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Family Law - Separation Information Required For Your Family Law Case

Date:

About Me
Name (full legal name): I am (check all that apply):

Husband Wife Statutory Common Law Partner Biological/Adoptive Parent of Child of this Relationship Step-Parent of Child of this Relationship
Age: Place: Social insurance number:

Address: Date of birth: Surname at birth: Phone Numbers: Home: Cell: Work: Fax: Email: Drivers License number:

Preferred; Confidential) ( Preferred; Confidential) ( Preferred; Confidential) ( Confidential) ( Confidential)


(

Identity verification (provide copy to lawyer)


Identity (ie. photo) verification document: Document number:

Passport

Drivers License
Date/Place of Issue:

Citizenship Card

Marital Status

Married, contemplating separation Married, already separated Common Law, contemplating separation Common Law, already separated Never married or common law, but had child(ren) together Divorced

Page 2 of 19 Other Party


Name (full legal name): Other Party is (check all that apply):

Husband Wife Statutory Common Law Partner Biological/Adoptive Parent of Child of this Relationship Step-Parent of Child of this Relationship
Age: Place: Social insurance number:

Address: Date of birth: Surname at birth: Phone Numbers: Home: Cell: Work: Fax: Email: Represented by: Lawyers Name: Firm: Address: Phone Numbers: Home: Cell: Work: Fax: Email: Drivers License number:

Details of Marriage (if applicable)


Date of marriage: If cohabited before marriage, date of cohabitation: Wife: Name at time of marriage: Marital status at time of marriage: If previously married, name of former spouse: Date of divorce from former spouse: Place of divorce from former spouse: Location:

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Husband: Name at time of marriage: Marital status at time of marriage: If previously married, name of former spouse: Date of divorce from former spouse: Place of divorce from former spouse:

Details of Common Law Relationship (if applicable ie. not married but living together)
Date cohabitation began: Location:

Details of Relationship (if applicable - ie. not married and not living together common law)
Date relationship began: Date relationship ended: Nature of the relationship:

Separation Details
Date of separation: Place of separation:

Still living in same residence (albeit separated)


Legal Proceedings
Current on-going court application/action?

Never lived together

No Yes (provide details, including court, location, file number, date commenced, status, orders,
endorsements) Prior court applications/actions?

No Yes (provide details, including court, location, file number, date commenced, status, orders,
endorsements)

Page 4 of 19 Domestic Contracts


Existing Domestic Contract?

KeyTerms:

Marriage Contract/Agreement Cohabitation Contract/Agreement Separation Agreement: Interim/Temporary Final

Children of the Marriage/Relationship


Child 1 Name (full legal name): Biological/adopted child of: Date of birth:

both parties mine only (ie. Other Party acted as parent) Other Party (I acted as parent)
School: Child's address: Special Needs (medical, educational, mental health, developmental): Childs lawyer / CAS worker (if applicable): With whom is the child currently living primarily? Grade level: Since:

Me Other Party Third Party

Time currently spent with parent with whom child does NOT live primarily): I am seeking and need further information about:

Sole Custody to me (ie. sole decision-making and child living primarily with me), with the
following access schedule for Other Party:

Sole Custody to Other Party (ie. sole decision-making and child living primarily with Other
Party), with the following access schedule for me:

Shared Custody (ie. shared decision-making), with child living primarily with me and with
Other Party on the following schedule:

Shared Custody (ie. shared decision-making), with child living primarily with Other Party and
with me on the following schedule:

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Child 2 Name (full legal name): Biological/adopted child of: Date of birth:

both parties mine only (ie. Other Party acted as parent) Other Party (I acted as parent)
School: Child's address: Special Needs (medical, educational, mental health, developmental): Childs lawyer / CAS worker (if applicable): With whom is the child currently living primarily? Grade level: Since:

Me Other Party Third Party

Time currently spent with parent with whom child does NOT live primarily): I am seeking and need further information about:

Sole Custody to me (ie. sole decision-making and child living primarily with me), with the
following access schedule for Other Party:

Sole Custody to Other Party (ie. sole decision-making and child living primarily with Other
Party), with the following access schedule for me:

Shared Custody (ie. shared decision-making), with child living primarily with me and with
Other Party on the following schedule:

Shared Custody (ie. shared decision-making), with child living primarily with Other Party and
with me on the following schedule: Child 3 Name (full legal name): Biological/adopted child of: Date of birth:

both parties mine only (ie. Other Party acted as parent) Other Party (I acted as parent)
School: Child's address: Special Needs (medical, educational, mental health, developmental): Childs lawyer / CAS worker (if applicable): With whom is the child currently living primarily? Grade level: Since:

Me Other Party Third Party

Time currently spent with parent with whom child does NOT live primarily): I am seeking and need further information about:

Sole Custody to me (ie. sole decision-making and child living primarily with me), with the
following access schedule for Other Party:

Sole Custody to Other Party (ie. sole decision-making and child living primarily with Other
Party), with the following access schedule for me:

Page 6 of 19

Shared Custody (ie. shared decision-making), with child living primarily with me and with
Other Party on the following schedule:

Shared Custody (ie. shared decision-making), with child living primarily with Other Party and
with me on the following schedule: Child 4 Name (full legal name): Biological/adopted child of: Date of birth:

both parties mine only (ie. Other Party acted as parent) Other Party (I acted as parent)
School: Child's address: Special Needs (medical, educational, mental health, developmental): Childs lawyer / CAS worker (if applicable): With whom is the child currently living primarily? Grade level: Since:

Me Other Party Third Party

Time currently spent with parent with whom child does NOT live primarily): I am seeking and need further information about:

Sole Custody to me (ie. sole decision-making and child living primarily with me), with the
following access schedule for Other Party:

Sole Custody to Other Party (ie. sole decision-making and child living primarily with Other
Party), with the following access schedule for me:

Shared Custody (ie. shared decision-making), with child living primarily with me and with
Other Party on the following schedule:

Shared Custody (ie. shared decision-making), with child living primarily with Other Party and
with me on the following schedule:

Existing Support Arrangements


Spousal Support Is spousal support being paid? Amount:

No Yes

By whom: Since:

How often:

Payments intended to be tax deductible to payor, and taxable to recipient? Paid Pursuant to:

No Yes

Oral agreement Written agreement, dated Court order, dated Voluntarily (no agreement/court order)

Page 7 of 19

Child Support Is child support being paid? Amount: Paid Pursuant to:

No Yes

By whom: Since:

How often:

Oral agreement Written agreement, dated Court order, dated Voluntarily (no agreement/court order)

My Employment Information

Employed Self-employed Unemployed Shareholder/Director/Officer of Corporation


If Employed: Current Employer: Position: Employer address: Employer telephone number: Date employment began: Annual gross income: Pension Plan:

No Yes

Details:

Name/Contact Info of Plan Administrator: Employee Benefits:

If Self-Employed:

No Life Insurance?: No Disability Insurance?: No Other Taxable Benefits?: No


Extended Health?:

Yes Yes Yes Yes

Details (incl. Policy #): Details (incl. Policy #): Details (incl. Policy #): Details:

Name of Business: Services Provided: Office address: Office telephone number: Date self-employment began: Annual gross income (before expenses deducted): Annual net income (after expenses deducted):

Page 8 of 19
If Unemployed (include details of prior employment as well): Date unemployment began:

No Yes Receiving Social Assistance? No Yes Receiving Workers Compensation? No Yes


Receiving Employment Insurance? If Shareholder/Director/Officer of Corporation: Name of Corporation: Position: Corporation address: Corporation telephone number: Date of Incorporation: Compensation Details: Prior Employment history:

Amount: Amount: Amount:

Other Partys Employment Information

Employed Self-employed Unemployed Shareholder/Director/Officer of Corporation


If Employed: Current Employer: Position: Employer address: Employer telephone number: Date employment began: Annual gross income: Pension Plan:

No Yes

Details:

Name/Contact Info of Plan Administrator: Employee Benefits:

No Life Insurance?: No Disability Insurance?: No Other Taxable Benefits?: No


Extended Health?:

Yes Yes Yes Yes

Details (incl. Policy #): Details (incl. Policy #): Details (incl. Policy #): Details:

Page 9 of 19
If Self-Employed: Name of Business: Services Provided: Business address: Business telephone number: Date self-employment began: Annual gross income (before expenses deducted): Annual net income (after expenses deducted): If Unemployed (include details of prior employment as well): Date unemployment began:

No Yes Receiving Social Assistance? No Yes Receiving Workers Compensation? No Yes


Receiving Employment Insurance? If Shareholder/Director/Officer of Corporation: Name of Corporation: Position: Corporation address: Corporation telephone number: Date of Incorporation: Compensation Details: Prior Employment history:

Amount: Amount: Amount:

Matrimonial Home/Family Residence


Home 1 (Primary Residence prior to separation) Address: Ownership:

Sole, by

Joint, with: No Yes, by:


Currently: Currently: Discharge / Renewal date:

Was this home brought into the marriage?

If yes, Fair Market Value at date of marriage: Value of mortgage at date of marriage: Fair Market Value at date of separation: Value of Mortgage at date of separation: Mortgagor: Address of Mortgagor:

Page 10 of 19
Home 2 (Secondary Residence prior to separation eg. cottage, chalet, Florida condominium etc.) Address: Ownership:

Sole, by

Joint, with: No Yes, by:


Currently: Currently: Discharge / Renewal date:

Was this home brought into the marriage?

If yes, Fair Market Value at date of marriage: Value of mortgage at date of marriage: Fair Market Value at date of separation: Value of Mortgage at date of separation: Mortgagor: Address of Mortgagor:

My Assets/Liabilities
[Provide the fair market value (FMV) of all assets you owned (or debts you owed) at the date of marriage (dom), the date of separation (dos) and currently. Include all assets you owned (or debts you owed) at the date of marriage, even if you no longer own/owe them.] Land (list real property not already included in Matrimonial Home/Family Residence Section above): Address: Ownership: FMV: At dom: Value of Mortgage: At dom: Mortgagor: Address of Mortgagor: Contents of home (household goods, furniture etc.): FMV: At dom: Vehicles (cars, boats, etc.): (1) Make/model/year: FMV: At dom: (2) Make/model/year: FMV: At dom: Works of art: Details: FMV: At dom: Jewellery: Details: FMV: At dom: At dos: Currently: At dos: Currently: At dos: Currently: At dos: Currently: At dos: Currently:

Sole

Joint, with
At dos: At dos: Currently: Currently: Discharge / Renewal date:

Page 11 of 19
Electronics: Details: FMV: At dom: At dos: Currently: Other special items (eg. musical instruments, valuable animals, valuable sports equipment, tools, special collections, etc.): Details: FMV: At dom: Bank accounts: (1) Details (incl. institution, address): At dos: Currently:

Savings Chequing Ownership: Sole Joint, with


Type of account: Balance: At dom: (2) Details (incl. institution, address): At dos:

Account Number:

Currently:

Savings Chequing Ownership: Sole Joint, with


Type of account: Balance: At dom: (3) Details (incl. institution, address): Type of account: At dos:

Account Number:

Currently:

Savings Chequing Ownership: Sole Joint, with


At dos:

Account Number:

Balance: At dom: RRSPs/RRIFs: Details (incl. institution, address): Account Number: FMV: At dom: At dos:

Currently:

Beneficiary: Currently:

Securities (including stocks, term deposits, GICs, stock options): (1) Details (incl. institution, address): Account Number: FMV: At dom: (2) Details (incl. institution, address): Account Number: FMV: At dom: (3) Details (incl. institution, address): Account Number: FMV: At dom: At dos: Type of Security: Currently: At dos: Type of Security: Currently: At dos: Type of Security: Currently:

Page 12 of 19
Pensions/RPPs: Details (incl. institution, address, acct. #): FMV: At dom: Life insurance: (1) Type: At dos: Currently:

Term (ie. no cash surrender value) Whole Life (ie. cash surrender value)
Face Value: Premiums:

Details (incl. institution, address): Policy Number: Name of Insured (if not you): Name of Beneficiary: Cash Surrender Value: At dom: (2) Type: At dos: Irrevocable?

Yes No

Currently:

Term (ie. no cash surrender value) Whole Life (ie. cash surrender value)
Face Value: Premiums:

Details (incl. institution, address): Policy Number: Name of Insured (if not you): Name of Beneficiary: Cash Surrender Value: At dom: Disability/Critical Illness insurance: Details (incl. institution, address): Policy Number: Business Interests: Company Name: Your Interest: FMV: At dom: Further Details: At dos: Currently: Incorporated? Face Value: Premiums: At dos: Irrevocable?

Yes No

Currently:

Yes No

Type of Business: (eg.sole proprietorship/partnership/jt venture etc.)

Receivables (ie. money owed to me, including accrued commissions, bonuses, royalties, shareholder loans, etc.): Owed by: Secured?

No Yes, against
Repayment Date: At dos:

Interest Rate: Currently:

Date Loaned: Amount Owing: At dom: Income Tax Refund Owing: Taxation Year: Amount Owing: At dom: Loyalty Points Programs (eg. Aeroplan, Air Miles etc.): Program: FMV: At dom:

Date Submitted: At dos: Currently:

Account Number: At dos:

Number of Points: Currently:

Page 13 of 19
Intellectual Property (eg. patents, trademarks, copyrights): Details: FMV: At dom: At dos: Currently: Contingent Assets (eg. trusts in which I have an interest): Details: FMV: At dom: At dos:
rd

Currently: person after dom:

Other Assets (excluded in Ontario and some other provinces): Property acquired by gift or inheritance from 3 Details: FMV: At dom: At dos: Currently:

Matrimonial Home/Family Residence?

Yes

No

Income from Gifted/Inherited Property (above) if donor/testator expressly provided for exclusion from division in the event of a separation: Details: FMV: At dom: Details: FMV: At dom: Proceeds from life insurance policy: Details: FMV: At dom: At dos: Currently: At dos: Currently: At dos: Currently: Damages in connection with a personal injury lawsuit:

Property which can be traced back to funds received from any of above property in this section: Details: FMV: At dom: At dos: Currently:

Matrimonial Home/Family Residence?

Yes

No

Property agreed to be excluded from division in the event of a separation pursuant to Marriage/Cohabitation Contract /Agreement: Details: FMV: At dom: Other Property/Assets: At dos: Currently:

Page 14 of 19
Debts/Liabilities (do not include mortgages already included in Matrimonial Home/Family Residence Section or Land Section above): (1) Type of Debt: Secured?

No Yes, against
Repayment Date: At dos:

Interest Rate:

Name/Address of Creditor: Date borrowed: Amount Owing: At dom: (2) Type of Debt: Secured? Currently:

No Yes, against
Repayment Date: At dos:

Interest Rate:

Name/Address of Creditor: Date borrowed: Amount Owing: At dom: (3) Type of Debt: Secured? Currently:

No Yes, against
Repayment Date: At dos:

Interest Rate:

Name/Address of Creditor: Date borrowed: Amount Owing: At dom: (4) Type of Debt: Secured? Currently:

No Yes, against
Repayment Date: At dos:

Interest Rate:

Name/Address of Creditor: Date borrowed: Amount Owing: At dom: Type of Contingent Debt: Secured?

Currently:

Contingent Debts/Liabilities (eg. contingent tax and costs of disposition, guarantees etc.):

No Yes, against
Repayment Date: At dos:

Interest Rate:

Name/Address of Creditor: Date borrowed: Amount Owing: At dom: Other Debts/Liabilities: Currently:

Page 15 of 19 Other Partys Assets/Liabilities


[Provide the fair market value (FMV) of all assets the other party owned (or debts he/she owed) at the date of marriage (dom), the date of separation (dos) and currently. Include all assets the other party owned (or debts he/she owed) at the date of marriage, even if he/she no longer owns/owes them.]

Land (list real property not already included in Matrimonial Home/Family Residence Section above): Address: Ownership: FMV: At dom: Value of Mortgage: At dom: Mortgagor: Address of Mortgagor: Contents of home (household goods, furniture etc.): FMV: At dom: Vehicles (cars, boats, etc.): (1) Make/model/year: FMV: At dom: (2) Make/model/year: FMV: At dom: Works of art: Details: FMV: At dom: Jewellery: Details: FMV: At dom: Electronics: Details: FMV: At dom: collections, etc.): Details: FMV: At dom: Bank accounts: (1) Details (incl. institution, address): Type of account: At dos: Currently: At dos: Currently: At dos: Currently: At dos: Currently: At dos: Currently: At dos: Currently: At dos: Currently:

Sole

Joint, with
At dos: At dos: Currently: Currently: Discharge / Renewal date:

Other special items (eg. musical instruments, valuable animals, valuable sports equipment, tools, special

Savings Chequing Ownership: Sole Joint, with


Balance: At dom: At dos:

Account Number:

Currently:

Page 16 of 19
(2) Details (incl. institution, address):

Savings Chequing Ownership: Sole Joint, with


Type of account: Balance: At dom: At dos: (3) Details (incl. institution, address): Type of account:

Account Number:

Currently:

Savings Chequing Ownership: Sole Joint, with


Balance: At dom: At dos:

Account Number:

Currently:

RRSPs/RRIFs: Details (incl. institution, address): Account Number: FMV: At dom: At dos: Beneficiary: Currently:

Securities (including stocks, term deposits, GICs, stock options): (1) Details (incl. institution, address): Account Number: FMV: At dom: (2) Details (incl. institution, address): Account Number: FMV: At dom: (3) Details (incl. institution, address): Account Number: FMV: At dom: Pensions/RPPs: Details (incl. institution, address, acct. #): FMV: At dom: Life insurance: (1) Type: At dos: Currently: At dos: Type of Security: Currently: At dos: Type of Security: Currently: At dos: Type of Security: Currently:

Term (ie. no cash surrender value) Whole Life (ie. cash surrender value)
Face Value: Premiums:

Details (incl. institution, address): Policy Number: Name of Insured (if not other party): Name of Beneficiary: Cash Surrender Value: At dom: At dos: Irrevocable?

Yes No

Currently:

Page 17 of 19
(2) Type:

Term (ie. no cash surrender value) Whole Life (ie. cash surrender value)
Face Value: Premiums:

Details (incl. institution, address): Policy Number: Name of Insured (if not other party): Name of Beneficiary: Cash Surrender Value: At dom: Disability/Critical Illness insurance: Details (incl. institution, address): Policy Number: Business Interests: Company Name: Other Partys Interest: FMV: At dom: shareholder loans, etc.): Owed by: Secured? Further Details: At dos: Currently: Incorporated? Face Value: Premiums: At dos: Irrevocable?

Yes No

Currently:

Yes No

Type of Business: (eg.sole proprietorship/partnership/jt venture etc.)

Receivables (ie. money owed to other party, including accrued commissions, bonuses, royalties,

No Yes, against
Repayment Date: At dos:

Interest Rate:

Date Loaned: Amount Owing: At dom: Income Tax Refund Owing: Taxation Year: Amount Owing: At dom: Loyalty Points Programs (eg. Aeroplan, Air Miles etc.): Program: FMV: At dom:

Currently:

Date Submitted: At dos: Currently:

Account Number: At dos:

Number of Points: Currently:

Intellectual Property (eg. patents, trademarks, copyrights): Details: FMV: At dom: At dos:
rd

Currently: person after dom:

Other Assets (excluded in Ontario and some other provinces): Property acquired by gift or inheritance from 3 Details: FMV: At dom: At dos: Currently:

Matrimonial Home/Family Residence?

Yes

No

Page 18 of 19
Income from Gifted/Inherited Property (above) if donor/testator expressly provided for exclusion from division in case of separation: Details: FMV: At dom: At dos: Currently:

Damages in connection with a personal injury lawsuit: Details: FMV: At dom: Proceeds from life insurance policy: Details: FMV: At dom: Details: FMV: At dom: At dos: Currently: At dos: Currently: Property which can be traced back to funds received from any of above excluded property: At dos: Currently:

Matrimonial Home/Family Residence?

Yes

No

Property agreed to be excluded from division in case of separation pursuant to Marriage/Cohabitation Contract /Agreement: Details: FMV: At dom: Other Property/Assets: At dos: Currently:

Debts/Liabilities (do not include mortgages already included in Matrimonial Home/Family Residence Section or Land Section above): (1) Type of Debt: Secured?

No Yes, against
Repayment Date: At dos:

Interest Rate:

Name/Address of Creditor: Date borrowed: Amount Owing: At dom: (2) Type of Debt: Secured? Currently:

No Yes, against
Repayment Date: At dos:

Interest Rate:

Name/Address of Creditor: Date borrowed: Amount Owing: At dom: Currently:

Page 19 of 19
(3) Type of Debt: Secured?

No Yes, against
Repayment Date: At dos:

Interest Rate:

Name/Address of Creditor: Date borrowed: Amount Owing: At dom: (4) Type of Debt: Secured? Currently:

No Yes, against
Repayment Date: At dos:

Interest Rate:

Name/Address of Creditor: Date borrowed: Amount Owing: At dom: Type of Contingent Debt: Secured?

Currently:

Contingent Debts/Liabilities (eg. contingent tax and costs of disposition, guarantees etc.):

No Yes, against
Repayment Date: At dos:

Interest Rate:

Name/Address of Creditor: Date borrowed: Amount Owing: At dom: Other Debts/Liabilities:

Currently:

Documents Required
See list of documents to provide to your lawyer: Basic Documents Required For Your Family Law Case. For Ontario residents, also complete a draft Financial Statement: Draft 13.1 Financial Statement with Instructions (ON only).

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