Form 84 — Certificate of Discharge

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(Subparagraph 168.1(1)(f)(ii) of the Act)

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(Title Form 1)

Date of bankruptcy Space to insert date of bankruptcy

I, Space to insert name of trustee, the trustee of the estate of Space to insert name of bankrupt, a bankrupt, hereby certify that, pursuant to subsection 168.1(1) of the Act, on the Space to insert day of month day of Space to insert month Space to insert year the bankrupt is discharged and released from all debts, except those matters referred to in subsection 178(1) of the Act.

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

Space to insert trustee's signature
Trustee

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