Form 36—Proxy

PDF version

Form 36

19 KB, 1 page

(Subsection 102(2) and paragraphs 51(1)(e) and 66.15(3)(b) of the Act)


(Title Form 1)

I, Space to insert name of creditor (name of creditor), of Space to insert town or city (name of town or city), a creditor in the above matter, hereby appoint Space to insert name of person appointed , of Space to insert town or city , to be my proxy holder in the above matter, except as to the receipt of dividends, with (or without) power to appoint another proxy holder in his or her place.

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

Space to insert name of witness
Witness

Space to insert name of individual creditor
Individual Creditor

Space to insert name of corporate creditor
Name of Corporate Creditor

Space to insert name of witness
Witness

Per Space to insert name and title of signing officer
Name and Title of Signing Officer

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.

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