Estate Information Summary

Important notice

All estates filed on July 15, 2024 and after must use the version of the Estate Information Summary issued through Directive No. 8R21, The Bankruptcy and Insolvency Act Forms. All estates filed prior to July 15, 2024 must continue using the pre-2024 version of the Estate Information Summary.

Original
Amendment

I – Complete the following in all cases

Proceeding
Assignment
Bankruptcy order
Proposal

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Individual
Corporation
Income Trust

Estate Name

Language
English
French
Other (please specify)

Has the debtor previously been bankrupt or made a proposal under the Bankruptcy and Insolvency Act in Canada?
Yes
No

List all estate numbers for any bankruptcy order application, bankruptcy, proposal or receivership related to the debtor.

Address

Home telephone no.

Work telephone no. (if any)

The debtor resides or has carried on business at the above address since: (D, M, Y)

E-mail address (if any)

Consumer debts only?
Yes
No

% of the total debt is business debt

If 50% or more is business debt, provide the 6-digit NAICS code of the primary business activity.

Enter Business Number(s), if applicable.

Joint Estate Name

Language
English
French
Other (please specify)

Has the debtor previously been bankrupt or made a proposal under the Bankruptcy and Insolvency Act in Canada?
Yes
No

List all estate numbers for any bankruptcy order application, bankruptcy, proposal or receivership related to the debtor.

Address

Home telephone no.

Work telephone no. (if any)

The debtor resides or has carried on business at the above address since: (D, M, Y)

E-mail address (if any)

Consumer debts only?
Yes
No

% of the total debt is business debt

If 50% or more is business debt, provide the 6-digit NAICS code of the primary business activity.

Enter Business Number(s), if applicable.

II – Voluntary self-identification (To be completed by the debtor)

What is your gender?
Male
Female
Other
I prefer not to answer

Highest level of education completed by bankrupt/debtor:
0-8 years
Some high school
High school diploma
Some post-secondary
Post-secondary certificate or diploma
University degree
I prefer not to answer

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Are you an Aboriginal person?
(An Aboriginal person is a North American Indian or a member of a First Nation, a Métis or an Inuk (Inuit). North American Indians or members of a First Nation include status, treaty or registered Indians, as well as non-status and non-registered Indians.)
Yes
No
I prefer not to answer

If you wish to provide further details, please specify the group to which you belong.
North American Indian/First Nation
Métis
Inuit

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Are you a person with a disability?
(Persons with disabilities are persons who have a long-term or recurring physical, mental, sensory, psychiatric or learning impairment and who consider themselves to be disadvantaged in employment by reason of that impairment or believe that an employer or potential employer is likely to consider them to be disadvantaged in employment by reason of that impairment. Persons with disabilities are also those whose functional limitations owing to their impairment have been accommodated in their current job or workplace.)
Yes
No
I prefer not to answer

If you wish to provide further details, please select the box(es) that apply to you.
Co-ordination or dexterity (difficulty using hands or arms, for example, grasping or handling a stapler or using a keyboard)
Mobility (difficulty moving around, for example, from one office to another or up and down stairs)
Blind or visual impairment (unable to see or difficulty seeing)
Deaf or hard of hearing (unable to hear or difficulty hearing)
Speech impairment (unable to speak or difficulty speaking and being understood)
Other disability (including learning disabilities, developmental disabilities and all other types of disabilities) (Please specify)

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Are you a member of a visible minority group?
(A member of a visible minority in Canada may be defined as someone (other than an Aboriginal person) who is non-white in colour/race, regardless of the place of birth.)
Yes
No
I prefer not to answer

If you wish to provide further details, please select the box(es) that best describes your origin.
Black
Chinese
Filipino
Japanese
Korean
South Asian/East Indian (including Indian from India; Bangladeshi; Pakistani; East Indian from Guyana, Trinidad, East Africa; etc.)
Southeast Asian (including Burmese; Cambodian; Laotian; Thai; Vietnamese; etc.)
Non-White West Asian, North African or Arab (including Egyptian; Libyan; Lebanese; Iranian; etc.)
Non-White Latin American (including indigenous persons from Central and South America, etc.)
Person of Mixed Origin (with one parent in one of the visible minority groups listed above)
Other Visible Minority Group (Please specify)

Voluntary self-identification (To be completed by joint debtor)

What is your gender?
Male
Female
Other
I prefer not to answer

Highest level of education completed by bankrupt/debtor:
0-8 years
Some high school
High school diploma
Some post-secondary
Post-secondary certificate or diploma
University degree
I prefer not to answer

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Are you an Aboriginal person?
(An Aboriginal person is a North American Indian or a member of a First Nation, a Métis or an Inuk (Inuit). North American Indians or members of a First Nation include status, treaty or registered Indians, as well as non-status and non-registered Indians.)
Yes
No
I prefer not to answer

If you wish to provide further details, please specify the group to which you belong.
North American Indian/First Nation
Métis
Inuit

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Are you a person with a disability?
(Persons with disabilities are persons who have a long-term or recurring physical, mental, sensory, psychiatric or learning impairment and who consider themselves to be disadvantaged in employment by reason of that impairment or believe that an employer or potential employer is likely to consider them to be disadvantaged in employment by reason of that impairment. Persons with disabilities are also those whose functional limitations owing to their impairment have been accommodated in their current job or workplace.)
Yes
No
I prefer not to answer

If you wish to provide further details, please select the box(es) that apply to you.
Co-ordination or dexterity (difficulty using hands or arms, for example, grasping or handling a stapler or using a keyboard)
Mobility (difficulty moving around, for example, from one office to another or up and down stairs)
Blind or visual impairment (unable to see or difficulty seeing)
Deaf or hard of hearing (unable to hear or difficulty hearing)
Speech impairment (unable to speak or difficulty speaking and being understood)
Other disability (including learning disabilities, developmental disabilities and all other types of disabilities) (Please specify)

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Are you a member of a visible minority group?
(A member of a visible minority in Canada may be defined as someone (other than an Aboriginal person) who is non-white in colour/race, regardless of the place of birth.)
Yes
No
I prefer not to answer

If you wish to provide further details, please select the box(es) that best describes your origin.
Black
Chinese
Filipino
Japanese
Korean
South Asian/East Indian (including Indian from India; Bangladeshi; Pakistani; East Indian from Guyana, Trinidad, East Africa; etc.)
Southeast Asian (including Burmese; Cambodian; Laotian; Thai; Vietnamese; etc.)
Non-White West Asian, North African or Arab (including Egyptian; Libyan; Lebanese; Iranian; etc.)
Non-White Latin American (including indigenous persons from Central and South America, etc.)
Person of Mixed Origin (with one parent in one of the visible minority groups listed above)
Other Visible Minority Group (Please specify)

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Your response to the self-identification questions (Section II) is collected under the authority of the Bankruptcy and Insolvency Act and will be stored in Personal Information Bank no. IC PPU 058 – Estate Files Under the Bankruptcy and Insolvency Act. This information will be used by the Office of the Superintendent of Bankruptcy (OSB) for statistical analysis, public policy research, and program development. Your response is voluntary and will remain confidential. Refusing to answer Section II will not negatively impact the processing of your file under the Bankruptcy and Insolvency Act. You may access, request correction or notation to your personal information by contacting the OSB. You further have the right to complain to the Privacy Commissioner of Canada respecting the handling of your personal information by the OSB.

I, the undersigned, do consent to the collection, disclosure, and use of my response to the self-identification questions by the OSB.

Signature (debtor)

Date

Signature (joint debtor)

Date

III – Complete the following if the debtor has guaranteed the debts of another person
N/A

The debtor is the guarantor of
Business debts
Consumer debts
Other specify

Name of persons whose debts are guaranteed	Amount guaranteed	Name of business if business debts	Is the person bankrupt?
			Yes	No

IV – Complete the following if the debtor is a corporation, including an income trust

Are the corporation's shares or units publicly traded?
Yes
No

Trade name(s) of the corporation (if different from the estate name)

Place of business (if different from the estate address)

Primary business activity of the corporation

Names of the corporation's officers

Name of person to be examined

Title

Telephone no.

Address of the person to be examined

Language
English
French
Other (please specify)

During the past 12 months, what was the maximum number of employees that you employed?

How long have you been in operation under this current legal name?

V – To be completed when filing a consumer proposal or amended consumer proposal

Terms of the Consumer Proposal:

Number of payments	Amount of payment	Total
	$	$
	$	$
	$	$
	$	$
		Total
		$

Describe other non-monetary terms below

Anticipated Completion Date of Consumer Proposal (D, M, Y)

Amount outstanding on mortgage or hypothec on principal residence

VI – To be completed and signed by the trustee in all cases

Creditor's Meeting Suggested Time and Place (D, M, Y)

Time

Location

Contact trustee

Name and licence number of the individual Trustee or administrator of consumer proposal responsible for the administration of the estate

Request for an investigation under the Debtor Compliance Referral Program
Yes
No

If yes, provide reasons for referral

A possible conflict of interest situation exists
Yes
No

If yes, explain

Indemnification
N/A
Deposit
Guarantee
Name of depositor or guarantor

Amount or extent of indemnity

Trustee absent when file submitted; amended summary to follow

Signature of Trustee

VII – Official receiver use only

Note: Quote this number in all future correspondence

No.

Administration
Summary
Ordinary

Date of filing (D, M, Y)

Type

Industry

District

Division

Court No.

Licence No. of appointed Trustee
As above
Other

Resp. O.R.

Assets

Liabilities

Security

Creditor's Meeting details fixed by O.R.
As above
Or

Date (D, M, Y)

Time

Location

Chairperson
O.R.
Trustee

Debtor Examination
Yes
No

Date (D, M, Y)

Time

Location

Official Receiver Comments

Note to file
A
B
C

Official Receiver's Initials

Data Processing Initials

Document Production Initials