Unclaimed Funds Claim Form – Business Creditor

Estate name, estate number or claim number:

(Note: Name or number appearing in the Unclaimed Funds Database)

Business Creditor Information:

Name:
Current address:
City:
Province:
Postal code:
Status of the company: Active Dissolved

Attached proof of address

(Note: Provide proof of the address appearing in the Unclaimed Funds Database.)

Attached current Certificate of Compliance or Certificate of Dissolution

Legal Representative of the Business Creditor:

Name:
Address:
City:
Province:
Postal code:
Phone: ext. (daytime) (evening)
Email:

Indicate relationship to business creditor:

Attached Letter of Authority, or equivalent documentation, establishing that you have the authority to make a claim on behalf of the aforementioned business creditor.

If you are an authorized third party making a claim on behalf of the business creditor, provide the following information:

Name:
Address:
City:
Province:
Postal code:
Phone: ext. (daytime) (evening)
Email:

Attached Power of Attorney or will authorizing you to make this claim on behalf of the aforementioned business creditor.

In cases where the business creditor is now operating under a different name:

Provide the required information as applicable:

The business creditor underwent a name change
- Attached copy of the change of name registration certificate or equivalent documentation.
The business creditor has gone through a change of ownership
- Attached proof of amalgamation, or proof that the assets (including receivables and debts) were acquired by the successor.
The business creditor operates under different names, one being the name appearing in the Unclaimed Funds Database
- Attached printout of the company registry, or equivalent documentation, demonstrating that the company also operates under the name appearing in the Unclaimed Funds Database.

Forward the completed form, the required documentation, an affidavit and a cheque or money order for $30 (payable to the Receiver General for Canada) to:

Office of the Superintendent of Bankruptcy
Business and Financial Services
Heritage Place
155 Queen Street, 4th Floor
Ottawa ON K1A 0H5