PERSONAL NET WORTH STATEMENT
Not for use by Corporations. Include Personal Assets and Debits only.
Land and buildings at costs:
TO BE SWORN BEFORE A COMMISSIONER OF OATHS, NOTARY PUBLIC, SOLICITOR OR PERSON LEGALLY
AUTHORIZED TO ADMINISTER AN OATH.
I/We the undersigned swear that the information set out above contains no material misrepresentations or omissions which would adversely affect the acceptance of this document, when making “Application for Registration” with Atlantic Home Warranty (AHW).
SWORN to before me at