Form 4 — Trustee Licence

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(Subsection 13(1) of the Act)

This form may not be completed online. It is provided here for reference purposes only.

This is to certify that

Space to insert name of trustee

is licensed to act as a trustee in the Bankruptcy District(s) of

First space to insert the bankruptcy district(s)

Second space to insert the bankruptcy district(s)

Third space to insert the bankruptcy district(s)

Space to insert signature of Superintendent of Bankruptcy
Superintendent of Bankruptcy

Date: Space to insert year of signature / Space to insert month of signature / Space to insert day of signature
YearMonthDay

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