Form 31—Proof of Claim

For persons to which the 2009 amendments do not apply

PDF and Word versions

Form 31 (PDF)

106 KB, 3 pages

Form 31 (Word)

47 KB, 3 pages

Section 50.1, subsections 65.2(4), 81.2(1), 81.3(8), 81.4(8), 102(2), 124(2), 128(1), and paragraphs 51(1)(e) and 66.14(b) of the Act)


All notices or correspondence regarding this claim must be forwarded to the following address:
Space to insert address Space to insert address Space to insert address Space to insert address

In the matter of the bankruptcy (or the proposal, or the receivership) of Space to insert name of debtor (name of debtor) of Space to insert city and province of debtor (city and province) and the claim of Space to insert creditor name, creditor.

I, Space to insert name of creditor or representative of the creditor (name of creditor or representative of the creditor), of Space to insert city and province of creditor or representative of creditor (city and province), do hereby certify:

  1. That I am a creditor of the above-named debtor (or that I am Space to insert state position or title (state position or title) of Space to insert the first name of the creditor or representative of the creditor Space to insert the last name of the creditor or representative of the creditor (name of creditor or representative of the creditor)).
  2. That I have knowledge of all the circumstances connected with the claim referred to below.
  3. That the debtor was, at the date of bankruptcy (or the date of the receivership, or in the case of a proposal, the date of the notice of intention or of the proposal, if no notice of intention was filed), namely the Space to insert day day of Space to insert month, Space to insert year, and still is, indebted to the creditor in the sum of $ Space to insert amount, as specified in the statement of account (or affidavit) attached and marked Schedule "A", after deducting any counterclaims to which the debtor is entitled. (The attached statement of account or affidavit must specify the vouchers or other evidence in support of the claim.)
  4. (Check and complete appropriate category.)
    1. Checkbox for unsecured claim amount unsecured claim of $ Space to insert amount

      (other than as a customer contemplated by Section 262 of the Act)

      That in respect of this debt, I do not hold any assets of the debtor as security and

      (Check appropriate description) Space to insert description

      Checkbox for claiming an amount with the right to a priority under section 136 of the Act Regarding the amount of $ Space to insert amount, I claim a right to a priority under section 136 of the Act.

      Checkbox for an amount claimed with no right to a priority Regarding the amount of $ Space to insert amount, I do not claim a right to a priority.

      (Set out on an attached sheet details to support priority claim.)

    2. Checkbox for Check for Claim of Lessor for Disclaimer of a Lease claim of lessor for disclaimer of a lease $ Space to insert amount

      That I hereby make a claim under subsection 65.2(4) of the Act, particulars of which are as follows:

      (Give full particulars of the claim, including the calculations upon which the claim is based.)

    3. Checkbox if Secured Claim secured claim of $ Space to insert amount

      That in respect of this debt, I hold assets of the debtor valued at $ Space to insert amount as security, particulars of which are as follows:

      (Give full particulars of the security, including the date on which the security was given and the value at which you assess the security, and attach a copy of the security documents.)

    4. Checkbox for Claim by Farmer, Fisherman or Aquaculturist claim by farmer, fisherman or aquaculturist of $ Space to insert amount

      Check if making a claim under subsection 81.2(1) of the Act That I hereby make a claim under subsection 81.2(1) of the Act for the unpaid amount of $ Space to insert amount

      (Attach a copy of sales agreement and delivery receipts.)

    5. Checkbox for Claim by Wage Earner claim by wage earner of $ Space to insert amount

      Checkbox for making a claim under subsection 81.3(8) of the Act That I hereby make a claim under subsection 81.3(8) of the Act in the amount of $ Space to insert amount,

      Checkbox for making a claim under subsection 81.4(8) of the Act That I hereby make a claim under subsection 81.4(8) of the Act in the amount of $ Space to insert amount,

    6. Checkbox for Claim Against Director claim against director $ Space to insert amount

      (To be completed when a proposal provides for the compromise of claims against directors.)

      That I hereby make a claim under subsection 50(13) of the Act, particulars of which are as follows:

      (Give full particulars of the claim, including the calculations upon which the claim is based.)

    7. Checkbox for Claim of a Customer of a Bankrupt Securities Firm claim of a customer of a bankrupt securities firm $ Space to insert amount

      That I hereby make a claim as a customer for net equity as contemplated by section 262 of the Act, particulars of which are as follows:

      (Give full particulars of the claim, including the calculations upon which the claim is based.)

  5. That, to the best of my knowledge, I am (or the above-named creditor is) (or am not or is not) related to the debtor within the meaning of section 4 of the Act.
  6. That the following are the payments that I have received from, and the credits that I have allowed to, and the transfers at undervalue within the meaning of subsection 2(1) of the Act that I have been privy to or a party to with the debtor within the three months (or, if the creditor and the debtor are related within the meaning of section 4 of the Act, within the 12 months) immediately before the date of the initial bankruptcy event within the meaning of Section 2(1) of the Act: (Provide details of payments, credits and transfers at undervalue.)

(Applicable only in the case of the bankruptcy of an individual.)

Checkbox to request a copy of the report I request that a copy of the report filed by the trustee regarding the bankrupt’s application for discharge pursuant to subsection 170(1) of the Act be sent to the above address.

Dated at Space to insert city, this Space to insert dayday of Space to insert month.

Space to insert signature of witness
Witness

Space to insert signature of creditor
Creditor

 

Phone Number: Space to insert telephone number
Fax Number: Space to insert fax number
E-mail Address: Space to insert email address

Note:

If an affidavit is attached, it must have been made before a person qualified to take affidavits.

Warnings:

A trustee may, pursuant to subsection 128(3) of the Act, redeem a security on payment to the secured creditor of the debt or the value of the security as assessed, in a proof of security, by the secured creditor.

Subsection 201(1) of the Act provides severe penalties for making any false claim, proof, declaration or statement of account.

Note:

If a copy of this Form is sent electronically by means such as email, the name and contact information of the sender, prescribed in Form 1.1, must be added at the end of the document

Important Notices

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

The HTML version of this Form is not the official version. In the event of an inconsistency between the HTML and PDF versions of this Form, the PDF version prevails. Users are required to exercise due diligence with respect to the HTML version.

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