6- OTHER MOVABLE PROPERTY
Do you own other movable property (cottage, land, income property, etc.)? Describe
Name of lessee Amount of rent Name of lessee Amount of rent
Municipal assessment Taxes Purchase price
Name of hypothecary creditor Amount of the hypothec Current balance of hypothec
Have you ever owned such property? If so, explain the circumstances in which you disposed of it (Date, sale price, buyer, etc.)
7- INSURANCE
Do you have a
Company Policy number Amount
life insurance policy?
Do you have accident or
Company Policy number
disability insurance or an illness?
Are you the beneficiary of an insurance policy? Describe
8- FINANCIAL SITUATION
Have you ever declared bankruptcy
Date Trustee in bankruptcy
or voluntarily assigned your property?
Are you registered
Record No.
Are you an officer, administrator
Name of the company or corporation
to make voluntary or associate of a company
deposits? or corporation?
Position
Have you ever Are you holding property, Is property
been a party to in trust or otherwise, being held in
a trust indenture? on someone’s behalf? trust for you?
Do you rent rooms?
Name(s) of lessee(s) Amount of rent
Do you have boarders?
In the past two years,
Name of the person to whom the property was given or sold Date of the transaction
have you given or sold
property to anyone?
Description of the property Amount of the transaction
Have you obtained a loan Name of creditor Amount of loan Loan guarantee
from a financial institution
or an individual?
Have any judgments been
Name of creditor Record No.
rendered against you?
Date of judgment Amount of the condemnation
Do you have
Name of creditor
other debts?
Type of debt Amount of the debt Name of creditor
Typeofdebt Amountofthedebt DoyouhaveaState-issuedlicenceorpermit?Describe
Do you have the assets necessary to comply with the judgment rendered against you?
9- OTHER INFORMATION
Do you wish to make a proposal in order to comply with this judgment?
SWORN STATEMENT
I, the undersigned,
domiciled and residing at
solemnly affirm that all the facts stated in this examination are true.
And I have signed
Signature
Swornbeforeme
In , on
Court clerk / Commissioner for oaths
•SJ-137A(2018-03)