Monthly Income and Expense Statement

The enclosed form will be used to determine and verify your surplus income requirements. The information provided will ultimately determine the length of your proceeding and the total amount to be paid as part of your surplus income requirement. Please remit a form each month for the entire duration of your bankruptcy proceedings. Each report, including the first report, is for the entire calendar month (i.e. 1st – 31st). The first report is for the entire month in which the assignment was made, regardless of whether you may have filed after the 1st of the month.

Verification of income reported is required for “Monthly Income” and “Monthly Non-Discretionary Expenses”.
For “Net employment income”, please provide a pay stub. For all other sources of income, please provide a bank statement. If you are reporting self-employment or business income please fill out the Self-employment /Business Income and Expense reporting form.

For “Monthly Discretionary Expenses” we do NOT require receipts.

When calculating net income, it is important to remember that if a deduction has been made from your net pay it must be a mandatory deduction for the purposes of these forms. If you are voluntarily contributing to expenditures being deducted from your pay, such as RRSPs, TSFAs, group lotto plans, bus passes, gym memberships, etc., then these deductions should be added back to the net income before submitting.

If your spouse is reporting income, then we will need supporting documents to verify their income as well. The calculation for surplus income is based on household income.

    Monthly Income and Expense Statement

    Income and Expense statement for the month of:

    Name:

    Estate Number:

    Joint Applicant (if applicable):


    Please attach proof of income and receipts for "Monthly Income" and "Monthly Non-Discretionary Expenses" For "Net employment income" please provide a pay stub, for "Self-employment income" please provide (Business Income and Expense form) and, for all other sources of income please provide a Bank statement.

    Monthly Income:

    Bankrupt/Debtor Other Member Total
    Net employment income:
    Net pension/annuities:
    Net child support:
    Net spousal support:
    Net employment insurance benefits:
    Net social assistance:
    Self-employment income:
    Other net income:
    Other net income:
    Total:

    Add additional documents (if required)


    MONTHLY NON-DISCRETIONARY EXPENSES

    Bankrupt/Debtor Other Member Total
    Child support payments:
    Spousal support payments:
    Child care:
    Health condition expenses:
    Fines/penalties imposed by the Court:
    Expenses as a condition of employment:
    Debts where stay has been lifted:
    Total:

    Add additional documents (if required)


    MONTHLY DISCRETIONARY EXPENSES (FAMILY UNIT)

    Housing Expenses
    Rent/mortgage/mortgage:
    Property taxes/condo fees:
    Heating/gas/oil:
    Telephone:
    Cable:
    Hydro:
    Water:
    Furniture:
    Other:
    Personal Expenses
    Smoking:
    Alcohol:
    Dining/lunches/restaurants:
    Entertainment/sports:
    Gifts/charitable donations:
    Allowances:
    Other:
    Non-recoverable Medical Expenses
    Prescriptions:
    Dental:
    Other:
    Living Expenses
    Food/grocery:
    Laundry/dry cleaning:
    Grooming/toiletries:
    Clothing:
    Other:
    Transportation Expenses
    Car lease/payments:
    Repair/maintenance/gas:
    Public transportation:
    Other:
    Insurance Expenses
    Vehicle:
    House:
    Furniture/contents:
    Life insurance:
    Other:
    Payments
    To secured creditor:
    Other:
    Total:

    Comments:

    Dated at,

    this

    day-of

    Name of Debtor:

    Name of Joint Debtor:

    Signature of Debtor:By you and your joint debtor (if applicable) typing your name(s) in the signature box, you are signing this document and confirming all of the information herein is complete and accurate.

    Signature of Joint Debtor:By you and your joint debtor (if applicable) typing your name(s) in the signature box, you are signing this document and confirming all of the information herein is complete and accurate.

    If you have any questions regarding this form, please contact our office. After clicking “submit”, the trustee will review and submit your tax filing on your behalf. If they require additional information, the trustee will contact you.