Form 12—Statement of Receipts and Disbursements (Other than Summary Administration and Consumer Proposals)

For persons to which the 2009 amendments apply

PDF version

Form 12

69 KB, 4 pages

(Section 152 of the Act)


(Title Form 1)

Trustee's Statement of Receipts and Disbursements
Receipts
1. Cash in hand and in bank Space to insert amount of cash in hand and in bank
2. Realization of assets: Book debts and bills of exchange Space to insert amount of book debts and bills of exchange
3. Realization of assets: Stock, fixtures, machinery and furniture Space to insert amount of realization of assets: Stock, fixtures, machinery and furniture
4. Realization of assets: Real property or immovable Space to insert amount of realization of assets: real property or immovable
5. Received from  
(a) Interim receiver as taxed Space to insert amount of amount from interim receiver as taxed
(b) Former trustee as taxed First Space to insert amount of amount from former trustee as taxed Second Space to insert amount of amount from former trustee as taxed
6. Operating receipts: Space to insert amount of amount from operating receipts
less: (a) purchases Space to insert amount of purchases  
  (b) operating expenses
(Attach statement detailing purchases and expenses)
Space to insert amount of operating expenses (attach statement detailing purchases and expenses) Space to insert amount of second amount of operating expenses (attach statement detailing purchases and expenses)
Net profit (Net loss to be shown in miscellaneous disbursements, 19(a)) Space to insert amount of net profit  
7. Miscellaneous:
(a) Bank interest, etc. (specify) Space to insert amount of bank interest, etc.
(b) Funds received from guarantor (if applicable) Space to insert amount of funds received from guarantor (if applicable)
Total Receipts Space to insert amount of the total of receipts
 
Disbursements
8 Fees paid:
(a) To official receiver Space to insert amount of fees paid to official receiver  
(b) To court First space to insert fees paid to court Second space to insert fees paid to court
9. Notice of first meeting:
(a) Local Paper Space to insert amount of disbursement of Notice of first meeting: Local paper  
(b) To (Number) Space to insert amount of number of creditors creditors Space to insert amount of disbursement of Notice of first meeting: creditors  
(c) Postage First space to insert amount of disbursement of Notice of first meeting: postage Second space to insert amount of disbursement of Notice of first meeting: postage
10. Other advertising Space to insert amount of Other advertising disbursement
11. Stock-taking and possession (actual expenses only) Space to insert amount of Stocktaking and possession (actual expenses only) disbursement
12. Premiums:
(a) Bond or Suretyship Space to insert amount of Bond or Suretyship  
(b) Insurance First space to insert amount of insurance Second space to insert amount of insurance
13. Notice of bankrupt's application for discharge:
(a) To (Number) Space to insert number of creditors creditors Space to insert amount for Notice of bankrupt's application for discharge  
(b) Postage Space to insert amount for postage Space to insert amount for postage
14. Auctioneer:
(a) Commission Space to insert amount of Commission for auctioneer  
(b) Expenses Space to insert amount of expenses for Auctioneer Space to insert amount of
15. Notice of final dividend and trustee's application for discharge:
(a) To (Number) Space to insert number of creditors creditors Space to insert amount for Notice of final dividend and trustee's application for discharge  
(b) Postage Space to insert amount of postage Space to insert amount of postage
16. Other notices and reports:
(a) To (Number) Space to insert number of creditors creditors Space to insert amount of other notices and reports  
(b) Postage First space to insert amount of Postage (Other notices and reports) Second space to insert amount of Postage (Other notices and reports)
17. Postage on general correspondence Space to insert amount of Postage on general correspondence
18. Inspector:
(a) Fees (provide details) Space to insert amount of Inspector's fees  
(b) Expenses First space to insert amount of inspector's expenses Second space to insert amount of inspector's expenses
19. Miscellaneous:
(a) Loss on operations Space to insert amount lost on operations  
(b) Cost of former trustee as taxed Space to insert Cost of former trustee as taxed  
(c) Other (provide details) First space to insert other costs (provide details) Second space to insert other costs (provide details)
20. Trustee's remuneration Space to insert Trustee's remuneration
21. Legal fees and legal services costs (taxed):
(a) Legal counsel on application or assignment Space to insert Legal counsel fees on application or assignment  
(b) Legal counsel to estate Space to insert Legal counsel fees to estate  
(c) Court fees awarded against trustee Space to insert Court fees awarded against trustee  
(d) Costs awarded to opposing creditor (pursuant to
subsection 197(6.1))
First space to insert Costs awarded to opposing creditor Second space to insert Costs awarded to opposing creditor
22. Taxes (federal and provincial) Space to insert amount of Taxes (federal and provincial)
23. Counselling fees Space to insert Counselling fees
24. Trust claim (Crown) Space to insert trust claim fees (Crown)
Total Disbursements: Space to insert total disbursements

Note: Total disbursements paid for services provided
by persons related to the trustee:
(a) Amount: $ Space to insert amount of total disbursements paid for services provided by persons related to the trustee
(b) Name of person related to the trustee:  Space to insert name of person related to the trustee
(c) Relationship to the trustee (e.g. spouse, parent): Space to insert relationship to the trustee

25. Amount available for distribution Space to insert amount available for distribution
26. Levy payable under section 147 of the Act Space to insert amount of levy
27. Secured creditors:
Dividend
Space to insert amount of dividends of secured creditors
less levy $ Space to insert amount of levy (deduct) for Secured creditors Space to insert amount of dividend less levy for Secured creditors
28. Preferred creditors:
Dividend
Space to insert amount of dividends of Preferred creditors
less levy $ Space to insert amount of levy (deduct) Preferred creditors Space to insert amount of dividend less levy for Preferred creditors
29. Unsecured creditors:
Proved claims of $ Space to insert amount of proved claims
Interim
Dividend Space to insert amount of interim dividend (in percentage) for unsecured creditors%
Space to insert amount of interim dividend for unsecured creditors less levy $ Space to insert amount of levy (deduct) Space to insert total amount of interim dividend
Final
Dividend Space to insert amount of final dividend in percentage%
Space to insert amount of final dividend less levy $ Space to insert amount of levy of final dividend (deduct) Space to insert amount of final dividend less levy
30. Amount refunded to the debtor Space to insert amount refunded to the debtor
31. Undistributed assets Space to insert amount of undistributed assets
32. Status of Bankrupt's Discharge (if an individual) / Status of Proposal
32. Status of Bankrupt's Discharge (if an individual) / Status of Proposal
Check this box if the status is Absolute discharge Absolute discharge
Check this box if the status is Discharge suspended Discharge suspended
Check this box if the status is Annulled by Court Annulled by Court
Check this box if the status is Deemed annulled Deemed annulled
Check this box if the status is Automatic Automatic
Check this box if the status is Hearing set Hearing set
Check this box if the status is Court approval refused Court approval refused
Check this box if the status is Full performance Full performance
Check this box if the status is Conditional Conditional
Check this box if the status is Refused Refused
Check this box if the status is Creditor acceptance rejected Creditor acceptance rejected
Check this box if the status is Withdrawn Withdrawn
Check this box if the status is Deceased Deceased
Check this box if the status is Sine die Sine die
Check this box if the status is Ongoing Ongoing

Status Date: Space to insert status date

Space to insert description and value of all property of the bankrupt
(Provide a description and value of all property of the bankrupt (whether or not secured) as shown in the Statement of Affairs, or otherwise known and not accounted for in the receipts, stating why the property has not been sold or realized and stating the disposition made)

Space to insert description and value of all property of the bankrupt
Date

Space to insert signature of trustee
Licensed Insolvency Trustee
Approved by the following inspectors:
First space to insert signature of approval of inspector

Second space to insert signature of approval of inspector

Third space to insert signature of approval of inspector

Fourth space to insert signature of approval of inspector

Taxed at the sum of $ Space to insert sum of taxes, on Space to insert month Space to insert day of month, 2Space to insert last 3 digit of year.

Space to insert signature of registrar
Registrar

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.

Important Notices

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