Form 87 — Notice and Statement of the Receiver

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(Subsections 245(1) and 246(1)of the Act)

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

The receiver gives notice and declares that:

  1. On the Space to insert day day of Space to insert month Space to insert year, I, Space to insert name of receiver , became the receiver in respect of the property of Space to insert name of insolvent person or bankrupt , an insolvent person (or a bankrupt), that is described below:

    (Provide an appropriate description of the property including the book value of each asset and broken down into the categories of inventory, accounts receivable and other assets.)
  2. I became a receiver by having taken possession or control of the property described above (or by virtue of being appointed by Space to insert name of person or court that appointed receiver (name of person or court that appointed receiver)) pursuant to Space to insert particulars of security agreement or court order pursuant to which receiver was appointed (State particulars of security agreement or court order pursuant to which receiver was appointed).
  3. The undersigned took possession or control of the property described above on the Space to insert day day of Space to insert month , Space to insert year .
  4. The following information relates to the receivership:
    1. Address of insolvent person (or bankrupt):
    2. Principal line of business:
    3. Location(s) of business:
    4. Amount owed by insolvent person (or bankrupt) to each creditor who holds a security on the property described above: Space to insert amount owed by insolvent person or bankrupt to each creditor who holds a security on the property described above $
    5. The list of other creditors of the insolvent person (or the bankrupt) and the amount owed to each creditor and the total amount due by the insolvent person (or the bankrupt) is as follows:
    6. The intended plan of action of the receiver during the receivership, to the extent that such a plan has been determined, is as follows:
    7. Contact person for receiver:

      (Provide name, telephone and fax numbers and, if applicable, an e-mail address.)

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 receiver
Name of Receiver

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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