other: |
$
|
| Other: |
$
|
| Other: |
$
|
Total Expenses
Taxes PAID
| GST remitted to CRA: attach receipts |
$
|
| PST remitted : attach receipts |
$
|
| Personal Income Tax Contribution: PAID to CRA |
$
|
TOTAL Taxes Remitted
Totals
| Total Gross Sales Collected in Month |
$
|
| Total Expenses |
$
|
| Subtotal: Revenue less Expenses |
$
|
| TOTAL Taxes Remitted |
$
|
Self employed after tax, Net Income
STATEMENT OF INCOME & EXPENSE FOR THE MONTH OF |
Instructions
Key data to the applicable disabled areas. The calculations are locked, and will automatically provide the totals.
General information
| Name: | |
| Number of family members: | |
| Are All your family members disclosing their income? | |
| Superintendent's Standard | |
| Adjusted Standard |
Income (Net After Normal Deductions) Per Month
Bankrupt 1's Income
| Net Employment |
$
|
| Pension/Annuities |
$
|
| Child Support |
$
|
| Spousal Support |
$
|
| Employment Insurance |
$
|
| Social Assistance/ WCB |
$
|
| Net Self-Employment |
$
|
| Other |
$
|
|
Subtotal
|
Bankrupt 2's Income
| Net Employment |
$
|
| Pension/Annuities |
$
|
| Child Support |
$
|
| Spousal Support |
$
|
| Employment Insurance |
$
|
| Social Assistance/ WCB |
$
|
| Net Self-Employment |
$
|
| Other |
$
|
|
Subtotal
|
Spouse's Income (non-bankrupt spouse only)
| Net Employment |
$
|
| Pension/Annuities |
$
|
| Child Support |
$
|
| Spousal Support |
$
|
| Employment Insurance |
$
|
| Social Assistance/ WCB |
$
|
| Net Self-Employment |
$
|
| Other |
$
|
|
Subtotal
|
Child's Income
| Child Tax Benefit |
$
|
| UCCB |
$
|
| Other |
$
|
|
Subtotal
|
|
Total Income of Bankrupt Members ($)
|
|
Total Income of Non-Bankrupt Members ($)
|
Total Family Income ($)
Non-Discretionary Expenses (For the Bankrupt and the Bankrupt's Children Only)
| Child Support Payments |
$
|
| Child Care |
$
|
| Health (Prescriptions/ Medical Supplies) |
$
|
| Health (MSP) |
$
|
| Employment Related Expenses |
$
|
| Other |
$
|
|
Subtotal
|
Surplus Income Calculation
|
Adjusted Net Income ($)
|
|
Bankrupt's % of Income
|
|
Surplus Income ($)
|
|
1/2 Surplus Income ($)
|
|
Bankrupt's Payable ($)
|
Monthly Discretionary Expenses
| Rent/Mortgage |
$
|
| Property Taxes/Strata Fees |
$
|
| Water |
$
|
| Heating - Gas/Oil |
$
|
| Hydro |
$
|
| Telephone |
$
|
| Cell Phone |
$
|
| Cable |
$
|
| Internet |
$
|
| Dental |
$
|
| Dining/Lunches/Restaurant |
$
|
| Food/Grocery |
$
|
| Health Supplements |
$
|
| Grooming/Toiletries |
$
|
| Laundry/Dry cleaning |
$
|
| Clothing |
$
|
| Furniture |
$
|
| Public Transportation |
$
|
| Car payment / lease |
$
|
| Repairs/Maintenance/Gas |
$
|
| Parking |
$
|
| Vehicle Insurance |
$
|
| House Insurance |
$
|
| Contents Insurance |
$
|
| Life Insurance |
$
|
| Allowances |
$
|
| Aesthetic Services |
$
|
| Alcohol |
$
|
| Smoking |
$
|
| Entertainment/Sports |
$
|
| Memberships |
$
|
| Gifts |
$
|
| Charitable Donations |
$
|
| Paid to Trustee |
$
|
Subtotal Discretionary Expenses ($)
Other
Other
$
Other
$
Other
$
Other
$
Other
$
Other
$
Subtotal
STATEMENT OF INCOME & EXPENSE FOR THE MONTH OF September |
2017 |
Instructions
Key data to the applicable disabled areas. The calculations are locked, and will automatically provide the totals.
If there is Surplus Income Payable owing, on average over the first 9 months of the bankruptcy, the bankruptcy will last for 21 months. If there is no Surplus Income Payable owing on average after 9 months than the bankruptcy will be complete after 9 months.
The above is an accurate statement of my income and expenses as witnessed by my signature. The Trustee has made me aware of my obligations to contribute a portion of my surplus income to the estate for the general benefit of creditors until I am discharged from bankruptcy.
Summary
| Total of Bankrupt(s) Income |
$
|
| Total Family Income |
$
|
| Total Non-Discretionary Expenses |
$
|
| Subtotal Discretionary Expenses |
$
|
NET Adjusted Family Income vs. Expenses
Surplus Income Calculation
| Adjusted Net Income |
$
|
| Bankrupt's % of Income | |
| Surplus Income |
$
|
| 1/2 Surplus Income |
$
|
Required Surplus Income Payable
Date and Signature
| Dated | |
| Please supply any updated contact information: |
Attach payslips and non-discretionary expenses
Uploaded Files:
Email
The above is an accurate statement of my income and expenses as witnessed by submitting this form in electronic format. The Trustee has made me aware of my obligations to contribute a portion of my surplus income to the estate for the general benefit of creditors until I am discharged from bankruptcy.
I agree to the terms
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