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 Trustee BankruptName Provide any additional information related to the form.