Personal Financial Statement

Personal Financial Statement — MECA Capital Advisory

Confidential — For Advisory Use Only All fields marked with blue text are input fields

Please complete all sections accurately. Totals in Sections 4–7 calculate automatically as you enter values. Once complete, click Submit at the bottom — your information will be sent securely to MECA Capital Advisory.

1 Personal Information

Full Legal Name

Date of Birth

SIN (Optional)

Marital Status

Home Address

City / Province

Postal Code

Years at This Address

2 Contact Information

Home Phone

Mobile Phone

Email Address

Preferred Contact Method

3 Employment & Income Information

Employer Name

Job Title / Position

Employer Address

Years Employed Here

Employment Type

Work Phone

Annual Gross Salary ($)

Net Monthly Income ($)

Other Income Source

Other Income Amount ($)

Business Name (if self-employed)

Business Role / % Ownership

4 Assets

Asset	Market Value ($)	Current / Cash Value ($)
Primary Residence
Secondary / Rental Property
Vehicle(s)
Registered Savings (RRSP / TFSA)
Non-Registered Investments
Cash & Bank Accounts
Business Ownership Interest
Life Insurance (Cash Surrender Value)
Receivables / Money Owed to You
Other Assets (describe)
TOTAL ASSETS	$0.00	$0.00

5 Liabilities

Liability	Outstanding Balance ($)	Monthly Payment ($)
Mortgage — Primary Residence
Mortgage — Other Property
Vehicle Loan(s)
Personal Line of Credit
Business Line of Credit
Credit Card Balances
Student Loans
Tax Owing (CRA)
Other Loans / Debts (describe)
Guarantees / Contingent Liabilities
TOTAL LIABILITIES	$0.00	$0.00

6 Net Worth Summary

Total Assets (Market Value)	$0.00
Total Liabilities (Outstanding Balance)	$0.00
NET WORTH (Assets − Liabilities)	$0.00

7 Monthly Cash Flow Summary

Total Monthly Income (Net)
Total Monthly Debt Payments	$0.00
Total Monthly Living Expenses (estimated)
MONTHLY SURPLUS / (DEFICIT)	$0.00

8 Declaration & Signature

I/We certify that the information provided in this Personal Financial Statement is true, complete, and accurate to the best of my/our knowledge. I/We authorize MECA Capital Advisory to share this information with authorized parties as outlined in the signed Non-Disclosure & Confidentiality Agreement.

Signature of Applicant

Date

Print Name

Co-Applicant Signature

Your information is transmitted securely and handled in accordance with MECA’s Non-Disclosure Agreement.

✓ Successfully Submitted

Thank you. MECA Capital Advisory has received your Personal Financial Statement and will be in touch shortly.

Personal Financial Statement

Personal Financial Statement

✓ Successfully Submitted

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