FINANCIAL INFORMATION

Name - Applicant 1:

Name - Applicant 2:

Financial information is one of the factorsconsidered in an adoption homestudy. It is used in assessingdegree of financial stability and degree of financial stress adding a child to the familymay create.

Please provide an outline of your financial situation as follows:

ANNUAL EMPLOYMENT INCOME / THIS YEAR / LAST YEAR
Applicant 1
Applicant 2
OTHER ANNUAL INCOME / THIS YEAR / LAST YEAR
Applicant 1
Applicant 2
TOTAL ANNUAL INCOME
MONTHLY NET DISPOSABLE INCOME – (AFTER TAXES / DEDUCTIONS)
Applicant 1 / $
Applicant 2 / $
OTHER MONTHLY DISPOSABLE INCOME
Applicant1 / $
Applicant 2 / $
TOTAL MONTHLY DISPOSABLE INCOME / $
MONTHLY EXPENSES / AMOUNT SPENT
Mortgage / Rent / $
Food: home, restaurants / $
Clothing / $
Household Bills: eg. heat / hydro / insurance / $
Transportation: eg. car / bus / taxi / $
Membership Fees: eg. sports / fitness / other activities / $
Loan Payments: eg. bank / personal / credit cards / $
Other Expenses: (specify) / $
TOTAL EXPENSES / $

HOMESTUDY: FINANCIAL INFORMATION

ASSETS / VALUE
Real Estate: Home / $
Real Estate: Other / $
Vehicles / $
RRSPs / Other Savings / $
Investments: eg. Stocks / GICs / Mutual Funds / $
Bank Accounts / $
Other Assets:specify / $
TOTAL ASSETS / $
LIABILITIES / TOTAL AMOUNT OWED
Mortgage
Bank Loans
Personal Loans
Credit Cards
Other Debts / Liabilities
TOTAL LIABILITIES
NET WORTH
TOTAL ASSETSMINUS TOTAL LIABILITIES / $

INSURANCE:

  • Homeowner’s /tenants’ insurance policy:

I/We have I/We will obtain

  • Minimum of $1,000,000 auto insurance coverage per vehicle:

I/We have I/We will obtain

  • Life insurance policies:

Amount held:

Applicant 1: $Applicant 2: $

  • Identify other insurance (health, disability, etc)

Applicant 1:

Applicant 2:

I/We confirm that the information given on this financial statement is accurate and complete to the best of my/our knowledge.

Signatures: Applicant 1: ______Date:______

Applicant 2: ______Date:______

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OntarioAdoptive Applicants February 20, 20061