Form 42—Certificate of Assignment

For persons to which the 2009 amendments do not apply

(Paragraph 61(2)(b) of the Act)

District of

Division No.

Court No.

Estate No.

In the Matter of the Bankruptcy of:

Debtor

Trustee

Administration

Date of Bankruptcy:

Security:

Date of Initial Bankruptcy Event:

Meeting of Creditors:

Chairman:

Designated Person:

I, the undersigned, Official Receiver in and for this bankruptcy district, do hereby certify that:

a proposal in respect of the aforementioned debtor was filed under section 62 of the Bankruptcy and Insolvency Act;
the court, by its order, has refused to approve the proposal and the debtor is thereupon deemed to have made an assignment.

The said trustee is required:

to provide to me, without delay, security in the aforementioned amount;
to send to all creditors, within five days after the date of the trustee’s appointment, a notice of the bankruptcy; and
when applicable to call in the prescribed manner, a first meeting of creditors, to be held at the aforementioned time and place or at any other time and place that may be later requested by the Official Receiver.

Date:
/ /

Official Receiver