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Debtor's information
Salutation
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Miss
Ms
Mrs
Mr
Dr
First Name
Middle Name
Last Name
Alias/AKA
Date of Birth
SIN
Gender
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Male
Female
Other
I prefer not to answer
Marital Status
Uncategorized
Date of change of marital status
# people in household
# people under 17 y.o.
Highest level of education completed
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0-8 years
Some High School
High School diploma
Some Post-secondary
Post Secondary certificate
University degree
Cause of Insolvency:
Addiction
Business Failure
Co-signed debt
Financial Mis-management
Foreclosure
Other
Other
Spouse's information
Salutation
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Miss
Ms
Mrs
Mr
Dr
First Name
Middle Name
Last Name
Alias/AKA
Date of Birth
SIN
Gender
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Male
Female
Other
I prefer not to answer
Highest level of education completed
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0-8 years
Some High School
High School diploma
Some Post-secondary
Post Secondary certificate
University degree
Address
Living Address
At address since
Mailing address (if different)
Debtor's contact information
Phone
Cellphone
Email
Spouse's contact information
Phone
Cellphone
Email
Confirmation
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I/we hereby certify that the information contained in this application is true and complete in every respect and fully discloses the state of my/our affairs. In addition, I/we consent to the use of the information contained in this application to be used for the preparation of any tax returns related to my/our insolvency, and I/we shall hold harmless any employee of Laura Gyldenbjerg & Associates Inc. for any errors by relying on this information.
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