Medical or dental insurance coverage: Is medical or dental insurance coverage for your children available to you through your employer or otherwise at a reasonable rate? Yes No Do you have medical or dental insurance coverage for your children? Yes No ADJUSTMENTS TO ANNUAL INCOME Give the current actual amount if you know it or can find it out. If you find out, give your best estimate. can’t Refer to Schedule III of the Federal Child Support Guidelines. Section numbers included below are Schedule III Federal Child Support Guidelines. references to of the If necessary attach an extra sheet to show calculations. Replacements in income: Recalculate the annual income shown as amount A above, after making the following (Where applicable) replacements: Total Income (A): Replace taxable amount of dividends from Canadian corporations (line 6) -- with the actual amount of dividends: (See s.5) Replace taxable capital gains (line 10) with the actual amount of capital gains realized in excess of the actual capital losses: -- Gains: - Losses: = Excess: Recalculated annual income: A1 = Deductions from income: 1. Union, professional association or like dues + (if you are an employee): s.1 2. Other employment expenses: s.1 (Specify) + + 3. Taxable amount of child support I receive: + s.2 4. Spousal support I receive from the other party: + s.3(1) 5. Social assistance I receive for other members of my household: + s.4 6. Actual amount of business investment losses suffered during the year: + s.7 7. Carrying charges and interest expenses paid by me and deductible under the Income Tax Act: + s.8 8. Prior period earnings included in self-employment income, net of reserves: + s.10 9. Portion of partnership or sole proprietorship income property required for capitalization: + s.12 Total deductions from income: B = Additions to income: 10. Payments to non-arm’s + s.9 length persons: 11. Allowable capital cost allowance with respect to real property: + s.11 12. Value of exercised employee stock options in Canadian-controlled private corporations: + s.13 Total additions to income: C =
Medical or dental insurance coverage: Is medical or dental insurance coverage for your children available to you through your employer or otherwise at a reasonable rate? Yes No Do you have medical or dental insurance coverage for your children? Yes No ADJUSTMENTS TO ANNUAL INCOME Give the current actual amount if you know it or can find it out. If you can’t find out, give your best estimate. Refer to Schedule III of the Federal Child Support Guidelines. Section numbers included below are references to Schedule III of the Federal Child Support Guidelines. If necessary attach an extra sheet to show calculations. Replacements in income: (Where applicable) Recalculate the annual income shown as amount A above, after making the following replacements: Total Income (A): Replace taxable amount of dividends from Canadian corporations (line 6) with the actual amount of dividends: (See s.5) -- Replace taxable capital gains (line 10) with the actual amount of capital gains realized in excess of the actual capital losses: Gains: - Losses: = Excess: -- Recalculated annual income: A1 = Deductions from income: 1. Union, professional association or like dues (if you are an employee): s.1 + 2. Other employment expenses: s.1 (Specify) + + 3. Taxable amount of child support I receive: s.2 + 4. Spousal support I receive from the other party: s.3(1) + 5. Social assistance I receive for other members of my household: s.4 + 6. Actual amount of business investment losses suffered during the year: s.7 + 7. Carrying charges and interest expenses paid by me and deductible under the Income Tax Act: s.8 + 8. Prior period earnings included in self-employment income, net of reserves: s.10 + 9. Portion of partnership or sole proprietorship income property required for capitalization: s.12 + Total deductions from income: B = Additions to income: 10. Payments to non-arm’s length persons: s.9 + 11. Allowable capital cost allowance with respect to real property: s.11 + 12. Value of exercised employee stock options in Canadian-controlled private corporations: s.13 + Total additions to income: C =