QUESTIONNAIRE DE PLANIFICATION - IQPF



Data Collection QuestionnaireConfidential File no.: FORMTEXT ?????Client name 1: FORMTEXT ?????Client name 2: FORMTEXT ?????Client type: FORMTEXT ?????Questionnaire completed on: FORMTEXT ?????Updated: FORMTEXT ?????Financial planner: FORMTEXT ?????*You can insert your logo here to personalize this document. This document was created for informational purposes only. The IQPF can not be held responsible for errors or losses incurred following its use.SECTION 1: PERSONAL INFORMATIONResidence and jobClient 1: FORMTEXT ?????Client 2: FORMTEXT ????? FORMCHECKBOX Mr. FORMCHECKBOX Ms. FORMCHECKBOX Mr. FORMCHECKBOX Ms. REF Texte3 \* MERGEFORMAT Address: FORMTEXT ?????Since (date): FORMTEXT ?????Date and place of birth: FORMTEXT ????? FORMTEXT ?????Date and place of birth: FORMTEXT ????? FORMTEXT ?????Start date of residence in Canada: FORMTEXT ?????Start date of residence in Canada: FORMTEXT ?????Citizenship: FORMTEXT ?????Citizenship: FORMTEXT ?????S.I.N.: FORMTEXT ?????S.I.N.: FORMTEXT ?????Home phone: FORMTEXT ?????Home phone: FORMTEXT ?????Office phone: FORMTEXT ?????Office phone: FORMTEXT ?????Cell phone: FORMTEXT ?????Cell phone: FORMTEXT ?????Fax: FORMTEXT ?????Fax: FORMTEXT ?????Email: FORMTEXT ?????Email: FORMTEXT ????? FORMCHECKBOX employer FORMCHECKBOX self-employed FORMCHECKBOX retired FORMCHECKBOX employer FORMCHECKBOX self-employed FORMCHECKBOX retiredName: FORMTEXT ?????Name: FORMTEXT ?????Address: FORMTEXT ?????Address: FORMTEXT ?????Since (date): FORMTEXT ?????Since (date): FORMTEXT ?????Position: FORMTEXT ?????Position: FORMTEXT ?????Job type: FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 4Job type: FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 41. Permanent2. Temporary3. Independent4. No jobCivil and matrimonial statusClient 1: FORMTEXT ?????Client 2: FORMTEXT ?????Since (date)Since (date) FORMCHECKBOX single FORMTEXT ????? FORMCHECKBOX single FORMTEXT ????? FORMCHECKBOX married/civil union FORMTEXT ????? FORMCHECKBOX married/civil union FORMTEXT ????? FORMCHECKBOX de facto union FORMTEXT ????? FORMCHECKBOX de facto union1 FORMTEXT ????? FORMCHECKBOX widowed FORMTEXT ????? FORMCHECKBOX widowed FORMTEXT ????? FORMCHECKBOX legally separated FORMTEXT ????? FORMCHECKBOX legally separated FORMTEXT ????? FORMCHECKBOX divorced FORMTEXT ????? FORMCHECKBOX divorced FORMTEXT ?????Support paymentsClient 1Client 2 FORMCHECKBOX paid FORMCHECKBOX received FORMCHECKBOX not applicable FORMCHECKBOX paid FORMCHECKBOX received FORMCHECKBOX not applicableMarriage or civil union contract (append a copy to the questionnaire) FORMCHECKBOX partnership of acquests FORMCHECKBOX separation of property FORMCHECKBOX community of property FORMCHECKBOX other FORMCHECKBOX n/aCohabitation agreement (append a copy to the questionnaire) FORMCHECKBOX yes FORMCHECKBOX no FORMCHECKBOX not applicableSurrender of family property rights FORMCHECKBOX yes FORMCHECKBOX no FORMCHECKBOX not applicable FORMCHECKBOX yes FORMCHECKBOX no FORMCHECKBOX not applicableChildrenGrandchildrenFirst nameDate of birthJobAnnual incomeCivil statusLast nameFirst nameDate of birth1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments: FORMTEXT ?????Other informationClient 1Client 2 FORMCHECKBOX smoker FORMCHECKBOX non-smoker FORMCHECKBOX never smoked FORMCHECKBOX smoker FORMCHECKBOX non-smoker FORMCHECKBOX never smokedState of health: FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 4State of health: FORMCHECKBOX 1 FORMCHECKBOX 2 FORMCHECKBOX 3 FORMCHECKBOX 41. Excellent2. Good3. Fair4. PoorDetails: FORMTEXT ?????Professional advisorsNameFirm and addressPhoneFaxEmailLawyer FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Notary FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Accountant or tax expert FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Account manager FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Financial security advisor FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Broker’s representative FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Liability insurance broker or agent FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????For the Client 2, if different:NameFirm and addressPhoneFaxEmailLawyer FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Notary FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Accountant or tax expert FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Account manager FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Financial security advisor FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Broker’s representative FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Liability insurance broker or agent FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????SECTION 2: GOAL SUMMARYPersonal and family situationYesNoCommentsGet married or enter civil union FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Live in a de facto union FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Get divorced FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Adopt children FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Have children FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Separate FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Other: FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Financial situationYesNoCommentsEvaluate net worth FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Evaluate cost of living FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Eliminate personal debts FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Establish a savings strategy FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Purchase a home FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Review investment strategy FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Help children or grandchildren pursue higher education FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Other: FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Tax situationYesNoCommentsReduce income taxes FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Optimize after-tax investment income FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Evaluate compensation method FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Evaluate business structure FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Use income-splitting strategies FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Other: FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Protection situation YesNoCommentsDraft or update a mandate in case of incapacity FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Draft or update a general power of attorney FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Review personal disability protection FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Review business-related disability protection FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Review other personal sickness or accident protections FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Review other business-related sickness or accident protections FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Other: FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Retirement situation YesNoCommentsRetire at age FORMTEXT ?????. Maintain a cost of living of FORMTEXT ?????, in today’s dollars. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Evaluate options for cashing out RRSPs, RRIF, annuities, etc. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Choose between a defined benefit pension plan and transfer to a LIRA FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Set up an individual pension plan FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Other: FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Situation at deathYesNoCommentsDraft or update the will FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Determine life insurance needs FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Maintain current cost of living for heirs for FORMTEXT ????? years FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Provide additional bequests for heirs FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Provide other bequests, such as to a foundation FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Minimize taxes payable on death FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Business: ensure continuation of the business after death FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Other: FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????SECTION 3: FINANCEActifClient 1? Client 2? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PassifClient 1Client 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Determination of cost of living FORMTEXT ?????How much do you save annually in your RRSP? FORMTEXT ?????How much do you save annually in your TFSA? FORMTEXT ?????How much do you save annually in an unregistered account? FORMTEXT ?????Are you expecting any unusual income or expenses in the next year (e.g., trips, renovations)? FORMCHECKBOX yes FORMCHECKBOX noComments: FORMTEXT ?????Have you made funeral pre-arrangements? FORMCHECKBOX oui FORMCHECKBOX nonCommentaires?: FORMTEXT ?????SECTION 4: TAXATIONDetermination of after-tax incomeComplete Appendix C using tax returns (or summaries) for the last three years.Client 1Client 2Annual earnings:$ FORMTEXT ?????$ FORMTEXT ?????Form (salary, commissions, business income, dividends): FORMTEXT ????? FORMTEXT ?????If earnings are variable, enter possible range: FORMTEXT ????? FORMTEXT ?????Client 1Client 2Gross rental income:$ FORMTEXT ?????$ FORMTEXT ?????Deductible expenses:$ FORMTEXT ?????$ FORMTEXT ?????Net rental income before depreciation:$ FORMTEXT ?????$ FORMTEXT ?????Capital cost allowance:$ FORMTEXT ?????$ FORMTEXT ?????Net rental income:$ FORMTEXT ?????$ FORMTEXT ?????Client 1Client 2Effective (or average) tax rate FORMTEXT ????? % FORMTEXT ????? %Marginal tax rate FORMTEXT ????? % FORMTEXT ????? %Net capital losses from prior years$ FORMTEXT ?????$ FORMTEXT ?????TFSA contribution rights$ FORMTEXT ??????$$ FORMTEXT ?????Taxable capital gains declared in last 3 years:Year: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Amount: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Have you sold any property since the beginning of the year? FORMCHECKBOX yes FORMCHECKBOX noIf so, complete the following chart.DescriptionYear of acquisitionQuantityNet proceeds of dispositionACBUCCGain or lossRecapture of depreciation1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Home Buyer’s Plan (HBP) or Lifelong Learning Plan (LLP) HBP FORMCHECKBOX LLPClient 1Client 2Year of withdrawal FORMTEXT ????? FORMTEXT ?????Amount withdrawn$ FORMTEXT ?????$ FORMTEXT ?????Amount of annual reimbursement$ FORMTEXT ?????$ FORMTEXT ?????Balance no January 1st $ FORMTEXT ?????$ FORMTEXT ?????Comments: FORMTEXT ?????What amount is available for the capital gains deduction from the sale of qualified small business corporation shares? What amount is available for qualified farming or fishing property?Client 1Type of propertyAmount availableQSMCSs FORMTEXT ?????Qualified farming or fishing property FORMTEXT ?????Client 2Type of propertyAmount availableQSMCSs FORMTEXT ?????Qualified farming or fishing property FORMTEXT ?????Have any of your investments been chosen mainly for tax reasons? FORMTEXT ?????Do you have foreign investment property ? FORMCHECKBOX yes FORMCHECKBOX noComments: FORMTEXT ?????For all the years when the total cost of foreign investment assets exceeds the CA$100,000 threshold, a declaration must be made in the federal tax return and federal form T1135 must be filed.Did you make an election in your 1994 tax return in relation to property you owned on February 22, 1994? FORMCHECKBOX yes FORMCHECKBOX noIf so, complete the following table:DescriptionQuantityAmount of election$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ?????SECTION 5: RETIREMENTClient 1Client 2yesnoyesnoAre you eligible for the Old Age Security pension (OAS)? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Are you eligible for the Québec Pension Plan or the Canada Pension Plan (append a statement of contributions)? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Do you belong to a registered pension plan (RPP), a supplemental pension plan, a stock option plan, etc.? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX If so, please append a copy of the most recent statement of participation and all documentation concerning the plan (brochures, regulations, etc.) and complete note 15 in the personal balance sheet.Do you belong to a group RRSP or group DPSP offered by your employer? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX If so, append a copy of the most recent statement of participation .Do you always contribute the annual maximum to your RRSP* or spousal RRSP? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX When do you make your annual RRSP or spouse RRSP contribution?End of year FORMCHECKBOX FORMCHECKBOX Beginning of year FORMCHECKBOX FORMCHECKBOX Systematic savings program FORMCHECKBOX FORMCHECKBOX Additional information about the RRSP:Deduction limit for FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Minus: Unused contributions previously reported and available to deduct in FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Available contribution room for FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Excess contributions FORMTEXT ????? FORMTEXT ?????Obtain Appendix 7 and the most recent federal notice of assessmentOther information: FORMTEXT ?????SECTION 6: LEGAL ASPECTS AND ESTATESClient 1Client 2yesnoN/AyesnoN/ADo you have a will? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX If so, append a copy.Is there a “last survivor” clause in your marriage or civil union contract? FORMCHECKBOX FORMCHECKBOX Does your will still reflect your last wishes? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Do you want to leave a bequest to a charity? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Have you drawn up a protection mandate (mandate in case of incapacity)? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Do you have a general power of attorney? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Do you have commitments arising from a previous marriage or union? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Do you serve as the administrator of the assets of another person (tutor, liquidator, trustee or mandatary)? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Do you have a shareholders’ or partners’ agreement? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Comments: FORMTEXT ?????Note:It is important to get a copy of all existing legal documents.SECTION 7: INVESTMENTSClient 1%Client 2%Determination of investor profileCash securities FORMTEXT ????? FORMTEXT ?????Fixed-income securities FORMTEXT ????? FORMTEXT ?????Growth securities FORMTEXT ????? FORMTEXT ?????100100Do you subscribe to an RESP? FORMCHECKBOX yes FORMCHECKBOX no FORMCHECKBOX n/aComments: FORMTEXT ?????If so, please provide the most recent account statements.yesnon/ayesnon/aAre any of your loans for investment purposes? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????yesnoyesnoAre any of your investments accounts to finance a specific plan or project? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX SECTION 8: INSURANCEClient 1Client 2yesnoN/AyesnoN/ADo you have life insurance ? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Do you have disability insurance *? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Do you have critical illness insurance *? Long-term care? Access to care? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Are your loans covered by life insurance with the lending institution? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Are your loans covered by disability or critical illness insurance with the lending institution? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Does a corporation hold insurance on your life? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX APPENDIX APersonal balance sheet as at FORMTEXT ?????Client 1$Client 2$Total$ASSETSCash and near-cash assetsBank accounts (note 3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Life insurance cash surrender value (note 4) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Non-registered investments (note 5) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Tax-free savings account (note 6) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Advances receivable (note 7) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total cash and near-cash assets FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Personal assetsPrincipal residence (note 8) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Secondary residence (note 9) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Automobiles (note 10) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Antiques, works of art, jewellery, collections (note 11) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total personal assets FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Income-producing assetsEquity ownership in a private corporation or partnership (note 12) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Rental property (note 13) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total income-producing assets FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Deferred taxation plansRRSP, RPDB or RRIF (note 14) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Registered Pension Plan (note 15) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????LIRA or LIF (note 16) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????RESP or RDSP (note 17) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Québec pension plan (QPP) (note 18) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other assets: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total deferred taxation plans FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????TOTAL ASSETS FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????LIABILITIESAccounts payable (note 19)Unpaid credit card balances FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Credit purchases FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Taxes payable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total accounts payable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Personal loans (note 20)Bank overdraft FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Line of credit FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Car FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????RRSP FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Investments FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Advances received from a private corporation FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total personal loans FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Mortgage loans (note 21)Principal residence FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Secondary residence FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Rental property FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total mortgage loans FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Future income taxes (note 22) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????TOTAL LIABILITIES FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????NET WORTH FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Notes to the personal balance sheetNOTE 1: Personal, professional and family situation FORMTEXT ?????NOTE 2: Accounting conventionsAssets and liabilities are evaluated at their estimated current value.NOTE 3: Bank accountsFinancial institutionType of accountBalance$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????NOTE 4: Life insurance cash surrender valueType of contractCash surrender value$Comments1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte576+Texte579+Texte582) 0 FORMTEXT ?????NOTE 5: Non-registered investmentsLiquid securitiesSavings bondsIssuerSeriesInterest rateMaturityFace value$Accrued value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte589+Texte595) 0 FORMTEXT ?????Term deposits or guaranteed investment certificates maturing in less than 1 yearFinancial institutionDate of depositDate of maturityInterest rateAccrued value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte601+Texte606+Texte611+Texte616) 0 FORMTEXT ?????Bonds maturing in less than 1 yearIssuerDate of acquisitionCost of acquisition$Interest rateMaturityMarket value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte623+Texte629+Texte635) 0 FORMTEXT ?????Money market mutual fundDescriptionDate of acquisitionMERACB$Number of unitsMarket value$Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Other liquid securities FORMTEXT ?????Total: FORMTEXT ?????Fixed-income securitiesTerm deposits or guaranteed investment certificatesFinancial institutionDate of depositDate of maturityInterest rateAccrued value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????BondsIssuerDate of acquisitionCost of acquisition$Interest rateMaturityMarket value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Stripped bondsIssuerDate of acquisitionCost of acquisition$Rate of returnMarket value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????;Total? FORMTEXT =(Texte641+Texte646) 0 FORMTEXT ?????Note: Also indicate interest declared each year on income tax return.Redeemable preferred sharesDescriptionDate of acquisitionACB$Rate of returnMaturityQuantityMarket value$Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Fixed income mutual fundsDescriptionDate of acquisitionACB$Rate of returnMaturityQuantityMarket value $1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Other fixed income securities FORMTEXT ?????Total: FORMTEXT ?????Growth securitiesCommon sharesDescriptionDate of acquisitionACB$Annual dividendQuantityMarket value$Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte674*Texte675) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte681*Texte682) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte688*Texte689) 0 FORMTEXT ?????4) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte695*Texte696) 0 FORMTEXT ?????Total: FORMTEXT =(Texte676+Texte683+Texte690+Texte697) 0,00 $ FORMTEXT ?????Perpetual preferred sharesDescriptionDate of acquisitionACB$Rate of returnMaturityQuantityMarket value$Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte674*Texte675) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte681*Texte682) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte688*Texte689) 0 FORMTEXT ?????Total: FORMTEXT =(Texte676+Texte683+Texte690+Texte697) 0,00 $ FORMTEXT ?????Growth securities mutual fundsDescriptionDate of acquisitionMERACB$Number of unitsMarket value$Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte736*Texte737) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte743*Texte744) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte750*Texte751) 0 FORMTEXT ?????Total: FORMTEXT =(Texte738+Texte745+Texte752+Texte759) 0,00 $ FORMTEXT ?????Income trustsDescriptionDate of acquisitionACB$Annual distributions$QuantityMarket value$Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte652*Texte653) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte659*Texte660) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte666*Texte667) 0 FORMTEXT ?????Total: FORMTEXT =(Texte654+Texte661+Texte668) 0,00 $ FORMTEXT ?????Note: The ACB should be adjusted downward each year to reflect capital distributions.Other growth securities FORMTEXT ?????Total: FORMTEXT ?????NOTE 6: Tax-free savings account (TFSA)LIQUID SECURITIESSavings bondsIssuerSeriesInterest rateMaturityFace value$Accrued value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte589+Texte595) 0 FORMTEXT ?????Term deposits or guaranteed investment certificates maturing in less than 1 yearFinancial institutionDate of depositDate of maturityInterest rateAccrued value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte601+Texte606+Texte611+Texte616) 0 FORMTEXT ?????Bonds maturing in less than 1 yearIssuerDate of acquisitionCost of acquisition$Interest rateMaturityMarket value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte623+Texte629+Texte635) 0 FORMTEXT ?????Money market mutual fundDescriptionDate of acquisitionMERACB $Number of unitsMarket value$Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Other liquid securities FORMTEXT ?????Total: FORMTEXT ?????FIXED-INCOME SECURITIESTerm deposits or guaranteed investment certificatesFinancial institutionDate of depositDate of maturityInterest rateAccrued value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????BondsIssuerDate of acquisitionCost of acquisition$Interest rateMaturityMarket value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Stripped bondsIssuerDate of acquisitionCost of acquisition $Rate of returnMarket value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte641+Texte646) 0 FORMTEXT ?????Redeemable preferred sharesDescriptionDate of acquisitionACB$Rate of returnMaturityQuantityMarket value$Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Fixed income mutual fundsDescriptionDate of acquisitionACB$Rate of returnMaturityQuantityMarket value $1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Other fixed income securities FORMTEXT ?????Total: FORMTEXT ?????GROWTH SECURITIESCommon sharesDescriptionDate of acquisitionACB $Annual dividendQuantityMarket value $Total $1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte674*Texte675) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte681*Texte682) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte688*Texte689) 0 FORMTEXT ?????4) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte695*Texte696) 0 FORMTEXT ?????Total: FORMTEXT =(Texte676+Texte683+Texte690+Texte697) 0,00 $ FORMTEXT ?????Perpetual preferred sharesDescriptionDate of acquisitionACB $Rate of returnMaturityQuantityMarket value $Total $1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte674*Texte675) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte681*Texte682) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte688*Texte689) 0 FORMTEXT ?????Total: FORMTEXT =(Texte676+Texte683+Texte690+Texte697) 0,00 $ FORMTEXT ?????Growth securities mutual fundsDescriptionDate of acquisitionMERACB $Number of unitsMarket value $Total $1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte736*Texte737) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte743*Texte744) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte750*Texte751) 0 FORMTEXT ?????Total: FORMTEXT =(Texte738+Texte745+Texte752+Texte759) 0,00 $ FORMTEXT ?????Income trustsDescriptionDate of acquisitionACB $Annual distributions $QuantityMarket value $Total $1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte652*Texte653) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte659*Texte660) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte666*Texte667) 0 FORMTEXT ?????Total: FORMTEXT =(Texte654+Texte661+Texte668) 0,00 $ FORMTEXT ?????Other growth securities FORMTEXT ?????Total: FORMTEXT ?????Total TFSA: FORMTEXT ?????NOTE 7: Advances receivable FORMTEXT ?????NOTE 8: Principal residenceAddressYear of acquisitionPrice paid$Municipal evaluation$Market value$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Note: Include the price paid for major improvements or renovations. If the market value differs from the municipal evaluation, identify the evaluation method.NOTE 9: Secondary residenceAddressYear of acquisitionPrice paid$Municipal evaluation$Market value$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Note: Include the price paid for major improvements or renovations. If the market value differs from the municipal evaluation, identify the evaluation method.NOTE 10: CarsModelYearCost of acquisition$Market value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte803+Texte807) 0 FORMTEXT ?????NOTE 11: Antiques, works of art, jewellery, collectionsDescriptionACB$Market value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total FORMTEXT =(Texte811+Texte814) 0 FORMTEXT ?????Note: Specify how market value was established. If there are charitable objectives, indicate the date and circumstances of acquisition of these assets.NOTE 12: Equity ownership in a private corporation or partnershipDescription% ownershipACB$Market value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte819+Texte823) 0 FORMTEXT ?????Note: Identify the evaluation method. The company’s financial statements can be.NOTE 13: Rental propertyDescriptionAddressDate of acquisitionACB$UCC$Municipal evaluation$Market value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Land portion FORMTEXT ?????n/a FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Land portion FORMTEXT ?????n/a FORMTEXT ????? FORMTEXT ?????Total FORMTEXT =(Texte831+Texte838) 0 FORMTEXT ?????NOTE 14: Registered Retirement Savings Plan (RRSP), Deferred Profit-Sharing Plan (DPSP) or Registered Retirement Income Fund (RRIF)LIQUID SECURITIESSavings bondsIssuerSeriesInterest rateMaturityFace value$Accrued value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte589+Texte595) 0 FORMTEXT ?????Term deposits or guaranteed investment certificates maturing in less than 1 yearFinancial institutionDate of depositDate of maturityInterest rateAccrued value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte601+Texte606+Texte611+Texte616) 0 FORMTEXT ?????Bonds maturing in less than 1 yearIssuerDate of acquisitionCost of acquisition$Interest rateMaturityMarket value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total FORMTEXT =(Texte623+Texte629+Texte635) 0 FORMTEXT ?????Money market mutual fundDescriptionDate of acquisitionMERACB$Number of unitsMarket value $Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Other liquid securities FORMTEXT ?????Total: FORMTEXT ?????FIXED-INCOME SECURITIESTerm deposits or guaranteed investment certificatesFinancial institutionDate of depositDate of maturityInterest rateAccrued value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????BondsIssuerDate of acquisitionCost of acquisition$Interest rateMaturityMarket value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Stripped bondsIssuerDate of acquisitionCost of acquisition $Rate of returnMarket value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte641+Texte646) 0 FORMTEXT ?????Redeemable preferred sharesDescriptionDate of acquisitionACB$Rate of returnMaturityQuantityMarket value$Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Fixed income mutual fundsDescriptionDate of acquisitionACB$Rate of returnMaturityQuantityMarket value $1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Other fixed income securities FORMTEXT ?????Total: FORMTEXT ?????GROWTH SECURITIESCommon sharesDescriptionDate of acquisitionACB $Annual dividendQuantityMarket value $Total $1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte674*Texte675) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte681*Texte682) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte688*Texte689) 0 FORMTEXT ?????4) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte695*Texte696) 0 FORMTEXT ?????Total: FORMTEXT =(Texte676+Texte683+Texte690+Texte697) 0,00 $ FORMTEXT ?????Perpetual preferred sharesDescriptionDate of acquisitionACB $Rate of returnMaturity QuantityMarket value $Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte674*Texte675) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte681*Texte682) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte688*Texte689) 0 FORMTEXT ?????Total: FORMTEXT =(Texte676+Texte683+Texte690+Texte697) 0,00 $ FORMTEXT ?????Growth mutual fundsDescriptionDate of acquisitionMERACB$Number of unitsMarket value $Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte736*Texte737) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte743*Texte744) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte750*Texte751) 0 FORMTEXT ?????4) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte757*Texte758) 0 FORMTEXT ?????Total: FORMTEXT =(Texte738+Texte745+Texte752+Texte759) 0,00 $ FORMTEXT ?????Income trustsDescriptionDate of acquisitionACB$Annual distributions $QuantityMarket value $Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte652*Texte653) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte659*Texte660) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte659*Texte660) 0 FORMTEXT ?????Total: FORMTEXT =(Texte654+Texte661+Texte668) 0,00 $ FORMTEXT ?????Other growth securities FORMTEXT ?????Total: FORMTEXT ?????Total RRSP or RRIF: FORMTEXT ?????NOTE 15: Registered Pension PlanDefined benefitsParticipantContribution ratePension accumulation rateEarnings subject to contributions$Current value $Other features1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other relevant information: FORMTEXT ?????Defined contributionParticipantContributionrateEmployer contribution rateEarnings subject to contributions$Market value $Other features1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Investment characteristics: FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Investment characteristics: FORMTEXT ?????NOTE 16: Voluntary Retirement Savings Plan (VRSP), Locked-In Retirement Account (LIRA) or Life Income Fund (LIF)LIQUID SECURITIESSavings bondsIssuerSeriesInterest rateMaturityFace value$Accrued value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte589+Texte595) 0 FORMTEXT ?????Term deposits or (Guaranteed investment certificates) maturing in less than 1 yearFinancial institutionDate of depositDate of maturityInterest rateAccrued value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte601+Texte606+Texte611+Texte616) 0 FORMTEXT ?????Bonds maturing in less than 1 yearIssuerDate of acquisitionCost of acquisition$Interest rateMaturityMarket value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte623+Texte629+Texte635) 0 FORMTEXT ?????Money market mutual fundsDescriptionDate of acquisitionMERACB$Number of unitsMarket value $Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Other liquid securities FORMTEXT ?????Total: FORMTEXT ?????FIXED INCOME SECURITIESTerm deposits or guaranteed investment certificatesFinancial institutionDate of depositDate of maturityInterest rateAccrued value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????BondsIssuerDate of acquisitionCost of acquisition$Interest rateMaturityMarket value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Stripped bondsIssuerDate of acquisitionCost of acquisition$Rate of returnMarket value$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte641+Texte646) 0 FORMTEXT ?????Redeemable preferred sharesDescriptionDate of acquisitionACB$Rate of returnMaturityQuantityMarket value$Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Fixed income mutual fundsDescriptionDate of acquisitionMER$ACB$Nomber of unitsMarket value$Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ?????Other fixed income securities FORMTEXT ?????Total: FORMTEXT ?????GROWTH SECURITIESCommon sharesDescriptionDate of acquisitionACB $Annual dividendQuantityMarket value$Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte674*Texte675) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte681*Texte682) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte688*Texte689) 0 FORMTEXT ?????4) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte695*Texte696) 0 FORMTEXT ?????Total?; FORMTEXT =(Texte676+Texte683+Texte690+Texte697) 0,00 $ FORMTEXT ?????Growth mutual fundsDescriptionDate of acquisitionMERACB$Number of unitsMarket value $Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte736*Texte737) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte743*Texte744) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte750*Texte751) 0 FORMTEXT ?????4) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte750*Texte751) 0 FORMTEXT ?????Total: FORMTEXT =(Texte738+Texte745+Texte752+Texte759) 0,00 $ FORMTEXT ?????Income trustsDescriptionDate of acquisitionACB$Annual distributions $QuantityMarket value $Total$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte652*Texte653) 0 FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte659*Texte660) 0 FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT =(Texte666*Texte667) 0 FORMTEXT ?????Total: FORMTEXT =(Texte654+Texte661+Texte668) 0,00 $ FORMTEXT ?????Other growth securities FORMTEXT ?????Total: FORMTEXT ?????Total LIRA or LIF: FORMTEXT ?????NOTE 17: Registered Education Savings Plan or Registered Disability Savings Plan FORMTEXT ?????Note:The RESP should only appear in the subscriber’s personal balance sheet and the value is equal to contributions made. The total value of the RDSP should appear in the beneficiary’s personal balance sheet.NOTE 18: Québec Pension PlanClientAccrued pension at age 65 Discount rateLife expectancyCurrent value$Before 65 65 and + FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments: FORMTEXT ?????NOTE 19: Accounts payableDescriptionMaturity dateInterest rateAmount$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte847+Texte851+Texte855+Texte859+Texte863) 0 FORMTEXT ?????NOTE 20: Personal loansDescriptionDate of loanDate of maturityPayments$Interest rateOriginal amount$Balance$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT =(Texte871+Texte878+Texte885+Texte892+Texte899) 0 FORMTEXT ?????NOTE 21: Mortgage loansLenderDescriptionDate of loanDate of maturityPayments$AmortizationFrequency Interest rateOriginal amount$Balance$1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????4) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total FORMTEXT ?????NOTE 22: Future income taxesClient 1AssetFMV$Estimated tax rateFuture income tax$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Client 2AssetFMV$Estimated tax rateFuture income tax$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????QCDD-A-003Data Collection QuestionnaireNOTE 23: Life, disability and other insurance contracts*You can insert your logo here to personalize this document. This document was created for informational purposes only. The IQPF can not be held responsible for errors or losses incurred following its use.PAGE \* MERGEFORMAT42Life insuranceIssuerUnderwriting yearType of contractOwnerAdherentInsuredBeneficiary$Annual premium$Cash surrender value$Adjusted cost base$Capitalization fundDeath benefitPayer FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments: FORMTEXT ?????Disability insuranceSalary (group insurance)Issuer Premium$Waiting periodMonthly income$Taxation of benefits Duration of benefits %indexation Profession protected for (years) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments: FORMTEXT ?????Income lossIssuerUnderwriting yearPremium $Waiting periodMonthly income $Duration of benefits% indexationProfession protected for (years) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments: FORMTEXT ?????*You can insert your logo here to personalize this document. This document was created for informational purposes only. The IQPF can not be held responsible for errors or losses incurred following its use.PAGE \* MERGEFORMAT43QCDD-A-003Data Collection QuestionnaireOverheadIssuerUnderwriting yearPremium$Waiting periodMonthly protection$Duration of benefitsOther features FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments: FORMTEXT ?????Critical illness, long-term care insurance and other insurance coverageIssuerUnderwriting yearPremium$Insured capital$Illnesses covered FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Comments: FORMTEXT ?????NOTE 24: Legal documents FORMTEXT ?????NOTE 25: Tax information FORMTEXT ?????NOTE 26: Contractual commitments FORMTEXT ?????NOTE 27: Contingencies FORMTEXT ?????NOTE 28: Employee stock program FORMTEXT ?????NOTE 29: Events subsequent to the balance sheet date FORMTEXT ?????APPENDIX BBudgetname: FORMTEXT ?????projected budget for the year FORMTEXT ?????EXPENSESClient 1$Client 2$Total$FoodGroceries FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Restaurant FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Subtotal FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????AccommodationsRent, mortgage payment FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Maintenance and repairs FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Insurance premiums (home and contents) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Property and school taxes FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Heat, electricity, water FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Phone, cable, internet FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Subtotal FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Household operationsDomestic help, maintenance FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Child care FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Animal expenses FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Cleaning products FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Yard work FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Subtotal FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Furnishings and equipment FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Clothing (purchases, cleaning) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Transportation costsAutomobile purchase (cash) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Loan payments FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Insurance, permits FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Maintenance and repairs FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Gas and oil FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Parking FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Public transit FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Subtotal FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Health careHealth, dental insurance premiums, etc. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Non-refundable medical expenses FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Subtotal FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Personal careHair care, aesthetician, beauty products FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Supplies and other services FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Subtotal FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Leisure and entertainmentPleasure vehicles FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Sports, camping FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Shows, outings FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Books, newspapers, CDs, DVDs, photos, etc. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Collections, crafts FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Vacations, trips FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Subtotal FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EducationTuition FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Books, supplies FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Subtotal FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Contributions, donations, gifts FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Tobacco and alcohol FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Debt repayment (other than car and mortgage) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Income taxes (federal and provincial) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Financial securityLife insurance FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Disability insurance (income insurance) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Accident insurance, liability insurance, etc. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Drug insurance FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Pension plan contributions FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Subtotal FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Miscellaneous expensesFinancial fees FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Professional fees FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Union or professional dues FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Lottery tickets FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Charitable donations FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Subtotal FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????TOTAL EXPENSES FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????APPENDIX CDetermination of after-tax income available and cost of livingYear: FORMTEXT ?????Name: FORMTEXT ?????Client 1Client 2Total$$$Sources of incomeEmployment income FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Employment or self-employment income (net) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Rental income FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Investment income FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Support payments received (paid) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Annuities and other pensions FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other income FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total gross income FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Income taxes and contributionsQPP or CPP contributions FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Employment insurance contributions FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????QPIP contributions FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Pension plan contributions FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Provincial taxes FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Federal taxes FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total taxes and contributions FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Income available FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Less: Non-RRSP savings FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????RRSP contributionsChange in cash and debt FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Cost of living FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????APPENDIX DEstate statement as at FORMTEXT ?????Death of the client 1$Death of the Client 2$Simultaneous death$Net worth according to balance sheet FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Plus:Life insurance - FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????- FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????- FORMTEXT ?????- FORMTEXT ?????Insured liabilities FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Future income taxes FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Sub-total: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Less:Life insurance cash surrender value FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Death-related expenses FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Taxes payable on death (note 1) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Specific bequests FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Charitable donations FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Subtotal: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????ESTATE ASSETS FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Plus: Sums received by heirs as beneficiaries FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Less: Income taxes assumed by heirs FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Value transferred to universal heirs FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????NOTE 1: Taxes payable on death a) Death of the client 1DescriptionIncome (loss) $Capital gain (loss)$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ????? FORMTEXT ?????×50% = FORMTEXT ?????Taxable income FORMTEXT ?????Tax rate: FORMTEXT ?????Income taxes: FORMTEXT ?????Charitable donations: FORMTEXT ????? × rates applicable to the donationTax credit for charitable donations: FORMTEXT ?????Income taxes payable on death: FORMTEXT ?????b) Death of the client 2DescriptionIncome (loss) $Capital gain (loss)$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ????? FORMTEXT ?????×50% = FORMTEXT ????? FORMTEXT ?????Taxable income FORMTEXT ?????Tax rate: FORMTEXT ?????Income taxes: FORMTEXT ?????Charitable donations: FORMTEXT ????? × rates applicable to the donationTax credit for charitable donations: FORMTEXT ?????Income taxes payable on death: FORMTEXT ?????c) Simultaneous deathDescriptionIncome (loss) $Capital gain (loss)$ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total: FORMTEXT ????? FORMTEXT ????? ×50% = FORMTEXT ?????Taxable income FORMTEXT ?????Tax rate: FORMTEXT ?????Income taxes: FORMTEXT ?????Charitable donations: FORMTEXT ????? × rates applicable to the donationTax credit for charitable donations: FORMTEXT ?????Income taxes payable on death: FORMTEXT ?????APPENDIX ECash position of the estate as at FORMTEXT ?????Client 1$Client 2$Simultaneous death $Cash and near-cash assets according to personal balance sheet FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Plus:Life insurance FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Registered retirement savings FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Subtotal: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Less:Liability to be repaid FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Cash surrender value – life insurance FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Death-related expenses FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Taxes payable on death FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Specific bequests of cash or near-cash securities FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Charitable donations of cash or near-cash securities FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????CASH SURPLUS (DEFICIT) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Plus: Sums received by heirs as beneficiaries FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Less: Income taxes assumed by heirs FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Cash available for universal heirs FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????APPENDIX FRisk tolerance questionnaire Name: FORMTEXT ?????In general, how would your best friend describe you as a risk taker? A real gambler Willing to take risks after completing adequate research CautiousA real risk avoider You are on a TV game show and can choose one of the following. Which would you take? $1,000 in cash50% chance at winning $5,000 A 25% chance at winning $10,000 A 5% chance at winning $100,000 You have just finished saving for a “once-in-a-lifetime” vacation. Three weeks before you plan to leave, you lose your job. You would:Cancel the vacation Take a much more modest vacation Go as scheduled, reasoning that you need the time to prepare for a job search Extend your vacation, because this might be your last chance to go first-classIf you unexpectedly received $20,000 to invest, what would you do? Deposit it in a bank account, money market account, or an insured CD?Invest it in safe high-quality bonds or bond mutual funds Invest it in stocks or stock mutual funds In terms of experience, how comfortable are you investing in stocks or stock mutual funds? Not at all comfortable Somewhat comfortableVery comfortableWhen you think of the word “risk,” which of the following words comes to mind first? LossUncertaintyOpportunityThrillSome experts are predicting prices of assets such as gold, jewels, collectibles, and real estate (hard assets) to increase in value; bond prices may fall, however, experts tend to agree that government bonds are relatively safe. Most of your investment assets are now in high interest government bonds. What would you do? Hold the bonds Sell the bonds, put half the proceeds into money market accounts, and the other half into hard assets Sell the bonds and put the total proceeds into hard assets Sell the bonds, put all the money into hard assets, and borrow additional money to buy moreGiven the best and worst case returns of the four investment choices below, which would you prefer? $200 gain best case; $0 gain/loss worst case $800 gain best case; $200 loss worst case $2,600 gain best case; $800 loss worst case $4,800 gain best case; $2,400 loss worst case In addition to whatever you own, you have been given $1,000. You are now asked to choose between: A sure gain of $500 A 50% chance to gain $1,000 and a 50% chance to gain nothing.In addition to whatever you own, you have been given $2,000. You are now asked to choose between: A sure loss of $500 A 50% chance to lose $1,000 and a 50% chance to lose nothing Suppose a relative left you an inheritance of $100,000, stipulating in the will that you invest ALL the money in ONE of the following choices. Which one would you select? A savings account or money market mutual fundA mutual fund that owns stocks and bonds A portfolio of 15 common stocks Commodities like gold, silver, and oil If you had to invest $20,000, which of the following investment choices would you find most appealing? 60% in low-risk investments 30% in medium-risk investments 10% in high-risk investments 30% in low-risk investments 40% in medium-risk investments 30% in high-risk investments10% in low-risk investments 40% in medium-risk investments 50% in high-risk investmentsYour trusted friend and neighbour, an experienced geologist, is putting together a group of investors to fund an exploratory gold mining venture. The venture could pay back 50 to 100 times the investment if successful. If the mine is a bust, the entire investment is worthless. Your friend estimates the chance of success is only 20%. If you had the money, how much would you invest? NothingOne month’s salaryThree months’ salarySix months’ salarySCORING1. a = 4; b = 3; c = 2; d = 16. a = 1; b = 2; c = 3; d = 410. a = 1; b = 32. a = 1; b = 2; c = 3; d = 47. a = 1; b = 2; c = 3; d = 411. a = 1; b = 2; c = 3; d = 43. a = 1; b = 2; c = 3; d = 48. a = 1; b = 2; c = 3; d = 412. a = 1; b = 2; c = 34. a = 1; b = 2; c = 39. a = 1; b = 313. a = 1; b = 2; c = 3; d = 45. a = 1; b = 2; c = 3??According to John Grable: “Average and mean scores were relatively constant over time, ranging from 25 to 27 after addition.” Even though it is not an official scoring system, it appears that the following scores are reliable with regard to risk tolerance: 18 or less=Low19 to 22=Below average23 to 28=Average or moderate29 to 32=Above average33 and over=HighSource: J.E. Grable and R. H. Lyton, “Financial Risk Tolerance Revisited: The Development of a Risk Assessment Instrument,” (1999) 8 Financial Services Review 163. Reproduced with permission.For the purposes of applying John Grable’s risk tolerance measure, the following chart was developed by the IQPF to convert the score to a target asset allocation:ScoreFixed incomeGrowth shares13 100%0%14 to 1580%20%16 to 1870%30%19 to 2260%40%23 to 2850%50%29 to 3240%60%33 and over30%70%The purpose of this grid is not just to establish the investor profile but to offer a guide on asset allocation that will reflect the client’s risk tolerance. Remember that risk tolerance is just one factor to take into consideration in developing a target asset distribution. Financial planners should also bear in mind the client’s goals, investment horizon, investment knowledge and financial capacity to take risk.APPENDIX GData to enter in your retirement projection softwareType of incomeOwnerAnnual income$Indexation before start%StartSubsequent indexation%EndSalaryClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????SalaryClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Business incomeClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Business incomeClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????QPPClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????QPPClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????OASClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????OASClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????RPPClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????RPPClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????RPPClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????RPPClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????RentalClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????RentalClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????DividendClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????DividendClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Non-taxableClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Non-taxableClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Retirement allowanceClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Retirement allowanceClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Client 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Client 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Type of expenseAmount$FrequencyAnnual indexation before start%StartSubsequent annual indexation%EndCost of living FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Mortgage FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Account typeHolderContribution rights$Locked-in amount$Market value$Return%RRSPClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????RRSPClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????TFSAClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????TFSAClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????DC RPP, VRSP, LIRAClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????DC RPP, VRSP, LIRAClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Net capital losses$ACB$Non-registeredClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Non-registeredClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Annual savingsOwnerPayer$Annual amount$StartIndexation%EndRRSPClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????RRSPClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????DC RPP or VRSPClient 1Employee FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Employer FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????DC RPP or VRSPClient 2Employee FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Employer FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????DB RPPClient 1Employee FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????DB RPPClient 2Employee FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????TFSAClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????TFSAClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Non-registeredClient 1 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Non-registeredClient 2 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Locked-in*You can insert your logo here to personalize this document. This document was created for informational purposes only. The IQPF can not be held responsible for errors or losses incurred following its use.PAGE \* MERGEFORMAT62QCDD-A-003Data Collection QuestionnaireAPPENDIX HAsset allocation analysis chartName: FORMTEXT ?????Unregistered investmentsRegistered investmentstotal investmentsTotal valueAfter-tax returnTotal valueReturn Combined totalAllocationProfileRiskLiquidity$%$$%$$%%Fixed-income securitiesShort term FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Medium term FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Long term FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Total FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Growth sharesCanadian FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN International FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Total FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Speculative securitiesCanadian FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN International FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Total FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Income-producing assetsShares of private corporation FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Real property FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Other FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Total FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Total FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN APPENDIX IEstate planning analysisCapital required at deathDeath of the Client 1$Death of the Client 2$Family cost of living FORMTEXT ????? FORMTEXT ?????Less:Expenses of the deceased FORMTEXT ????? FORMTEXT ?????Payments for mortgages repaid at death FORMTEXT ????? FORMTEXT ?????Cost of living after the death FORMTEXT ????? FORMTEXT ?????Income available after the deathSurvivor’s income after taxes and savings FORMTEXT ????? FORMTEXT ?????QPP survivor’s pension after taxes FORMTEXT ????? FORMTEXT ?????Other income FORMTEXT ????? FORMTEXT ?????Total income available after the death FORMTEXT ????? FORMTEXT ?????Annual surplus or shortfall (Income available – cost of living after the death) FORMTEXT ????? FORMTEXT ?????Capital required1 FORMTEXT ????? FORMTEXT ?????Less:- Cash available for universal heirs FORMTEXT ????? FORMTEXT ?????- Current value of QPP orphan’s pension FORMTEXT ????? FORMTEXT ?????- Current after-tax value of assets to be sold FORMTEXT ????? FORMTEXT ?????Additional life insurance required FORMTEXT ????? FORMTEXT ?????Capital required to achieve net indexed annual incomeBGN (the income must be available at the beginning of the period)FV = $0PMT = Annual shortfallI/Y =After-tax rate of return on investments corrected for inflation: { ( 1 + after-tax return) / (1 + expected inflation rate) } – 1n = Number of years when survivors will need the income.PV = Capital required APPENDIX JProfessional service contract (template)City, dateToAddressSubject: Financial planningRef. no.: File No.____________Dear Mr./Ms. Client,Further to our recent meeting, we would like to offer you our services to prepare an integrated personal financial plan, develop an action plan and formulate recommendations that will allow you to meet the financial goals we discussed together.We are authorized to act in the following fields: financial planning, individual insurance, group savings, (specify other disciplines). We also offer the following financial products and services: financial planning, life and disability insurance, mutual funds (specify).In particular, our services include an examination of the following: Personal and family situation Financial situation Tax situation Protection situation Retirement situation Situation at deathFor each of the areas mentioned above, we take into consideration the financial, accounting and tax consequences, both in the analysis of the current situation and in the formulation of recommendations.ConsiderationFor these services, you agree to pay us the sum of ______________ dollars for every hour of work undertaken in relation to this contract, which we estimate to be approximately __________ hours.The appropriate taxes (GST, QST), along with any fees and expenses incurred, will be added to this price.You agree to make a down payment of __________ dollars, deductible from the total sum invoiced, the balance of which will be due thirty (30) days after invoicing. Interest of ________% will be levied on any amount unpaid after 30 days.The present contract may be rescinded at any time. If you rescind the contract, you agree to pay for any hours worked and any expenses incurred up to the date of revocation. Charges and conditionsAs your financial planners, we agree to provide you with a written report that covers all of the items listed below, including analysis charts and recommendations where relevant.We will inform you of the progress of our work and submit the final report to you in about _________________________. We will then invite you to a meeting at which we will explain our analysis and our recommendations. If additional work is required, you will be informed and additional fees may be charged.You should understand that the report provided within the scope of this contract may require regular updating. The fees for periodically updating the file can be agreed upon at a later date.You agree to respond to all questions and to provide the documents required for the execution of the contract, whether they are held by you or by third parties. To this end, you agree to immediately sign letters authorizing us to obtain information directly from third parties. The information obtained from these third parties will remain confidential at all times and will not be used for any other purposesYou understand that our responsibility is limited by access to the documents provided and to their content. The recommendations are based on assumptions and must be updated from time to time to take account of your social and family situation, changes in tax and other laws, as well as developments in the economy and fluctuating markets. Should the implementation of the recommendations in the report require the services of specialists, our co-ordination and integration fees will be charged over and above their fees.Sincerely,(Signature)Name of financial planner (BLOCK LETTERS)Name of financial institution or firmI, first and last name of client , accept the terms of the present service contract and agree to meet all the conditions outlined.Signed at, thisth day of(month, year)(Signature)Client’s name (BLOCK LETTERS)Note:If remuneration is to be based on commissions on financial products sold, this must be clearly indicated. In such a case, before the purchase of any financial products, it is recommended that an alternative type of remuneration be provided, such as an hourly rate, in case the contract is rescinded, if the financial planner wishes. Financial planners must also disclose in writing to the client any other form of compensation they will receive for the products sold or services rendered, if such is the case. The content of this contract and this note does not provide an exhaustive statement of all the obligations of the financial planner, who is responsible for ensuring that the contract concluded with the client and the presentation of the financial planner’s services comply with the rules that govern the profession. ................
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