Section 2- Income & Assets Information Declaration of Income: Please indicate “yes” or “no” for each type of income received by each household member: TYPE OF INCOME Answer “yes” or “no” for each type of income Name(s) of household member in receipt of income: Attach the following documentation Employment Yes____ No___ Minimum of eight (8) weeks of paystubs Self-Employment Yes____ No___ Income and Expense Statement Notice of Assessment after 12 months of self-employment Ontario Works (OW) Yes____ Statement of Assistance and Drug card Ontario Disability Support Program (ODSP) Yes____ No___ Statement of Assistance and Drug card Support Payments (received or paid) Yes____ Court Order or Notarized/Sworn Separation Agreement Employment Insurance (EI) Yes____ No___ Cheque stub or Source Document Workplace Safety Insurance (WSIB) Yes____ Cheque stub or Source Document Ontario Student Assistance Program (OSAP) Yes____ No___ Loan Document(s) Canada Pension Plan (CPP) Yes____ No___ Cheque stub or Source Document Old Age Security (OAS) Yes____ No___ Cheque stub or Source Document Guaranteed Income Supplement Yes____ No___ Cheque stub or Source Document Other Pension Income Yes____ Cheque stub or Source Document Other Income See page 10 for examples Yes____ Source Document Information slips for income tax purposes (T4, T5, etc.) Yes____ No___ Current information slips and/or Notice of Assessment
Declaration of Assets: Please indicate “yes” or “no” for each type of asset and attach required documents: TYPE OF ASSET Answer “yes” or “no” for each type of income holder’s Name(s): IF “YES” PROVIDE A COPY OF Bank Accounts Yes____ No___ Yes____ No___ Yes____ No___ Yes____ No___ The last 90 days of transactions for all bank/trust/credit union accounts. Term Deposits/Bonds/ Debentures Yes____ No___ Yes____ No___ Source Document(s) Stocks/Shares/ GICs Mutual Funds/ Securities/Annuities Yes____ No___ Yes____ No___ Source Document(s) Retirement Savings Plan(s) (registered/unregistered) Yes____ No___ Yes____ No___ Source Document(s) Life Insurance Yes____ Source Document(s) Interest/Equity in a Business or Investment Yes____ No___ Yes____ No___ Source Document(s) Taxi Plate(s) and Taxi Licenses Yes____ No___ Yes____ No___ Source Document(s) Real Property (House/Cottage and/or Land) Yes____ No___ Yes____ No___ Source Document(s) Other Asset(s) See page 10 for examples Yes____ No___ Yes____ Source Document(s)
Examples of Income and Assets (The following is not to be considered an exhaustive list) Employment Income: Full-time employment Part-time employment Irregular employment Casual employment Seasonal employment Retroactive payments Severance payments Self-Employment: Teaching/Tutoring Child Care/babysitting Driving a taxi Farm income Independent business income Other Assets: Debentures Mortgages Loans Term Deposits Registered Retirement Savings Plan Locked-In Retirement Account Canada Savings Bonds Other Income: Alimony payments Support (from relatives or other sources) Sponsorship payments Bonuses Short term disability Long term disability Disability payments Sickness payments Commissions Tips or gratuities Lump sum payments (Inheritances/settlements/ court settlements) Insurance payments Training allowance Retraining allowance Mortgage income Rental Income Other Pension Income: Quebec Pension Plan Military Pension War Veteran’s Allowance Civilian War Pension Private Pension (from: RRSP/LIRA/RRIF) Private Company Pension Public Service Pension Out of Country Pension Widow’s Pension Civilian War Pension Disability Pension Military/Militia/Civilian Allowance