Form 2 — Application for Trustee Licence (Individual)

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(Subsection 13(1) of the Act)

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

General Information

Family Name

Space to insert Family Name

Given Name(s)

Space to insert Given Name(s)

Date of Birth

Space to insert year of birth /Space to insert month of birth /Space to insert day of birth
 YearMonthDay

Other Previous Legal Names or Aliases

Space to insert Other Previous Legal Names or Aliases

Business Address

Space to insert business address, line 1

Space to insert business address, line 2

Space to insert business address, line 3

Telephone No. Space to insert telephone number

Fax No. Space to insert Fax number

E-mail address

Space to insert email address

Home Address

Space to insert Home address, line 1

Space to insert Home address, line 2

Space to insert Home address, line 3

Telephone No. Space to insert telephone number

Fax No. Space to insert fax number

Current Employer

Space to insert name of current employer

Employment Began

Space to insert year of when employment began /Space to insert month of when employment began /Space to insert day of when employment began
YearMonthDay

Professional organization(s) of which you are or were a member (if any)

Space to insert name of Professional organization(s), line 1

Space to insert name of Professional organization(s), line 2

Space to insert name of Professional organization(s), line 3

Bankruptcy district(s) for which a licence is requested: Space to insert Bankruptcy District(s)

Attestation Regarding Prerequisite Qualifications

I hereby attest, pursuant to paragraph 4 of Directive No. 13R4, Trustee Licensing, that:

  1. I am not an insolvent person nor have I been in a state of insolvencyFootnote 1 at any time within the five (5) years preceding the date of this application.;
  2. I have:
    1. successfully completed the Chartered Insolvency and Restructuring Professional (CIRP) Qualification Program (CQP), unless otherwise exempted;
    2. passed the CIRP National Insolvency Examination (CNIE); and
    3. successfully completed the Insolvency Counsellor's Qualification Course (ICQC), or I have enrolled in the ICQC and I agree to successfully complete the course before obtaining a licence.
  3. I am in good standing with, and I am not subject to any current disciplinary action by, any professional organization of which I am or was a member.

Declaration Regarding Reputation

To assess whether you satisfy the reputation requirements under Directive No. 13R4, Trustee Licensing, please answer the following questions:

  1. Have you ever been found guilty of an indictable offence for which a pardon has not been granted?

    Yes Select if you have ever been found guilty of an indictable offence for which a pardon has not been granted No Select if you have never been found guilty of an indictable offence for which a pardon has not been granted

    If yes, please provide details on the nature of the offence(s):
    Field 1 to insert details on the nature of the offence(s), first line
    Field 2 to insert details on the nature of the offence(s), second line
    Field 3 to insert details on the nature of the offence(s), third line

  2. Have you ever been found guilty of professional misconduct by any professional organization of which you are or were a member?

    Yes Select if you have ever been found guilty of professional misconduct by any professional organization of which you are or were a memberNo Select if you have never been found guilty of professional misconduct by any professional organization of which you are or were a member

    If yes, please provide details on the nature of the misconduct:
    Field 1 to insert details on the nature of the misconduct, first line
    Field 2 to insert details on the nature of the misconduct, second line
    Field 3 to insert details on the nature of the misconduct, third line

  3. Have you ever been in a state of insolvency?

    Yes Select if you have ever been in a state of insolvencyNo Select if you have never been in a state of insolvency

    If yes, please provide details (estate name, estate number, district of the filing, date of discharge, etc.).
    Field 1 to insert details of the insolvency, first line
    Field 2 to insert details of the insolvency, second line
    Field 3 to insert details of the insolvency, third line

  4. Have you ever been a principal shareholder, director or officer of a bankrupt corporation?

    Yes Select if you have never been a principal shareholder, director or officer of a bankrupt corporation No Select if you have never been a principal shareholder, director or officer of a bankrupt corporation

    If yes, please provide details (corporation's estate name, estate number, district of the filing, date of discharge, etc.):
    Field 1 to insert details on the corporation in which you were a principal shareholder, first line
    Field 2 to insert details on the corporation in which you were a principal shareholder, second line
    Field 3 to insert details on the corporation in which you were a principal shareholder, third line

Personal Suitability

If you are a member of a professional organization, do you intend to retain your membership in that organization when you begin to practise as a trustee?

Yes Select if you intend to retain your membership in that organization when you begin to practise as a trusteeNo Select if you do not intend to retain your membership in that organization when you begin to practise as a trustee

(If yes, and if such membership entitles you to practise a profession that is an incompatible occupation,Footnote 2 you are required to satisfy the Superintendent that you will be a non-practising member of the organization. Please refer to paragraphs 33 to 36 of Directive No. 13R4, Trustee Licensing.)

Authorization

I understand that my application for a trustee licence is subject to an investigation and verification by the Royal Canadian Mounted Police (RCMP) regarding criminal records, ongoing or completed investigations and arrest warrants, as well as regarding my background. I hereby authorize, and give consent to, the RCMP or other police forces to release personal information and make full disclosure to the Office of the Superintendent of Bankruptcy, as provided by the Privacy Act.

Declaration and Signature

I, the undersigned, do solemnly declare that I am the applicant named in this application and that the information set out in this application and in the attached documents is, to the best of my knowledge and belief, true, correct and complete in all respects, and that I agree to respect the conditions contained in this form if the Superintendent issues me a licence.

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 Applicant's name
Applicant's name in block letters

Space to insert Signature of applicant
Signature of applicant

Required Documentation

Please include the documents listed below with your application. If any items are not provided, please indicate the reason for the information being excluded and the date when it will be provided to the Office of the Superintendent of Bankruptcy.

  1. A copy of your certificate of completion of the Insolvency Counsellor's Qualification Course or proof of enrolment.
  2. A curriculum vitæ containing your academic background and a list of employment positions held during the last ten (10) years with a brief description of duties.
  3. A detailed description of your experience in insolvency matters (see attached table).
  4. A recent photograph (approximately 5 cm X 3.5 cm).
  5. A cheque for $300 payable to the Receiver General of Canada.
    Where you intend to practise either with a trustee firm (i.e., partnership or corporate licence) or as an employee of another trustee:
  6. A supporting letter in which a partner or the employer undertakes to provide the necessary resources (work facilities, equipment and personnel) that will be required for the execution of your duties as a trustee, as well as insurance coverage (professional liability insurance and employee dishonesty (fidelity) insurance).
    In all other cases (to obtain authorization to begin accepting professional engagements):
  7. A personal balance sheet.
  8. Details of necessary resources (work facilities, equipment and personnel) that will be at your disposal during the execution of your duties as a trustee, and of banking arrangements.
  9. Proof of insurance coverage (professional liability insurance and employee dishonesty (fidelity) insurance).

Breakdown of Area of Experience in Insolvency Matters

Name of Applicant: Space to insert name of applicant for a Trustee Licence

Firm: Space to insert name of firm

Please estimate the amount of time worked, during the periods indicated, in each of the fields listed in the table below. The breakdown is to be shown as a percentage (%) of the overall time during the year.

Application for a Trustee Licence — Breakdown of Area of Experience in Insolvency Matters
  Consumer Bankruptcies Consumer Proposals Commercial Bankruptcies Commercial Proposals Interim Receiverships Receiverships, Agent or mandatary, Look-see, Secured Creditors, CCAA Other work not directly related to insolvency work (audit, tax, accounting, forensic)
Previous Year              
During Space to insert years of experience in Insolvency Matters (year)              
During Space to insert years of experience in Insolvency Matters (year)              
During Space to insert years of experience in Insolvency Matters (year)              

Total years of experience working in insolvency matters: Space to insert total years of experience working in insolvency matters

I, the undersigned applicant for a trustee licence, hereby attest that the above information faithfully reflects my experience in insolvency and other fields during the periods shown above.



Space to insert signature of applicant
Signature of applicant

Date: Space to insert date

I, the undersigned, a trustee of the firm where the applicant is presently employed or associated, hereby attest that the information provided by the applicant, for the period of time with this firm, faithfully reflects the extent of his/her experience in insolvency and other fields.

Space to insert signature of trustee
Signature of trustee

Space to insert Trustee's name
Trustee's name in block letters

Space to insert dateDate:

Footnotes

  1. 1 "State of insolvency" means being bankrupt, having filed a notice of intention or a proposal under the BIA, or being subject to any similar proceedings under federal, provincial or foreign legislation. (back to footnote reference 1)
  2. 2 "Incompatible occupation" includes, notably, a collection agent, bailiff, trade association representative, lawyer or notary in the Province of Quebec, or an employee of the Office of the Superintendent of Bankruptcy, as well as any other occupation, business or profession that may be in conflict with the duties and responsibilities of a trustee. (back to footnote reference 2)

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