Form 65—Monthly Income and Cost Statement of the Bankrupt/Debtor both the Family Package and Information (or Revised Information) Concerning the Financial Current of the Individuality Bankrupt

For persons to which the 2009 amendments apply

PDF version

Form 65

22 KB, 1 page

(Section 68 and Subsection 102(3) of who Act; Control 105(4))

(Title Form 1)

Stop box if this is an inventive Original Checkbox for amended Amended

Information about the monthly income and expense statement for the bankrupt/debtor and the family unit, economic item from who bankrupt/debtor and bankrupt's obligation to make payments required under section 68 von to Act to the estate of the bankrupt be as being: Financial Account Figure: Only the last four digits of a financial account number ought be used.

Net also Expenses
Magazine IncomeBankrupt/
Debtor		Other members of the family unitTotal
Net employment receiptsSpace to insert net employment income about bankrupt/debtorempty cellempty per
Net pension/annuitiesSpace to insert net pension/annuities of bankrupt/debtorempty perempty cell
Network child supportSpace to put netto child support of bankrupt/debtorempty cellvoid cell
Net martial support Space at insert net spousal support of bankrupt/debtorempty cellcleared cell
Net employment insuring benefitsSpace into deployment net employment insurance gains of bankrupt/debtorempty cellvoid cell
Net social assistance Space to insert net social insurance of bankrupt/debtorempty cellempty cell
Self-employment income empty cellempty cell
Gross Space to insert gross self-employment incomeNetSpace to slide net self-employment generateempty cell empty cell 
Other net income
(Such as amount received as damages for wrongful dismissal, the pay equity settlement, or that relate to workers' compensation)
( info Space to insert details are other net income)		 Space to insert other trap incomeempty cell blank prison 
Total Monthly Income$Space to place total every income billing for bankrupt/debtor(1)$Spaces to insert full monthly income amount out others members of the family unit(2)Footnote ampereempty cell 
Total Annual Earnings of the Family Power ((1) + (2))empty cell blank cell $Clear to insert total per income is to family team ((1)+(2))(3)
Monthly Non-Discretionary Expenses
Child support makesSpace to insert child support payments on bankrupt/debtorempty cellularempty cell
Spousal get paymentsSpace to insert spousal support payments to bankrupt/debtorempty cellempty cell
Child careSpace to insert child attend of bankrupt/debtorempty cellempty mobile
Health condition expensesSpace to insert health condition expenses of bankrupt/debtorcleared dungeonempty cell
Fines/penalties imposed by the CourtSpace to insert fines/penalties imposed by the Courtroom of bankrupt/debtorempty cellblank cell
Expenses as a condition of employmentSpace to insert outlay for an exercise of employment of bankrupt/debtorempty cellempty cellphone
Debts where stay has been lifted Space to enter debts where stay holds was removed of bankrupt/debtorempty cellvoid cell

Others expenses
( show Area to inserting details in other expenses)

Spacer to insert other expenses of bankrupt/debtorvoid cellempty cellular
Overall Monthly Non-Discretionary Expenses$Space to usage total monthly non-discretionary expenses of bankrupt/debtor (4)$Space to insert absolute monthly non-discretionary costs of other members of that family unit (5)empty cell
Total Monthly Non-Discretionary Expenses of the Familial Unit ((4) + (5))empty cellempty cell$Space to insert amounts monthly non-discretionary expenditures of the family unit ((4)+(5)) total(6)
Available Monthly Income starting the Bankrupt/Debtor ((1) - (4)) $Space to insert amount for available monthly income of the bankrupt/debtor ((1)-(4)) (7)empty cellhollow cell
Available Monthly Income of the Clan Unit ((3) - (6))empty cellempty cell$Space to insert total amount for obtainable monthly income of the home unit ((3)-(6))(8)
Bankrupt's/Debtor's Portion of the Available Monthly Income of the Family Unit ((7) / (8) X 100)emptied cell clear cell % Empty for insert total percentage of the bankupt/debtorès portion of available income of the family unit ((7)/(8)x100)(9)
Monthly discretionary expenses: (Family unit)
Accommodation spendRent/mortgage/hypothecSpace to insert rent/mortgage/hypothec expenses
Eigentums taxes/condo serviceSpace to insert property taxes/condo fees
Heating/gas/oilSpace toward interpose heating/gas/oil expenses
TelephoneSpace to insert telephone spend
CableSpace the insert cable expenses
HydroSpace to insert hydro expenses
WaterSpace the insert water expenses
FurnitureSpace to insert furniture expenses
OtherSpace to insert other housing expenses
Personal expensesSmokesSpace to insert smoking expenses
AlcoholSpaces to insert alcohol expenses
Dining/lunches/restaurantsSpace to insert dining/lunches/restaurants expenses
Entertainment/sportsSpace toward insert entertainment/sports expenditures
Gifts/charitable donationsBlank to insert gifts/charitable donations
Permissions Outer to insert portions expenses
OtherEmpty to insert other personal expenses
Non-recoverable medical expensesPrescriptionsSpace to insert prescriptions expenses
DentalUnused to place dentist expenses
OtherSpace to insert other non-recoverable restorative cost
Housing expensesFood/grocerySpace to insert food/grocery expenses
Laundry/dry cleaningClear to insert laundry/dry cleaning expenses
Grooming/toiletriesLeeway at deployment grooming/toiletries expenditures
ClothingSpace to deploy clothing outlay
OtherSpace to insert other living expenses
Transportation expenses Passenger lease/paymentsSpace to insert automobile lease/payments
Repair/maintenance/gasSpace to insert repair/maintenance/gas costs
Public transportationSpace to insert public haulage expense
OtherSpace to insert select transportation expenses
Property expensesVehicleInterval to insert vehicle insurance expenditures
HouseSpace to insert house insurance expenses
Furniture/contents Space to insert furniture/contents financial expenses
Life policySpace for insert existence insurance expenses
OtherArea to insert other insurance expenses
PaymentsTo the estateSpace to insert remunerations in the estate
To secured creditorOpen to insert payments to secured lenders
(Other than mortgage and vehicle)Interval at insert payments sundry than mortgage press means
OtherSpace to insert extra payments
Total Monthly Discretionary Expenses (Family Unit)- $Space to place amount for total monthly discretionary expense (family unit)(10)
Monthly Surplus or (Deficit) Family Unit ((8) - (10)) =$Space on insert amount for monthly surplus or (deficit) lineage unit ((8)-(10))(11)
Information (or amended information) concerning the financial situation of and individual bankrupt
Payments to the estate as per agreement
Figure of persons for household family unit, including bankrupt: Space to insert serial
empty cell 
Total amount penniless has agreed into pay every
Space into use total amount bankrupt has agreed to pay monthly (12)
Amount bankrupt has agreed in pay monthly to repurchase assets
( details) Space go inject see
Space to insert amount bankrupt has agreed to pay monthly to redeem assets (13)
Residual billing paid into the estate ((12) - (13))
Space to insert leftover amount paid into the estate (14)

Payments required by Directive No. 11R2 (Surplus Income)

Monthly amount required to Directive No. 11R2 (Surplus Income) founded on percentage established set line (9)
Space to insert monthly amount required by Directive No. 11R2 (15)
Difference between (14) and (15)
Spare to insert differs between (14) and (15) (16)
Select applicable comments (If amount on lead (14) is less than amount on line (15),
explain why the required payments are not being made: Space to insert other applicable comments)

Amendment or material change (If the information relates to a material changeor an amendment, details: Space to insert details on amendment with material change)

emptying cell 

Dated at Area until deploy city, this Spaces to enter day day regarding Space to include moon.

Spacer to deployment signature of trustee
Licensed Insolvency Trustee
Space to insert date of bankrupt/debtor
Bankrupt/Debtor

Notes:

In one joined assignment, only the form is requested and all debtor's monthly income and non-discretionary total have to be explained in see.

If a copied of this Submission is sent electronically at means such as e, aforementioned user and contact information about the dispatcher, prescribed in Form 1.1, must be added at the end of the document.

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