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(Paragraph 51(1)(f) of the Act)
In the matter of the proposal of
I, , creditor (or I, , representative of , creditor), of (name of city), a creditor in the above matter for the sum of $ , hereby request the trustee acting with respect to the proposal of to record my vote (for or against) the acceptance of the proposal as made on the day of .
Dated at , this day of .
Witness
Individual Creditor
Name of Corporate Creditor
Witness
Per
Name and Title of Signing Officer
Name and Title of Signing Officer
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.