Form 60—Request for Mediation Made by Trustee

PDF version

Form 60

55 KB, 2 pages

(Subsections 68(6), 68(7) and 170.1(1) of the Act)


(Title Form 1)

I, space to insert name of trustee, trustee of the estate of space to insert name of bankrupt, a bankrupt, who made an assignment (or against whom a bankruptcy order was made) on the Space to insert dayday of Space to insert month  Space to insert year, hereby apply to the official receiver to refer this matter to the mediator, who shall set the time and place for the mediation.

This application for mediation is being made for the following reasons:

(Check appropriate description(s))

  • Checkbox: Subsection 68(6) Subsection 68(6) – There is disagreement as to the amount of surplus income to be paid by the bankrupt.
  • Checkbox: Subsection 68(7) Subsection 68(7) – There is a written request from Space to insert name of creditor, a creditor, Space to insert creditor's address (creditor's address), to proceed with the mediation process.
  • Checkbox: Subsection 170.1(1) Subsection 170.1(1) – The trustee is opposed to the discharge of the bankrupt on a ground referred to in paragraph 173(1)(m) or (n) of the Act.
  • Checkbox: Subsection 170.1(1) Subsection 170.1(1) – Space to  insert name of creditor, a creditor, Space to insert creditor's address (creditor's address), is opposed to the discharge of the bankrupt on a ground referred to in paragraph 173(1)(m) or (n) of the Act.

An income and expense statement of the bankrupt is attached to this request (Form 65).

(Indicate names, mailing addresses, phone numbers and email addresses of all parties, including the trustee’s representative (if applicable))

First space to insert names, mailing addresses, phone numbers and email addresses of all parties
Second space to insert names, mailing addresses, phone numbers and email addresses of all parties
Third space to insert names, mailing addresses, phone numbers and email addresses of all parties

(Provide details (names and estate number) of any related estate file requiring concurrent mediation (e.g., spousal file))

First space to insert names and estate number of any related estate file requiring  concurrent mediation
Second space to insert names and estate number of any related estate file requiring  concurrent mediation
Third space to insert names and estate number of any related estate file requiring  concurrent mediation

(Check applicable box(es))

Has a Mediation Settlement Agreement (Form 63) been reached by the parties?
Check here if Mediation Settlement Agreement has been reached by the parties Yes
Check here if Mediation Settlement Agreement has not been reached by the parties No

If "yes,"
i) Has the Mediation Settlement Agreement (Form 63) been signed by the parties?
Check here if Mediation Settlement Agreement has been signed by the parties Yes, and a copy of the signed settlement agreement is attached to this request.
Check here if Mediation Settlement Agreement has not been signed by the parties but details are attached No, but details pertaining to the settlement agreement (draft – Form 63) are attached to this request.

ii) Are you willing to proceed with this mediation via email, if applicable? Footnote 1
Check here if you are willing to proceed with this mediation via email Yes
Check here if you are not willing to proceed with this mediation via email No

Dated at space to insert name of city, this space to insert day of month day of space to insert month and year.

space to insert signature of trustee
Licensed Insolvency Trustee

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