Win Law
330 Bay Street
Toronto, ON
M5J 0B6
(437)703-7554
Bankruptcy Worksheet
Thank you so much for contacting our law office! Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.
Privacy Policy
All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.
Your Social Security number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.
Social Security numbers are most often used to positively identify parties. Most courts require Social Security numbers of all parties in a case. Some other examples of how this information may be used include:
initial service
in court orders
in required reports or other documents filed with the State
If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!
CLIENT'S INFORMATION
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Default email false
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Addresses
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Primary
Default address false
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Phone numbers
Phone number
Type
Work
Home
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Other
Primary
Add phone number
List any other names you've previously used:
(Including maiden name)
Social Security #:
How long have you lived at your current address?
Mailing Address:
(if different from above)
List all addresses you have had in the last three years, the dates when you lived there:
Marital Status:
Single
Married, living together
Married, separated
Common Law
Divorced
SPOUSE'S INFORMATION
(If applicable)
Full Name:
List any other names you've previously used.
(Including maiden name)
Residential Address:
(If different from client)
How long have you lived at your current address?
Mailing Address:
(if different from above)
List all addresses you have had in the last three years, the dates when you lived there.
Home Number:
Work Number:
Email address:
Social Security Number:
Date of Birth:
MARRIAGE INFORMATION
(If applicable)
Date of Marriage:
Is your spouse filing for bankruptcy jointly with you?
Yes
No
Have you ever been divorced?
Yes
What year and where was the divorce finalized?
Name of Ex-Spouse:
Any assets or personal property divided?
If yes, please describe the property divided and value
Do you pay court ordered child support or alimony?
If yes, who do you pay (name, address, and how much)?
Past due?
If yes, how much?
No
Has your spouse ever been divorced?
Yes
What year and where was the divorce finalized?
Name of Ex-Spouse:
Any assets or personal property divided?
If yes, please describe the property divided and value
Do you pay court ordered child support or alimony?
If yes, who do you pay (name, address, and how much)?
Past due?
If yes, how much?
No
CHILDREN AND/OR DEPENDENTS INFORMATION
(If applicable)
How many children or other dependents do you have?
Child/Dependent #1:
Yes
Name:
Date of Birth:
Relationship to you:
Do they live with you?
No
Child/Dependent #2:
Yes
Name:
Date of Birth:
Relationship to you:
Do they live with you?
No
Child/Dependent #3:
Yes
Name:
Date of Birth:
Relationship to you:
Do they live with you?
No
Child/Dependent #4:
Yes
Name:
Date of Birth:
Relationship to you:
Do they live with you?
No
Child/Dependent #5:
Yes
Name:
Date of Birth:
Relationship to You:
Do they live with you?
No
PRIOR AND/OR PENDING BANKRUPTCY CASES
Have you or your spouse ever filed for bankruptcy in the past?
Yes
Date Filed:
Location Where Filed:
File Number:
If discharged, date of discharge:
If dismissed, date and reason:
No
Are there currently any bankruptcy cases pending against you or your spouse?
Yes
Name of Debtor(s):
Location where bankruptcy was filed:
Relationship to debtor:
No
EMPLOYMENT INFORMATION
Client - EMPLOYMENT INFORMATION
Are you currently employed?
Yes
Occupation:
Employer’s Name and Address:
Length of Employment:
Income to Date this Year:
Approx. Gross Income Last Year:
$________________
Approx. Gross Income Year Prior:
$________________
No
Have you owned a business or self-employed in the last two years?
Yes
Name of Business:
Description of Business:
Location:
Date(s):
No
Spouse - EMPLOYMENT INFORMATION
(If filing together)
Are you currently employed?
Yes
Occupation:
Employer’s Name and Address:
Length of Employment:
Income to Date this Year:
Approx. Gross Income Last Year:
$________________
Approx. Gross Income Year Prior:
$________________
No
Have you owned a business or self-employed in the last two years?
Yes
Name of Business:
Description of Business:
Location:
Date(s):
No
OTHER MONTHLY INCOME
Non-employment source (social security, disability, unemployment, retirement, etc.)
CLIENT - Other Monthly Income:
Yes
Source:
Amount:
$________________
No
SPOUSE - Other Monthly Income:
Yes
Source:
Amount:
$________________
No
MONEY OWED TO YOU
Expected Tax Refund:
Yes
Amount:
$________________
Any Additional Information Regarding Expected Tax Refund:
No
Past Due Alimony:
Yes
Amount:
$________________
Any Additional Information Regarding Past Due Alimony:
No
Past Due Child Support:
Yes
Amount:
$________________
Any Additional Information Regarding Past Due Child Support:
No
Past Due Spousal Support:
Yes
Amount:
$________________
Any Additional Information Regarding Past Due Spousal Support:
No
Property Settlement:
Yes
Amount:
$________________
Any Additional Information Regarding Property Settlement:
No
Divorce Settlement:
Yes
Amount:
$________________
Any Additional Information Regarding Divorce Settlement:
No
Unpaid Wages:
Yes
Amount:
$________________
Any Additional Information Regarding Unpaid Wages:
No
FINANCIAL AND ASSET INFORMATION
Real Property
Do you own real property?
Yes
Who is on the Title?
Location of Property:
(Address)
Value:
$________________
Do you have a Mortgage?
If yes, Mortgage Company Name:
Monthly Mortgage Payment:
$________________
Current Balance:
$________________
No
Other Real Property you Own:
Yes
Who is on the Title?
Location of Property:
(Address)
Value:
Do you have a Mortgage?
If yes, Mortgage Company Name:
Monthly Mortgage Payment:
$________________
Current Balance:
$________________
No
Do you Rent?
Yes
Landlord's Name and Address:
Monthly Payment:
Security Deposit:
Are you past due?
(If yes, how much?)
Do you have a pending eviction day?
(If yes, date of eviction)
No
Vehicles
(Cars/Trucks/RV/Boats/Motorcycles etc.)
Vehicle #1:
Yes
Type:
Make, Model, Year:
Estimated Current Value:
$________________
Are you currently making payments on this vehicle?
(If yes, how much?)
Are you behind on any payments for this vehicle?
(If yes, by how much?)
No
Vehicle #2:
Yes
Type:
Make, Model, Year:
Estimated Current Value:
$________________
Are you currently making payments on this vehicle?
(If yes, how much?)
Are you behind on any payments for this vehicle?
(If yes, by how much?)
No
Vehicle #3:
Yes
Type:
Make, Model, Year:
Estimated Current Value:
$________________
Are you currently making payments on this vehicle?
(If yes, how much?)
Are you behind on any payments for this vehicle?
(If yes, by how much?)
No
Cash Accounts
CHECKING/SAVINGS ACCOUNT, CERTIFICATES OF DEPOSIT, OTHER BANK ACCOUNTS:
Cash on Hand:
Yes
Bank:
Owner:
Market Value:
$________________
No
Account #1:
Yes
Bank:
Type:
(checking, savings, etc.)
Account Number:
Balance:
$________________
Date closed:
(if applicable)
No
Account #2:
Yes
Bank:
Type:
(checking, savings, etc.)
Account Number:
Balance:
$________________
Date closed:
(if applicable)
No
Account #3:
Yes
Bank:
Type:
(checking, savings, etc.)
Account Number:
Balance:
$________________
Date closed:
(if applicable)
No
Stocks or Bonds
Stocks or Bond #1:
Yes
Bank:
Owner:
Market Value:
$________________
No
Stocks or Bond #2:
Yes
Bank:
Owner:
Market Value:
$________________
No
Stocks or Bond #3:
Yes
Bank:
Owner:
Market Value:
$________________
No
Stocks or Bond #4:
Yes
Bank:
Owner:
Market Value:
$________________
No
Life Insurance
Policy #1:
Yes
Type:
Institution Name:
Value:
Who is the Beneficiary?
No
Policy #2:
Yes
Type:
Institution Name:
Value:
Who is the Beneficiary?
No
Policy #3:
Yes
Type:
Institution Name:
Value:
Who is the Beneficiary?
No
Retirement or Pension Accounts
Account #1:
Yes
Type:
(401k, IRA, CDs, etc.)
Institution name:
Value:
$________________
No
Account #2:
Yes
Type:
(401k, IRA, CDs, etc.)
Institution name:
Value:
$________________
No
Account #3:
Yes
Type:
(401k, IRA, CDs, etc.)
Institution name:
Value:
$________________
No
Other Assets/Income Sources:
valuable collections, pending inheritances, cryptocurrency etc.
AVERAGE MONTHLY EXPENSES
Electricity:
$________________
Water:
$________________
Utilities Telephone/ Cell Cable:
$________________
Internet:
$________________
Home Security:
$________________
Food:
$________________
Clothing:
$________________
Laundry and Cleaning:
$________________
Child Care:
$________________
Child Support:
$________________
Alimony/Maintenance:
$________________
Support of Elderly, Ill or Disabled not in Household:
$________________
Health Insurance:
$________________
Educational Expenses:
$________________
Life Insurance:
$________________
Medical and Drug Expenses:
$________________
Car Payments:
$________________
Car Insurance:
$________________
Car Maintenance, Gas and Other Transportation Expenses:
$________________
Religious and Other Charitable Contributions:
$________________
Expenses for Others Claimed on Taxes and will be Claimed Next Year:
$________________
Taxes Not Deducted from Wages for Others Claimed on Taxes and will be Claimed Next Year:
$________________
Dues:
(Union, professional, social, school expenses or otherwise not deducted from wages; 401K or retirement deductions from payroll)
Storage Facility:
$________________
Expenses for Operating your Business:
$________________
Other Expense #1 (Description + $___________):
(e.g., cigarettes, diapers, security system, school, birthday and holiday gifts, pets)
Other Expense #2 (Description + $___________):
(e.g., cigarettes, diapers, security system, school, birthday and holiday gifts, pets)
Other Expense #3 (Description + $___________):
(e.g., cigarettes, diapers, security system, school, birthday and holiday gifts, pets)
COSIGNERS AND DEBTS INCURRED FOR OTHER PEOPLE
Were there any cosigners for you on any of the debts you have listed in these forms?
Yes
If yes, give the cosigner’s name and address, and which debts were cosigned:
No
Have you ever been the cosigner on someone else’s loan or debt which hasn't been paid off?
Yes
If yes, Creditor’s Name and Address:
Name and Address of the Person you Cosigned for:
Date of Debt:
Amount Owing:
No
Other Debts/Loans:
credit card debt, money owed to family members, etc.
OTHER IMPORTANT INFORMATION
Any additional information you think would be helpful:
E-ACKNOWLEDGEMENT AND ACCEPTANCE:
I affirm and acknowledge that all of the above information is true and accurate to the best of my knowledge.
Thank you
Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We will contact you as soon as possible with any updates.
Please click the
SUBMIT
button below when you have finished answering all questions.