PERSONAL WORTH STATEMENT

Pursuant to Regulations 76(1)(b) of the Immigration and Refugee Protection Act and
Regulations, skilled worker applicants must possess a minimum amount of funds for settlement
in Canada, unless they have arranged employment in Canada (ie. a validated offer of
indeterminate employment by Human Resources and Skills Development Canada).

The funds must be:

1. Available and transferrable;

2. Unencumbered by debts or other obligations.

The amount of funds required is calculated by use of the Low Income Cut-Off (LICO) statistic
provided by Statistics Canada. The amount of funds also varies with family size. Currently, the
minimum funds required are:

# OF FAMILY MEMBERS FUNDS REQUIRED

1 CAD$10,833
2 CAD$13,486
3 CAD$16,580
4 CAD$20,130
5 CAD$22,831
6 CAD$25,749
7 CAD$28,668

Complete the attached personal worth statement. Submit it with all supporting documentation
(ie. Bank books, bank statements, property deeds, etc.).

Thank you for your co-operation.

WARNING: Directly or indirectly misrepresenting or withholding material facts that could

induce an error in the administration of the Immigration and Refugee Protection Act will
result in refusal of the application and could have other serious consequences.
 ASSETS
[ 1 ] Current and Savings Accounts [ 2 ] Fixed Deposits

Account Number Amount Maturity Date Amount

(Specify (Specify
Currency) Currency)

TOTAL (in Cdn$): Cdn$ TOTAL (in Cdn $) : Cdn$

[ 3 ] Property *
* Current Property evaluations must be provided at interview.

Complete Address Mortgaged? Market Value

YES (Specify
NO Currency)

TOTAL (in Cdn $): Cdn$

[ 4 ] Stocks, Shares, Bonds and Trading Commodities (metals, etc.)

Item Quantity Value Value

(Specify (in Cdn $)
Currency)

TOTAL (in Cdn$) : Cdn$

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 LIABILITIES
[ 5 ] Mortgages

Complete Address Mortgaged Amount

(Specify Currency)

TOTAL (in Cdn $) : Cdn$

[ 6 ] Personal Debts, Legal Obligations* and Other Liabilities

* Legal obligations refer to any contract or court order requiring payment of any kind (e.g.
alimony, child support, etc.)

Nature of Obligation Amount

(Specify Currency)

TOTAL (in Cdn$) : Cdn$

====================================================

A. Assets : [total of (1) + (2) + (3) + (4)]

_________________________________________________

B. Less Liabilities : [total of (5) + (6)]

___________________________________________________

Equals Net Personal Worth

_________________________________________________________

====================================================

Exchange Rate Used : Cdn $1 = __________

====================================================

I certify that the above is a complete and true statement of my personal worth.

Date : ____________________ Signature : ______________________

 Value of All Assets Already in Canada

Funds to Accompany

Assets to be Transferred Later

TOTAL (in Cdn $) : Cdn$

__________________________________

Signature / Date

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