Personal Income Expense Report
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EI Benefits, Pensions, Old Age Security (attach bank statement) Child Tax Benefit Universal Child Benefit (attach bank statement or government notice) Other income (describe) TOTAL INCOME FOR MONTH Bankrupt Spouse other family members + = EXPENSES NON-DISCRETIONARY EXPENSES (attach copies of receipts or proof of payments) Child or spousal support payments Medical/dental expenses/prescription drugs Child care (describe) Other non-discretionary expenses (eg: fines from before the date of bankruptcy) DISCRETIONARY EXPENSES (do NOT attach receipts) Housing: Rent or mortgage payment Property taxes/condo fees Natural Gas Telephone, Cable, Internet Electricity Personal: Tobacco Alcohol Charitable donations/tithing/gifts Entertainment/sports Living: Food/groceries Dining out/coffee or lunch at work Grooming / toiletries/ laundry / dry cleaning Clothing Transportation: Car lease/payments Gas/repairs/maintenance Public transportation/parking Other Insurance: Vehicle House / Furniture / Contents Life / Medical/ Disability Miscellaneous: To secured creditors (other than mortgage and vehicle) Other (describe) Payments to Trustee as agreed TOTAL EXPENSES FOR MONTH INCOME LESS EXPENSES = SAVINGS The above is an accurate statement of my income and expenses as witnessed by my signature..
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