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Statement of Affairs (Non-Business Bankruptcy/Proposal) (Subsections 49(2) and 158(d) of the Act / Subsections 50(2) and 62(1) and Paragraph 66.13(2)(d) of the Act
Type of assets Description E dollar value Exempt property Secured amount/liens Net Value
1. Cash on hand  Yes    No
2. Furniture  Yes    No
3. Personal effects  Yes    No
4. policies  Yes    No
5. Securities  Yes    No
6. Real property House  Yes    No
Cottage  Yes    No
Land  Yes    No
7. Motor vehicle Automobile  Yes    No
Motorcycle  Yes    No
Snowmobile  Yes    No
Other  Yes    No
8. Rec equipment  Yes    No
9. tax refund  Yes    No
10. Other assets  Yes    No
Total
LIABILITIES

Liabilities type code (LTC)

1 Real property or immovable mortgage or hypothec

2 Bank loans (except real property mortgage)

3 Finance company loans

4 Credit cards - bank/trust company issuers

5 Credit cards - other issuers

6 Taxes - federal/provincial/municipal

7 Student loans

8 Loans from individuals

9 Other

Creditor Address, including postal code Account No. Amount of debt Enter LTC
Unsecured secured Preferred
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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