Form 21 — Assignment for the General Benefit of Creditors

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(137 KB, 1 page)

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Coming into force September 18, 2009
(Section 49 of the Act)

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

(Title Form 1)

This indenture made this Space to insert day  Space to insert month, 2Space to insert year,

between

Space to insert full legal name of debtor
(Insert the full legal name of the debtor)

Space to insert address of debtor
(Insert address of the debtor)

hereinafter called "the debtor"

and

Space to insert name of trustee
(Insert the name of the trustee)

hereinafter called "the trustee".

(Check applicable category)

checkboxNatural person

checkboxCorporate or other legal entity

Whereas the debtor is insolvent and desires to assign and to abandon all his/her property for distribution
among his/her creditors, in pursuance of the Act,

This indenture witnesses that the debtor does hereby assign to the trustee all the debtor's property for the uses, intents and purposes provided by the Act.

Signed at the Space to insert day of Space to insert month, in the Province ofSpace to insert province,
in the presence of Line.

Space to insert witness
Witness

Space to insert date
Date

Space to insert debtor or legal representative of the debtor
Debtor
(or legal representative
of the debtor)

Notes: If the debtor is a corporation, a certified copy of the resolution of the board of
directors must be attached to this document.

If the debtor is deceased, attach a copy of the Court Order.

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 notice: The XHTML version of this Form is not the official version. In the event of an inconsistency between the XHTML and PDF versions of this Form, the PDF version prevails. Users are required to exercise due diligence with respect to the XHTML version.