Form 65—Monthly Income and Expense Statement of the Bankrupt/Debtor and the Family Unit and Information (or Amended Information) Concerning the Financial Situation of the Individual Bankrupt (New, coming into force in 2024)

Important notice

All estates filed on July 15, 2024 and after must use the version of Form 65, Monthly Income and Expense Statement of the Bankrupt/Debtor and the Family Unit and Information (or Amended Information) Concerning the Financial Situation of the Individual Bankrupt, issued through Directive No. 8R21, The Bankruptcy and Insolvency Act Forms. All estates filed prior to July 15, 2024 must continue using the pre-2024 version of this Form.

For persons to which the 2009 amendments apply

(Section 68 and subsection 102(3) of the Act; Rule 105(4))

 

 (Title Form 1)

  Original         Amended

 

Information concerning the monthly income and expense statement of the Bankrupt/Debtor and the Family Unit, the financial situation of the Bankrupt/Debtor and the Bankrupt’s obligation to make payments to the estate of the Bankrupt pursuant to section 68 of the Act are as follows:

 

Monthly Income
No.	Type of income1	Details	Income exempt from the operation of the Act	Bankrupt/Debtor	Other members of the Family Unit □ One or more members of the Family Unit refused or neglected to divulge income (Provide required details in comments)	Total
			□	$		$
				Total Net Monthly Income: $ (1)	Total Net Monthly Income: $(2)	Total Net Monthly Income of the Family Unit ((1)+(2)):  $ (3)

¹ Choose one option for each line: Net employment income; Net pension/annuities; Net child support; Net spousal support; Net employment insurance benefits; Net other insurance benefits; Net social assistance; Gross self-employment income (Exclude from totals); Net self-employment income; Net government benefits (Provide details); Net other benefits (Provide details); Other net income (Provide details).

Monthly Non-Discretionary Payments
No.	Type of payment2	Details	Bankrupt/Debtor	Other members of the Family Unit	Total
			$		$
			Total Monthly Non-Discretionary Payments: $ (4)	Total Monthly Non-Discretionary Payments: $(5)	Total Monthly Non-Discretionary Payments of the Family Unit ((4)+(5)): $ (6)

² Choose one option for each line: Child support payments; Spousal support payments; Child care; Medical condition expenses; Fines/penalties imposed by the Court; Expenses as a condition of employment; Debts where stay has been lifted; Other payments (Provide details).

Available monthly income of the Bankrupt/Debtor ((1) - (4)):		$(7)
Available monthly income of the Family Unit ((3) - (6)):		$(8)
Bankrupt’s/Debtor’s portion of the available monthly income of the Family Unit ((7) / (8) X 100):		% (9)

Monthly Expenses of the Family Unit
No.	Type of expenses	Details	Monthly Total
Housing3
			$
Personal4
			$
Living5
			$
Transportation6
			$
Insurance7
			$
Payments8
			$

³ Choose one option for each line: Rent/mortgage/hypothec; Property taxes/condo fees; Heating/gas/oil; Telephone/cell phone; Cable/streaming services; Internet; Electricity; Water; Furniture; Other.

⁴ Choose one option for each line: Tobacco/vaping/cannabis; Alcohol; Meals/restaurants; Entertainment/sports; Gifts/charitable donations; Allowances; Other.

⁵ Choose one option for each line: Food/grocery; Laundry/dry cleaning; Grooming/toiletries; Clothing; Other.

⁶ Choose one option for each line: Vehicle lease/payments; Vehicle insurance/registration; Repair/ maintenance/gas; Public transportation; Other.

⁷ Choose one option for each line: Home; Furniture/contents; Life; Other.

⁸ Choose one option for each line: To the estate; To secured creditor (Other than mortgage and vehicle); To provider of financial advice (Other than the Licensed Insolvency Trustee); Other.

 

Total monthly expenses of the Family Unit:	$(10)
Monthly surplus or (deficit) of the Family Unit ((8) - (10)):	$(11)

Information (or Amended Information) Concerning the Financial Situation of the Individual Bankrupt/Debtor

Payments to the estate as per agreement

Total amount Bankrupt/Debtor has agreed to pay monthly:	$(12)
Amount Bankrupt/Debtor has agreed to pay to repurchase assets (Provide details): ____________________________________________________________	$(13)
Residual amount paid into the estate ((12) - (13)):	$(14)

 

Payments required by Directive No. 11R2, Surplus Income

Number of persons in the Family Unit, including the Bankrupt/Debtor:
Monthly amount required to be paid to the estate by the Bankrupt/Debtor as surplus income obligation:	$(15)
Difference between the residual amount paid into the estate and the amount of the surplus income obligation ((14) - (15)):	$(16)
Provide details if the required payments are not being made:

Remarks

Provide details on the amended information in the Monthly Income and Expense Statement of the Bankrupt/Debtor and the Family Unit and Information (or Amended Information) Concerning the Financial Situation of the Individual Bankrupt:

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

Other applicable comments:

Dated at , this  day of .

 

 

                                           

Licensed Insolvency Trustee   

 

 Bankrupt/Debtor

 

Notes:  In a joint assignment, only one form is required and each debtor’s monthly income and non-discretionary expenses have to be explained in detail.

If a copy of this Form is sent electronically by means such as email, the name and contact information of the sender, prescribed in Form 1.1, must be added at the end of the document.