Beruflich Dokumente
Kultur Dokumente
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:
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
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:
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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:
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)
KeyTerms:
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:
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:
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:
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:
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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:
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:
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)
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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
No Yes
Details:
If Self-Employed:
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):
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If Unemployed (include details of prior employment as well): Date unemployment began:
No Yes
Details:
Details (incl. Policy #): Details (incl. Policy #): Details (incl. Policy #): Details:
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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:
Sole, by
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:
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Home 2 (Secondary Residence prior to separation eg. cottage, chalet, Florida condominium etc.) Address: Ownership:
Sole, by
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:
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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:
Account Number:
Currently:
Account Number:
Currently:
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:
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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
Receivables (ie. money owed to me, including accrued commissions, bonuses, royalties, shareholder loans, etc.): Owed by: Secured?
No Yes, against
Repayment Date: At dos:
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:
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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
Other Assets (excluded in Ontario and some other provinces): Property acquired by gift or inheritance from 3 Details: FMV: At dom: At dos: Currently:
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:
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:
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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:
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
Account Number:
Currently:
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(2) Details (incl. institution, address):
Account Number:
Currently:
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:
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(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
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:
Intellectual Property (eg. patents, trademarks, copyrights): Details: FMV: At dom: At dos:
rd
Other Assets (excluded in Ontario and some other provinces): Property acquired by gift or inheritance from 3 Details: FMV: At dom: At dos: Currently:
Yes
No
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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:
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:
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(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:
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).