Remittance Advice Form — RA1

PDF version
(28 KB, 2 pages)

Word version
(168 KB, 2 pages)

PDF readers/Word viewers

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.

To Remit Unclaimed Dividends, see Form RA2.

View a sample of a completed form.

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
Date
YYYY/MM/DD
 
Trustee Firm and Address
Telephone No
(     )
Fax No
(     )
Contact Name
Name of Trustee:
Trustee License Number:
Select only one remittance type:
Select only one remittance type: Levy Levy
Select only one remittance type: Registration Fees Registration Fees
Select only one remittance type: Undistributed Assets Undistributed Assets
Select only one remittance type: Interest Interest
Select only one remittance type: Other. Please specify (<abbr title=NSF, closed account, untraceable cheque, court costs)" title="Select only one remittance type: Other. Please specify (NSF, closed account, untraceable cheque, court costs)" /> Other. Please specify (NSF, closed account, untraceable cheque, court costs)
Total Remittance Amount:
Instructions:
  • To ensure legibility, information must be typed.
  • If a cheque applies to multiple estates, include a sub-total below all estate amounts for that cheque, and make sure the sub-total equals the cheque amount.
  • Ensure the total of all cheques matches the Total Remittance Amount entered above.
  • Complete all fields below.
  • Continue list on page 2 if additional space is required.
Cheque No
OSB District Office No and Estate No
Estate Name
Administration Type
Amount
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
top of page

Sample of a completed form

PDF version
(32 KB, 2 pages)

PDF readers

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
Date
 
2011-06-14
YYYY/MM/DD
 
Trustee Firm and Address
 
XYZ Trustee Firm
555 Anywhere Boulevard
City, Province, Postal Code
Telephone No
 
(613) 555-1234
 
Fax No
 
(613) 555-4321
 
Contact Name
 
Eric Contact, XYZ Trustee Firm
Name of Trustee: Jean Trustee
Trustee License Number: 12345
Select only one remittance type:
Selected remittance type: Levy Levy
Non-selected remittance type: Registration Fees Registration Fees
Non-selected remittance type: Undistributed Assets Undistributed Assets
Non-selected remittance type: Interest Interest
Non-selected remittance type: Other. Please specify (<abbr title=NSF, closed account, untraceable cheque, court costs)" title="Non-selected remittance type: Other. Please specify (NSF, closed account, untraceable cheque, court costs)" /> Other. Please specify (NSF, closed account, untraceable cheque, court costs)
Total Remittance Amount: $1,409.71
Instructions:
  • To ensure legibility, information must be typed.
  • If a cheque applies to multiple estates, include a sub-total below all estate amounts for that cheque, and make sure the sub-total equals the cheque amount.
  • Ensure the total of all cheques matches the Total Remittance Amount entered above.
  • Complete all fields below.
  • Continue list on page 2 if additional space is required.
Cheques of debtor with amounts
Cheque No OSB District Office No and Estate No Estate Name Administration Type Amount
12345 xx-xxxxx Debtor 1 Summary Bankruptcy $139.91
12345 xx-xxxxx Debtor 2 Summary Bankruptcy $200.00
12345 xx-xxxxx Debtor 3 Summary Bankruptcy $5.29
      Sub-total: $345.20
         
12346 xx-xxxxx Debtor 4 Consumer Proposal $175.23
12346 xx-xxxxx Debtor 5 Consumer Proposal $123.88
      Sub-total: $299.11
         
98765 xx-xxxxx Debtor 6 Ordinary Bankruptcy $765.40
         
      Total: $1,409.71