Estate Information Summary

Information

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Checkbox for original Original Checkbox for amended Amended

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Estate Information Summary

345 KB, 2 pages

I - COMPLETE THE FOLLOWING IN ALL CASES
PROCEEDING
Checkbox for assignment Assignment
Checkbox for Referral Referral
Checkbox for Bankruptcy order Bankruptcy order
Checkbox for Proposal Proposal
Checkbox for Individual Individual
Checkbox for Corporation Corporation
Checkbox for Income Trust Income Trust
Estate Name
Occupation
Language
 
 
Checkbox for language: English English Checkbox for language: French French Checkbox for language: Other Other, specify
Ind. date of birth
 D
 M
 Y
Previous or current BIA proceeding?
If yes, enter estate number(s)
Indicate if previous bankruptcy
If yes, how many?
 
 
 
 
Check box if this is a previous or a current BIA proceeding Yes
Check box if this not is a previous nor a current BIA proceeding No
Indicate estate number(s)
 
Check box if previously bankrupt Yes
Check box if not previously bankrupt No
indicate number of bankruptcies
 
Address (Street No. and Apt. No.)
Indicate if receivership
DMY
 
Check box for positive receivership Yes Check box for non receivership No
 
City
Province
Postal Code
Home Telephone no.
Work Telephone no.
 
 
 
()
()
E-mail address (if any)
Consumer debts only?
of the total debt
The debtor resides or has carried on
DMY
 
Check box if consumer debts Yes Check box if not only consumer debts No Indicate % of the total business debt %
is business
business at the above address since:
Highest level of education completed by joint bankrupt/debtor: (for statistical purposes only)
Check box if education is from 0 to 8 years 0–8 years
Check box if education is some high school some high school
Check box if education is high school graduate high school graduate
Check box if education is some post-secondary some post-secondary
Check box if education is some post-secondary certificate or diploma post-secondary certificate or diploma
Check box if education is university degree University Degree
Check box if debtor refuses to answer or doesn't know refuses to answer or doesn't know
Joint Estate Name
Occupation
Language
 
 
Checkbox for English language English Checkbox for French language French Checkbox  for other language Other, specify
Ind. date of birth
 D
 M
 Y
Previous or current BIA proceeding?
If yes, enter estate number(s)
Indicate if previous bankruptcy
If yes, how many?
 
 
 
 
Check box if this is a previous or a current BIA proceeding for joint debtor Yes
Check box if this is not a previous nor a current BIA proceeding for joint debtor No
Indicate estate number(s) for joint debtor
 
Check box if  joint debtor is previously bankrupt Yes
Check box if  joint debtor is not previously bankrupt No
Indicate how many bankruptcies joint debtor has
 
E-mail address (if any)
Indicate if receivership
DMY
 
Check box if joint debtor has receivership Yes Check box if joint debtor does not have receivership No
 
Highest level of education completed by joint bankrupt/debtor: (for statistical purposes only)
Check box if Joint debtor's education is from 0 to 8 years 0–8 years
Check box if Joint debtor's education is some high school some high school
Check box if Joint debtor's education is high school graduate high school graduate
Check box if Joint debtor's education is some post-secondary some post-secondary
Check box if Joint debtor's education is some post-secondary certificate or diploma post-secondary certificate or diploma
Check box if Joint debtor's education is university degree University Degree
Check box if joint debtor refuses to answer or doesn't know refuses to answer or doesn't know
II - COMPLETE THE FOLLOWING IF THE DEBTOR HAS GUARANTEED THE DEBTS OF ANOTHER PERSON
Check box if this section do not apply N/A
The debtor is the guarantor of
 
Check box if the debtor is the guarantor of business debts Business debts Check box if the debtor is the guarantor of consumer debts Consumer debts Check box if the debtor is the guarantor of other debts Other specify Indicate nature of other debts
Is the person bankrupt?
Name of persons whose debts are guaranteed
Amount Guaranteed
Name of business if business debts
Yes
No
 
 
 
indicate here if the person is bankrupt
indicate here if the person is not bankrupt
III - COMPLETE THE FOLLOWING IF THE DEBTOR WAS PREVIOUSLY OR IS PRESENTLY IN BUSINESS
Check box if this section do not apply N/A
Trade name(s) if different from the estate name
Place of business
Nature of business
Corporation, partnership or sole proprietorship (specify)
 
 
 
 
Names of the partners if a partnership:
During the past 12 months, what was the maximum number of employees that you employed?
How long have you been in operation under this current legal name?
IV - COMPLETE THE FOLLOWING IF THE DEBTOR IS A CORPORATION, INCLUDING AN INCOME TRUST
Are the corporation's shares or units publicly traded?
Federal Charter?
Check box if the corporation's shares or units are publicly traded Yes Check box if the corporation's shares or units are not publicly traded No
Check box if this is a Federal Charter Yes Indicate charter number
Charter Number
Check box if this is not a Federal Charter No
Names of the Corporation's officers:
Name of person to be examined
Title
Telephone No.
 
 
()
Address (Street No. and Apt. No.)
City
Province
Postal Code
Language
 
 
 
Check box if language is English English Check box if language is French French Check box if language is other, specify Other, specify
During the past 12 months, what was the maximum number of employees that you employed?
How long have you been in operation under this current legal name?
V - TO BE COMPLETED WHEN FILING A CONSUMER PROPOSAL OR AMENDED CONSUMER PROPOSAL
Terms of the Consumer Proposal: (choose one only of A, B, C or D)
A)
 
(number)
payments of
$
for a total of
$
B)
A lump sum
payment of
$
C)
A lump sum
payment of
$
+
 
(number)
payments of
$
for a combined
total of
$
D) Other: please describe terms below
Anticipated Completion Date of Consumer Proposal:
DMY
 
Amount outstanding on
mortgage or hypothec
on principal residence
$
VI - TO BE COMPLETED AND SIGNED BY THE TRUSTEE IN ALL CASES
Creditor's Meeting Suggested Time and Place
DMY
Time
Location
TRUSTEE APPOINTMENT
Licence Number
Name & Licence number of the Trustee or, if a Corporate Trustee, the name &
licence number of the person responsible for the administration of the estate.
Request for an investigation under the Debtor Compliance Referral Program
Check box if request is for an investigation under the DCRP Yes Check box if request is not for an investigation under the DCRP No
If yes, provide reasons for referral
provide reasons for referral
 
A possible conflict of interest situation exists
Check box if this is a possible conflict of interest situation Yes Check box if this is not a possible conflict of interest situation No
If yes, explain
explain if this is a possible conflict of interest
 
Indemnification:
Check box if this is not an indemnification N/A Check box if indemnification represents a deposit Deposit
Check box if indemnification represents a guarantee Guarantee
Name of depositor or guarantorinput name of  depositor or guarantor
 
Amount or extent of indemnity
Indicate amount or extent of indemnity
 
Check box if trustee was absent when file submitted
Trustee absent when file submitted
Amended summary to follow
Signature of Trustee
move to space to insert signature
VII - OFFICIAL RECEIVER USE ONLY
NOTE: QUOTE THIS NUMBER IN ALL FUTURE CORRESPONDENCE
Administration
 
DMY
Type
No. Form number
Check box if this is a summary Summary Check box if this is an ordinary form Ordinary
Date of filing
 
 
Industry
District
Division
 
Licence No. of appointed Trustee
Resp. O.R.
 
 
 
Court No.
Check box if licence number is same as above As above Check box if licence number is different Other Indicate other licence number
 
Assets
Liabilities
Security
 
Creditor's Meeting
Date D MY
Time
Location
Chairperson
Check box if creditor's meeting is same as above As above Check box if creditor's meeting is different than above Or
 
 
 
 
Debtor Examination
Date D MY
Time
Location
Check box if debtor examination is same as above As above Check box if debtor examination is different than above Or
 
 
 
Official Receiver Comments
Note to file
Check box if Note to file is A A Check box if Note to file is B B Check box if Note to file is CC
Data Processing Initials
 
Official
Receiver's
Initials
Document
Production
Initials
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