An example for the Step 1 page of Free Debt Evaluation Survey |
| Name of specific creditor | Dollar amount of individual unsecured debt | Date of last payment or date of default (YYYY/MM) |
| Canadian Tire credit card | $8,000 |
2008/03 |
| Sears credit card | 4,000 |
2008/01 |
| CIBC Aerogold VISA credit card | 12,000 |
2007/12 |
| Royal Bank line of credit | 20,000 |
2007/06 |
| Bell Mobility | 800 |
2006/01 |
| Bally’s Total Fitness | 1,200 |
2005/12 |
| AAA Garage Doors | 1,800 |
2004 |
| Portfolio Management Canada Inc. | 3,000 |
1999 |
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