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MONTHLY INCOME

Net Employment Income

Child Tax Benefit

Net Earnings of Spouse

Net Spousal Support

Net Pensions/Annuities

Net Unemployment Insurance Benefits

Net Child Support

Net Social Assistance

Other net income

Self-Employed

Gross Net

TOTAL MONTHLY INCOME (A)

MONTHLY NON-DISCRETIONARY EXPENSES

Child Support Payments

Fines/Penalties Imposed by Court

Spousal Support Payments

Expenses as a Condition of Employment

Child Care

Debts Where Stay Has Been Lifted

Medical Condition Expenses

Other

TOTAL MONTHLY NON-DISCRETIONARY EXPENSES (B)

AVAILABLE MONTHLY INCOME (A – B) = (C)

MONTHLY DISCRETIONARY EXPENSES

Housing Expenses

Living Expenses

Rent/Mortgage

Food/grocery

Property taxes/condo fees

Laundry/dry cleaning

Heating/gas/oil

Grooming/toiletries

Telephone

Clothing

Cable

Other

Hydro

Transportation Expenses

Water

Car lease/payments

Furniture

Repairs/maintenance/gas

Other

Public transportation

Personal Expenses

Other

Smoking

Insurance Expenses

Alcohol

Vehicle

Dining/lunches/restaurants

House

Entertainment/sports

Furniture/contents

Gifts/charitable donations

Life insurance

Allowances

Other

Other

Payments

Non-recoverable Medical Expenses

Prescriptions

To secured creditor

Dental

(Other than mortgage and vehicle)

Other

Other

TOTAL MONTHLY DISCRETIONARY EXPENSES (D)

TOTAL - SURPLUS/(SHORTFALL) (C)-(D)

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