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40 Shields Court, Suite 201
Markham, Ontario
L3R 0M5 Canada

Write to us
Fax: (416) 901-0061
Email: info@rosedalefs.com

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Telephone: (416) 901-0060
Toll-free: 1 (855) 901-0060

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Financial questionnaire

Consumer Protection BC

Financial questionnaire

Use this financial questionnaire to determine your monthly surplus / deficit, net assets and list out your creditors for debt management and financial planning.

Mandatory fields are denoted with an asterisk (*).


CONTACT INFORMATION
* Full name
* Phone number
* E-mail address
* Preferred method of contact
Reference ID A reference ID is issued by Rosedale Financial Solutions to debtors.

MONTHLY BUDGET INFORMATION
Revenue / Income
* Employee (salary and wages) * Business (professional)
* Investment (interest, dividends) Other
Expenses / Expenditures
Home
* Mortgage / Rent * Home insurance
* Electricity / Gas * Water and sewage
* Waste removal * Home phone
* Cable Maintenance and repairs
Supplies Other
Transportation
* Vehicle * Taxi / Ferry / Bus
Auto insurance Fuel
Maintenance and repairs Other
Taxes
Federal Provincial
International Other
Loans
* Credit card * Education / Student
* Personal Other
Legal obligations
* Attorney * Alimony
* Court orders Other
Savings and contributions
* Investments * Retirement
Charitable donations Other
Personal care and lifestyle
* Groceries * Dining out
Clothing Dry cleaning
Personal care (hair, nails, spa) Fitness memberships
Life insurance Other
Dependents
Pets Children (allowance, etc.)
Elderly (parents, etc.) Other
Entertainment
Rental (DVDs, etc.) Music (in store, online)
Live theatre Concerts
Sporting events Other

NET ASSETS
Assets
* Cash * Investments
* Home * Car
Liabilities
# Creditor's Name # Creditor's Name
1 2
3 4
5 6
7 8

CONFIRMATION
* Disclaimer I agree that the foregoing data provided is valid and true to the best of my knowledge.
* AntiSpam challenge: Please re-type the alphanumeric characters as shown in the image below:
Case-sensitive

You must complete all the required fields in order for your financial questionnaire to be submitted.
Please do not click the submit button more than once.