Schema documentation for Form65.xsd

Monthly Income and Expense Statement of the Bankrupt and the Family Unit and Information (or Amended Information) Concerning the Financial Situation of the Individual Bankrupt
(Section 68 and Subsection 102(3) of the Act and Rule 105(4))

Net Employment Income

Net Pension/Annuities

Net Child support income

Net Spousal support income

Net Employment Insurance Benefits

Net Social Assistance Income

Self employment gross income -  not to be included in Totals

Self Employment net income

Other net income

Details of other net income

(1) Total Monthly Income of bankrupt

(2) Total monthly income of other members of the family unit.

Details if family members refuse to divulge information on Monthly Income

(3) Total monthly income of the entire family unit (1) + (2)

Monthly non-discretionary expenses

Child support payments

Spousal support payments

Child Care expenses

Medical condition expenses

Fines/Penalties imposed by the court

Expenses as a condition of employment

Debts where stay has been lifted

Other Expenses

OtherExpensesDetails

(4) Total monthly non-discretionary
expenses of bankrupt

(5) Total monthly non-discretionary
expenses of other members of the family unit

(6) Total monthly non-discretionary
expenses ((4) + (5))

(7) Available monthly income
of the bankrupt ((1) - (4))

(8) Available monthly income
of the family unit ((3) - (6))

(9) Bankrupt's portion of the available monthly family unit income ((7) / (8) x 100))

Monthly discretionary expenses: (Family unit)

Rent or Mortgage

Property Taxes or Condo fees

Heating, Gas or Oil costs

Telephone

Cable

Hydro

Water

Furniture

Other Housing Expenses

Detailed information related to Other Housing Expenses

Smoking

Alcohol

Dining, Lunches and Restaurants

Entertainment or Sports

Gifts, charitable donations

Allowances

Other Personal Expenses

Detailed information related to Other Personal Expenses

Prescriptions

Dental

Other non-recoverable medical expenses

Detailed information related to Other non-recoverable medical expenses

Food and Groceries

Laundry or Dry Cleaning

GroomingToiletries

Clothing

Other Living Expenses

Detailed information related to Other Living Expenses

Lease or Car Payments

Vehicle Repairs, Maintenance and Gas

Public Transportation

OtherTransportation costs

Detailed information related to Other Transportation costs

Vehicle Insurance

House Insurance

Furniture and Contents Insurance

Life Insurance

Other Insurance

Detailed information related to Other Insurance

Payments to the estate

Payments to secured creditors

Detailed information related to Secured Creditor Payments

Other Payments excluding mortgage and vehicle

Detailed information related to Other Payments

(10) Total monthly discretionary expenses (family unit)

(11) Monthly surplus or (deficit) family unit  (8) - (10)

Payments to the estate as per the agreement.  Mandatory for Summary Administrations

Number of persons in household family unit, including bankrupt

(12) Total amount bankrupt has agreed to pay monthly

(13) Amount bankrupt has agreed to pay monthly to repurchase assets

Details of the plan to Repurchase Assets.  Mandatory if it is an individual debtor and the  RepurchaseAssetsAmount is > 0.00

(14) Residual amount paid into the estate ( (12) - (13))

Payments required by the Directive on Surplus Income. Mandatory for Summary Administrations

(15) Monthly amount required by the Directive on Surplus Income based on percentage established on line (9)

(16) Difference between amounts at lines (14) and (15)

If amount at line (14) is less than amount at line (15),
explain why the required payments are not being made

If the information relates to a material change or an amendment, provide details

SignedAt

Type of Municipality