Financial Information Form

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FINANCIAL INFORMATION FORM
Form 20I Ont. Reg. No.: 258/98
This form is to be completed by the debtor and served on the creditor.
This form is not to be filed at the court office. The debtor must provide a completed copy of this form to the judge at the
examination hearing. The debtor must also bring to the hearing documents that support the information given in this
form.
MONTHLY INCOME
MONTHLY EXPENSES
Employer(s)
Rent/Mortgage
$
Employer(s)
Maintenance/Support Payments
$
Net salary
$
Property taxes
$
Commissions
$
Utilities (heat, water & light)
$
Tips and gratuities
$
Phone
$
Employment insurance
$
Cable
$
Pension income
$
House/Tenant insurance
$
Investment income
$
Life insurance
$
Rental income
$
Food
$
Business income
$
Childcare/Babysitting
$
Child tax benefit
$
Motor vehicle (lease or loan)
$
(licence, insurance, fuel & maintenance)
Maintenance (if any)
$
Monthly income of other adult household
Transportation (public)
$
$
members
Other
$
Income assistance
$
INCOME TOTAL $
EXPENSES TOTAL $
Les formules des tribunaux sont affichées en anglais et en français sur le site Visitez ce site pour des
renseignements sur des formats accessibles.
RSCC-20I-E (2014/01)

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