D.Kwasnicky & Associates Inc.
Confidential On-line Financial Summary
If you would like to submit a confidential on-line summary of your financial position, we will contact you to advise you of our preliminary assessment of your options. You are cautioned however that this assessment is solely based on the brief information you have provided and we reserve the right to amend our initial assessment for any additional information which may subsequently be provided.
Income:

Including yourself, how many people reside in your personal residence?

    
        • Over 18 years of age
 
        • Under 18 years of age
 

What is your net monthly income (after taxes) from all sources?

   $

What is your spouse's net monthly income (after taxes) from all sources?

   $
Debts:

Total credit cards and lines of credit in your name?

   $

Total credit cards and lines of credit you have co-signed with your spouse or party?

   $

Bank and other financial loans in your name?

   $

Student loans?

    
        • Within 10 years
   $
        • Over 10 years
  $

CRA debt for income taxes, GST, payroll, etc.

   $

Other debt you have guaranteed?

   $
Assets:

Market value of your personal residence?

   $

Mortgage or other secured loans against your personal residence?

   $

Market value of all vehicles in your name?

   $

Secured loans or leases against the vehicles?

   $

RRSP balance?

   $

RESP or other savings balances?

   $
Other:

Have you been bankrupt before?

  



Has any creditor taken legal action (Judgment or Garnishee)?

  



Please provide your contact details:

Name:

E-mail Address:

Home Phone Number:

Work Phone Number:

Please provide any other information or questions that you may have relating to your financial position or the options available to you.