Debt Shield Intake

Part 1

Applicant Details

Applicant 1 Full legal name Street address

City Province Postal code

SIN Date of birth

Email Phone number

Applicant 2 Full legal name Street address

City Province Postal code

SIN Date of birth

Email Phone number

Part 2

Financial History

Have you bought or sold a house in the last 5 years?

Yes No

Have you disposed of any assets in the last 12 months?

Yes No

Do you have life insurance with a cash surrender value?

Yes No

Do you have an RRSP, and have you made contributions in the last 12 months?

Yes No

Do you have an RDSP, and have you made contributions in the last 12 months?

Yes No

Do you have an RESP?

Yes No

Do you have a TFSA?

Yes No

Part 3

Household Income

Applicant 1 monthly income $0.00

Applicant 2 monthly income $0.00

Part 4

Personal Assets

Net is estimated value minus debt owing.

Personal asset value $0.00

Personal asset debt $0.00

Personal net assets $0.00

Part 4

Business Assets

Only complete this section if business assets apply.

Business asset value $0.00

Business asset debt $0.00

Business net assets $0.00

Part 5

Personal Liabilities

Examples include credit cards, tax debt, student loans, and personal loans.

Total personal liabilities $0.00

Part 6

Business Liabilities

Examples include CRA debt, business loans, credit cards, and loans from individuals.

Total business liabilities $0.00

Review

Your Intake Snapshot

Monthly household income $0.00

Total asset value $0.00

Total asset debt $0.00

Total net assets $0.00

Total liabilities $0.00

Estimated position $0.00

Anything else Debt Shield should know? View prefilled PDF form

Your information is used only to review your file and follow up with next steps.

Complete Your Intake

Applicant Details

Financial History

Household Income

Personal Assets

Business Assets

Personal Liabilities

Business Liabilities

Your Intake Snapshot

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