PERSONAL NET WORTH STATEMENT

Not for use by Corporations. Include Personal Assets and Debits only.
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ASSETS

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Land and buildings at costs:
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LIABILITIES

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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
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I/we agree that all the information provided on this form may be used and disclosed by the Program for the purpose of assessing this application to become a member of AHW, and for re-assessing such membership from time to time. AHW will provide a copy of its Privacy Policy upon request.