Personal Bankruptcy&Consumer Credit Counseling - Edmonton Alberta Canada

	Assessment

	Single or Not Married Married or Common-Law

	Forms

	Personal Financial Information Monthly Statement of Income and Expenses

Free Assessment

Single or Not Married
Please select the office you will be dealing with:


	Edmonton #300 10612 124 Street NW	Phone: 780-451-4357

	Calgary #200 550 11 Avenue SW	Phone: 403-232-6220

	Kelowna #260 1855 Kirschner Road	Phone: 250-979-4357

For log-in purposes only, type your e-mail address for a quick reply. All information supplied will be held in the strict confidence. We will be communicating with you by return email so please make sure that you can accept a message from info@billmcculloch.com.


	Your E-Mail Address

To assess your situation, enter the dollar amount or answer yes or no to the following. Leave a blank if the answer is not applicable to your situation.


	1. How many dependents live with you?


	2. What is your monthly take home pay?	$


3. What are you spending on:

	a) Alimony and maintenance	$
	b) Child care	$
	c) Health related expenses	$
	d) Court fines and penalties	$
	e) Employment related expenses	$


	4. Have you been bankrupt before?		Yes No


	5. When?


	6. Did you get discharged?		Yes No


	7. What was date of discharge?


8. What do you owe on the following:

	a) Credit cards?	$
	b) Unsecured bank loans or lines of credit?	$
	c) Student loans?	$
	d) Alimony and maintenance?	$
	e) Court fines?	$
	f) Other debts (excluding Canada Revenue Agency)?	$


	9. Do you have any co-signors on unpaid bills and loans?		Yes No


	10. Do you live in a home that you own?		Yes No


	11. If you own your own residence, is there more than $40,000 total equity in the home ($9,000 per registered owner in B.C.) after property taxes, and mortgages are considered?		Yes No


	12. Do you own a vehicle that is worth more than $5,000 after the debt against the vehicle is paid off?		Yes No


	13. Is the furniture in your residence worth more than $4,000 at liquidation value?		Yes No


	14. What value of RRSPs do you own?	$


	15. Did your RRSPs come from a rollover of a pension plan?		Yes No


	16. Is the RRSP being held by a life insurance company?		Yes No


	17. What value of RSPs do you own?	$


	18. What value of RESPs do you own?	$


	19. What value of other investments do you own?	$


	20. What is the value of luxury items that you own (consider big screen televisions, pianos, computers, video cameras, boats, recreational vehicles) after deducting the balance owed on any loans secured by these assets?	$


	21. What is the value of any other assets that you own that have not been specifically mentioned above after deducting the balance owed on any loans secured by these assets?	$


	22. If you are a tradesperson or a professional, what is the value of any tools that you may have after deducting the balance owed on any loans secured by these assets?	$


	23. What is the amount of funds that you have on deposit with banks after considering the repayment of any debt that you owe to the banks where your funds are located?	$


	24. What amount is owed to Canada Revenue Agency (CRA)for personal income taxes?	$


	25. Did you carry on a business during the last five years?		Yes No


	26. Was your business incorporated?		Yes No


	27. What was the amount of money that your business owed to CRA for unremitted employee deductions and GST?	$


	28. What was the amount of corporate debt that you guaranteed personally which will not be paid by the liquidation of the assets in the corporation?	$


	29. If your business was not incorporated what is the amount of debt that it owes (this debt should not be included with amounts of debt requested earlier)?	$


	30. Has anyone co-signed or guaranteed a loan on your behalf?		Yes No


	31. Have you liquidated assets for more than $1,000 and paid the funds to your creditors?		Yes No


	32. Have you made payments to your creditors for more than $1,000 in the last year which were not in the normal course of business?		Yes No


	33. Has anyone seized an asset from you?		Yes No


	34. When the value of the seized asset is taken into consideration, what do you think will remain owing to the seizing creditor (this amount should not have been included elsewhere)?	$


	35. What amount from real estate sales during the last five years have you used to pay creditors and not invested in replacement property?	$


	36. What amount of gifts did you make over $500 during the last five years?	$


	37. If you decide to take bankruptcy protection, do you plan to make payments to any of your unsecured creditors?		Yes No


	38. Approximately how much do you now pay to creditors who have not secured themselves against your assets per month?	$


	39. Are creditors threatening legal action against you?		Yes No


	40. What amount of money is being garnisheed from your monthly income?	$


	41. Are you expecting an inheritance in the near future?		Yes No


	42. Are you suing anyone who you believe will be forced to pay you some type of monetary settlement?		Yes No

43. How did you find out about our website?

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You can print out this form and mail to the nearest BMA office as indicated above. We will respond to you by print email. Please make sure that your email will accept a message from us. info@billmcculloch.com.


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