Form 33 — Notice of Intention To Make a Proposal

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(Subsection 50.4(1) of the Act)

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

(Title Form 1)

Take notice that:

1. I, Space to insert name of insolvent person , an insolvent person, state, pursuant to subsection 50.4(1) of the Act, that I intend to make a proposal to my creditors.

2. Space to insert name of trustee (name of trustee), of Space to insert address of trustee (address of trustee), a licensed trustee, has consented to act as trustee under the proposal. A copy of the consent is attached.

3. A list of the names of the known creditors with claims of $250 or more and the amounts of their claims is also attached.

4. Pursuant to section 69 of the Act, all proceedings against me are stayed as of the date of filing of this notice with the official receiver in my locality.

Dated at Space to insert city , this Space to insert day day of Space to insert month Space to insert year .

Space to insert insolvent person's signature
Insolvent Person

To be completed by Official Receiver:

Filing Date Space to insert filing date

Space to insert official receiver's signature
Official Receiver

Note: If a copy of this Notice 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 notice: The XHTML version of this Form is not the official version. In the event of an inconsistency between the XHTML and PDF versions of this Form, the PDF version prevails. Users are required to exercise due diligence with respect to the XHTML version.