Form 84 — Certificate of Discharge
Coming into force September 18, 2009
(Subsection 168.1(6) and Paragraph 170.1(4)(a) of the Act)
This form may not be completed online. It is provided here for reference purposes only.
(Title Form 1)
Date of bankruptcy 
I, , trustee of the estate of , a bankrupt, hereby certify that
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 
day of 
, 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 day of 
, 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:
subparagraph 168.1(1)(a)(i) – Automatic discharge on the expiry of 9 months for first-time bankrupts without surplus income;
subparagraph 168.1(1)(a)(ii) – Automatic discharge on the expiry of 21 months for first-time bankrupts with surplus income;
subparagraph 168.1(1)(b)(i) – Automatic discharge on the expiry of 24 months for second-time bankrupts without surplus income;
subparagraph 168.1(1)(b)(ii) – Automatic discharge on the expiry of 36 months for second-time bankrupts with surplus income.
Pursuant to section 156.1 of the Act, the trustee and the bankrupt have entered into a post-discharge payment agreement.
Dated at , this day of .
Trustee
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