Remittance Advice Form — RA2 Unclaimed Dividends
Please Note: When you click on the link to the right, the form may open in Quick View Plus. To fill in the form, you need to save it by clicking on the Word icon on the left-hand side of your screen. If you don’t see the icon, make sure the Toolbar is activated.
For all other remittance types, see Form RA1.
Estate Name
OSB District Office No.
and Estate No.
and Estate No.
Date
YYYY/MMM/DDD
Trustee Firm and Address
Telephone No.
( )
( )
Fax No.
( )
( )
Contact Name
Name of Trustee:
Trustee License Number:
Total Remittance Amount:
Submit the completed form and cheque(s) payable to
Receiver General for Canada, to:
Office of the Superintendent of Bankruptcy
Heritage Place
155 Queen St., 4th Floor
Ottawa, Ontario, Canada K1A 0H5
Receiver General for Canada, to:
Office of the Superintendent of Bankruptcy
Heritage Place
155 Queen St., 4th Floor
Ottawa, Ontario, Canada K1A 0H5
Instructions:
- To ensure legibility, information must be typed.
- You must include only one estate per remittance advice form for Unclaimed Dividends.
- Ensure the total of all cheques submitted with this form agrees with the Total Remittance Amount above.
- Complete all fields below.
- Continue list on the next page if additional space is required.
Creditors and Mailing Addresses
Name:
Amount:
Address:
City:
Province
Postal Code
Name:
Amount:
Address:
City:
Province
Postal Code
Name:
Amount:
Address:
City:
Province
Postal Code
