daniel@dmdivorcemediation.ca
905-808-2521
PRE-MEDIATION INTERVIEW FORM
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Inheritance
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Location
Oakville
Burlington
Blog
Financial Disclosure Agreement
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Financial Disclosure Agreement
Details Needed for Separation Agreement
Please enable JavaScript in your browser to complete this form.
Date of cohabitation
DD
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MM
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YYYY
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2015
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1932
1931
1930
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1925
1924
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1921
1920
Date of marriage
DD
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MM
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2
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10
11
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YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
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1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
City of marriage
Date of separation
DD
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MM
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3
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7
8
9
10
11
12
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YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
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1928
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1926
1925
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1923
1922
1921
1920
Children 1
Full Name
Date of birth
DD
1
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5
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14
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22
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24
25
26
27
28
29
30
31
/
MM
1
2
3
4
5
6
7
8
9
10
11
12
/
YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Children 2
Full Name
Date of birth
DD
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31
/
MM
1
2
3
4
5
6
7
8
9
10
11
12
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YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Children 3
Full Name
Date of birth
DD
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18
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22
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26
27
28
29
30
31
/
MM
1
2
3
4
5
6
7
8
9
10
11
12
/
YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Children 4
Full Name
Date of birth
DD
1
2
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18
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22
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24
25
26
27
28
29
30
31
/
MM
1
2
3
4
5
6
7
8
9
10
11
12
/
YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Partie one
Full name ( first middle and last)
Your Email
Date of birth
DD
1
2
3
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5
6
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10
11
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13
14
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25
26
27
28
29
30
31
/
MM
1
2
3
4
5
6
7
8
9
10
11
12
/
YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Occupation
Name of your lawyer
Lawyer's Email
Lawyer's Phone
Name of the accountant
Accountant's Email
Accountant's Phone
Gross Income
Gross Income
Gross Income
Gross Income
All assets registered in your name (except houses)
Example CIBC # 6593 ( last 4 digits) $ 1500
All assets registered in your name (except houses)
All assets registered in your name (except houses)
All assets registered in your name (except houses)
All assets registered in your name (except houses)
All assets registered in your name (except houses)
All assets registered in your name (except houses)
All assets registered in your name (except houses)
All assets registered in your name (except houses)
All assets registered in your name (except houses)
Address and fair market value of the property /properties owned by you
Address and fair market value of the property /properties owned by you
Address and fair market value of the property /properties owned by you
Address and fair market value of the property /properties owned by you
All debt registered in your name (Including credit cards)
Example VISA 8986 $ 2390
All debt registered in your name (Including credit cards)
All debt registered in your name (Including credit cards)
All debt registered in your name (Including credit cards)
All debt registered in your name (Including credit cards)
All debt registered in your name (Including credit cards)
All debt registered in your name (Including credit cards)
Private pension plan name and accrued monthly benefit.
Private pension plan name and accrued monthly benefit.
Private pension plan name and accrued monthly benefit.
Life insurance name amount and beneficiary
Life insurance name amount and beneficiary
Life insurance name amount and beneficiary
Life insurance name amount and beneficiary
Specify asset/s and value/s inherited or gifted before marriage
Specify asset/s and value/s inherited or gifted before marriage
Specify asset/s and value/s inherited or gifted before marriage
Specify asset/s and value/s inherited or gifted before marriage
Specify assets/s and value/s inherited or gifted during marriage.
Specify assets/s and value/s inherited or gifted during marriage.
Specify assets/s and value/s inherited or gifted during marriage.
Specify assets/s and value/s inherited or gifted during marriage.
Partie two
Full name ( first middle and last)
Email
Date of birth
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
MM
1
2
3
4
5
6
7
8
9
10
11
12
/
YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Occupation
Name of your lawyer
Lawyer's Email
Lawyer's Phone
Name of the accountant
Accountant's Email
Accountant's Phone
Gross Income
Gross Income
Gross Income
Gross Income
All assets registered in your name (except houses)
Example CIBC # 6593 ( last 4 digits) $ 1500
All assets registered in your name (except houses)
All assets registered in your name (except houses)
All assets registered in your name (except houses)
All assets registered in your name (except houses)
All assets registered in your name (except houses)
All assets registered in your name (except houses)
All assets registered in your name (except houses)
All assets registered in your name (except houses)
Address and fair market value of the property /properties owned by you
Address and fair market value of the property /properties owned by you
Address and fair market value of the property /properties owned by you
Address and fair market value of the property /properties owned by you
All debt registered in your name (Including credit cards)
Example VISA 8986 $ 2390
All debt registered in your name (Including credit cards)
All debt registered in your name (Including credit cards)
All debt registered in your name (Including credit cards)
All debt registered in your name (Including credit cards)
All debt registered in your name (Including credit cards)
All debt registered in your name (Including credit cards)
Private pension plan name and accrued monthly benefit.
Private pension plan name and accrued monthly benefit.
Private pension plan name and accrued monthly benefit.
Life insurance name amount and beneficiary
Life insurance name amount and beneficiary
Life insurance name amount and beneficiary
Life insurance name amount and beneficiary
Specify asset/s and value/s inherited or gifted before marriage
Specify asset/s and value/s inherited or gifted before marriage
Specify asset/s and value/s inherited or gifted before marriage
Specify asset/s and value/s inherited or gifted before marriage
Specify assets/s and value/s inherited or gifted during marriage.
Specify assets/s and value/s inherited or gifted during marriage.
Specify assets/s and value/s inherited or gifted during marriage.
Specify assets/s and value/s inherited or gifted during marriage.
JOINTLY
All assets registered jointly (except houses)
All assets registered jointly (except houses)
All assets registered jointly (except houses)
All assets registered jointly (except houses)
All assets registered jointly (except houses)
All assets registered jointly (except houses)
All assets registered jointly (except houses)
All debt registered jointly Example TD Visa with ( + -) value of $ 4000
All debt registered jointly Example TD Visa with ( + -) value of $ 4000
All debt registered jointly Example TD Visa with ( + -) value of $ 4000
All debt registered jointly Example TD Visa with ( + -) value of $ 4000
All debt registered jointly Example TD Visa with ( + -) value of $ 4000
All debt registered jointly Example TD Visa with ( + -) value of $ 4000
House
All debt registered jointly Example TD Visa with ( + -) value of $ 4000
Specify assets and values of any assets owned at the beginning of relationship and the value
Specify assets and values of any assets owned at the beginning of relationship and the value
Specify assets and values of any assets owned at the beginning of relationship and the value
Specify assets and values of any assets owned at the beginning of relationship and the value
Specify assets and values of any assets inherited or gifted to one of the Parties by a third party
Specify assets and values of any assets inherited or gifted to one of the Parties by a third party
Specify assets and values of any assets inherited or gifted to one of the Parties by a third party
Submit