Form 84—Certificate of Discharge

For persons to which the 2009 amendments apply

PDF version

Form 84

13 KB, 1 page

(Subsection 168.1(6) and Paragraph 170.1(4)(a) of the Act)


(Title Form 1)

Date of bankruptcy Space to insert date of bankruptcy

I, Space to insert name of trustee, trustee of the estate of Space to insert name of bankrupt, a bankrupt, hereby certify that

  •  Check box if the bankrupt has complied with the conditions that were established as a result of the mediation agreement and that, pursuant to subsection 170.1(4) of the Act, the bankrupt is discharged and released from all debts, except those matters referred to in subsection 178(1) of the Act. the bankrupt has complied with the conditions that were established as a result of the mediation agreement and that, pursuant to subsection 170.1(4) of the Act, on the Space to insert day 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.
  •  Check box if the bankrupt is discharged and released from all debts, except those matters referred to in subsection 178(1) of the Act. pursuant to subsection 168.1(1) of the Act, on the Space to insert day 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.

(Please check applicable box)

The bankrupt is automatically discharged under the following provision:

  •  Check box if the bankrupt is automatically discharged on the expiry of 9 months for first-time bankrupts without surplus income subparagraph 168.1(1)(a)(i) – Automatic discharge on the expiry of 9 months for first-time bankrupts without surplus income;
  •  Check box if the bankrupt is automatically discharged on the expiry of 21 months for first-time bankrupts with surplus income subparagraph 168.1(1)(a)(ii) – Automatic discharge on the expiry of 21 months for first-time bankrupts with surplus income;
  •  Check box if the bankrupt is automatically discharged on the expiry of 24 months for second-time bankrupts without surplus income subparagraph 168.1(1)(b)(i) – Automatic discharge on the expiry of 24 months for second-time bankrupts without surplus income;
  •  Check box if the bankrupt is automatically discharged on the expiry of 36 months for second-time bankrupts with surplus income subparagraph 168.1(1)(b)(ii) – Automatic discharge on the expiry of 36 months for second-time bankrupts with surplus income.
  •  Check box if  the trustee and the bankrupt have entered into a post-discharge payment agreement Pursuant to section 156.1 of the Act, the trustee and the bankrupt have entered into a post-discharge payment agreement.

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

Space to insert trustee's signature
Licensed Insolvency Trustee

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