Schema documentation for Form65bis.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))

Details if family members refuse to divulge information on Monthly
Income

Information concerning the monthly income and expense statement of the
bankrupt/debtor and the family unit, financial situation of the bankrupt/debtor and bankrupt's obligation to make
payments required under section 68 of the Act to the estate of the bankrupt

Type of income. Pick from list.

Detail of income if required

Income exempt from the operation of the Act

Income for bankrupt/debtor

Total income (1) + (2)

(1) Total monthly income for bankrupt/debtor

(2) Total monthly income for other family members

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

Monthly non-discretionary expenses

Type of expense. Pick from list.

Detail of expense if required

Expense for bankrupt/debtor

Total expense (1) + (2)

(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 Expenses

Type of expense. Pick from list.

Detail of expense if required

Expense for the family unit

(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

(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))

Number of persons in household family unit, including bankrupt

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

The amended information relates to a material change in the financial situation of the individual Bankrupt/Debtor.

Other applicable comments:

SignedAt

Type of Municipality

Name of Municipality

Province where the Municipality is located

Date of document signing

Trustee

BankruptName

Person's Given Names

Person's Family Name

Person's occupation

Provide any additional information related to the form.

Claimant Given Names

Claimant Family Name

Type of Municipality where Claimant resides

Name of the Municipality

Province for the Municipality

Name of person making sworn declaration

Declarant Given Names

Declarant Family or Company Name

Municipality Type where Signing was done

Name of the Municipality

Province for the Municipality

Signing Date

Name of commissioner for oaths or official receiver

Province in which the commissioner is licensed or the bankruptcy district of the official receiver

Name of person making sworn declaration

Declarant Given Names

Declarant Family or Company Name

Municipality Type where Signing was done

Name of the Municipality

Province for the Municipality