Annual Review Package

Welcome!

You will be asked to provide information on the following:
1. Your monthly income (net and gross)
2. Information about your assets
3. List of monthly expenses
4. Questionnaire
5. Evaluation
NOTE: In order for your counsellor to help you, it is important that you supply complete and accurate answers to these questions. If at any time you feel uncomfortable with the process you can contact us and talk to a certified counsellor over the telephone. They will be happy to explain the process and talk you through the form.
General Information Disclosure Policy*
- I agree to the General Information Disclosure Policy
Consent*
- I consent to receive electronic messages via email and to my mobile device from Resolve Credit & Financial Counselling Services.

Co-applicant Information

Please provide co-applicant information or you can skip this step if you do not have a co-applicant
Co-applicant Information
First Name:
Middle Initial:
Last Name:
Date Of Birth:
MM slash DD slash YYYY
Education Level:

Monthly Income Information

When completing the following MONTHLY income questions, please keep in mind that "MONTHLY Gross Income" is income before any deductions. Your "MONTHLY Net Income" is your take home pay after all deductions have been subtracted. Examples of deductions include taxes, insurance, union dues, RRSP, etc… DO NOT ENTER DOLLAR SIGNS or any other characters, just the dollar amount
Monthly Income Information
Net Income (take home/after tax):*
Spousal/Child Support:
Retirement/Pension:
Child Tax Credit:
Other Income:
Specify source of other Income:
Social Assistance:
Employment Insurance:
Part Time:
Name of Employer:
Job Title:
Pay Period:
Co Applicant Monthly Income
Co Applicant Monthly Income
Net Income (take home/after tax):
Spousal/Child Support:
Retirement/Pension:
Child Tax Credit:
Other Income:
Specify source of other Income:
Social Assistance:
Employment Insurance:
Part Time:
Name of Employer:
Job Title:
Pay Period:

Monthly Expense Information

When completing the following MONTHLY expense categories, make sure that all fields reflect how much you spend "Monthly". For example, if you estimate that you spend $1,200 a year on clothing your monthly expense would be $100.
Monthly Expense Information
Groceries
Meals Out
Rent / Mortgage
Property Taxes/Condo Fees
Hydro
Water
Heat
Water Tank/Equipment Rentals
Garbage
Gas
Vehicle Payment
Parking
Bus/Taxis
Car Insurance
Home Insurance
Life Insurance
Support Payments
Telephone
Cell Phone
Satellite/Cable
Internet

Monthly Expense Information continued

When completing the following MONTHLY expense categories, make sure that all fields reflect how much you spend "Monthly". For example, if you estimate that you spend $1,200 a year on clothing your monthly expense would be $100.
Banking Fees
Laundry
Pets
Prescriptions
Smoking
Alcohol
Toiletries
Recreation
Memberships
Charity/Church
Emergency Savings
Gifts
Car Maintenance, License
Clothing
Vacation
Sports
School
OTHER MONTHLY EXPENSES
Other-Specify 1 : Item
Other-Specify 1 : Amount
Other-Specify 2 : Item
Other-Specify 2 : Amount
Other-Specify 3 : Item
Other-Specify 3 : Amount
Other-Specify 4 : Item
Other-Specify 4 : Amount

Questionnaire
Do you have any new debts that you have incurred since the time that you signed with Credit Counselling?*
- Yes
- No
If yes, please fill out the following: What is the debt? How much is owed?*
Has your financial situation changed and/or are you having any difficulty making your monthly payments to Credit Counselling?*
- Yes
- No
If yes, please explain:*
Please list any short-term goals and long-term goals that you have:
Would you like us to contact you to discuss your file further?*
- Yes
- No
If yes, please list the telephone number we should use to contact you. Is it okay to leave a detailed message?*

Evaluation
I have been on my Debt Management Program for
- 0-1 years
- 1-4 years
- 4+ years

I would like to connect with my counsellor to discuss what happens after I have successfully completed my Debt Management Program.*
- Yes
- No
I would recommend this service to others.*
- Strongly agree
- Somewhat agree
- No opinion
- Disagree
- Strongly disagree
Comments
Any final comments:
Do you want a copy of your submission sent to your email address?
- Yes, I want a copy

Personal Information