Form 31—Proof of Claim

For persons to which the 2009 amendments do not apply

PDF and Word versions

1. That I am a creditor of the above-named debtor (or that I am (state position or title) of (name of creditor or representative of the creditor)).
2. That I have knowledge of all the circumstances connected with the claim referred to below.
3. That the debtor was, at the date of bankruptcy (or the date of the receivership, or in the case of a proposal, the date of the notice of intention or of the proposal, if no notice of intention was filed), namely the day of , , and still is, indebted to the creditor in the sum of $ , as specified in the statement of account (or affidavit) attached and marked Schedule "A", after deducting any counterclaims to which the debtor is entitled. (The attached statement of account or affidavit must specify the vouchers or other evidence in support of the claim.)
4. (Check and complete appropriate category.)
   1. unsecured claim of $ (other than as a customer contemplated by Section 262 of the Act) That in respect of this debt, I do not hold any assets of the debtor as security and (Check appropriate description) Regarding the amount of $ , I claim a right to a priority under section 136 of the Act. Regarding the amount of $ , I do not claim a right to a priority. (Set out on an attached sheet details to support priority claim.)
   2. claim of lessor for disclaimer of a lease $ That I hereby make a claim under subsection 65.2(4) of the Act, particulars of which are as follows: (Give full particulars of the claim, including the calculations upon which the claim is based.)
   3. secured claim of $ That in respect of this debt, I hold assets of the debtor valued at $ as security, particulars of which are as follows: (Give full particulars of the security, including the date on which the security was given and the value at which you assess the security, and attach a copy of the security documents.)
   4. claim by farmer, fisherman or aquaculturist of $ That I hereby make a claim under subsection 81.2(1) of the Act for the unpaid amount of $ (Attach a copy of sales agreement and delivery receipts.)
   5. claim by wage earner of $ That I hereby make a claim under subsection 81.3(8) of the Act in the amount of $ , That I hereby make a claim under subsection 81.4(8) of the Act in the amount of $ ,
   6. claim against director $ (To be completed when a proposal provides for the compromise of claims against directors.) That I hereby make a claim under subsection 50(13) of the Act, particulars of which are as follows: (Give full particulars of the claim, including the calculations upon which the claim is based.)
   7. claim of a customer of a bankrupt securities firm $ That I hereby make a claim as a customer for net equity as contemplated by section 262 of the Act, particulars of which are as follows: (Give full particulars of the claim, including the calculations upon which the claim is based.)

   (Applicable only in the case of the bankruptcy of an individual.)

   I request that a copy of the report filed by the trustee regarding the bankrupt’s application for discharge pursuant to subsection 170(1) of the Act be sent to the above address.

   Dated at , this day of .

   Phone Number:
   Fax Number:
   E-mail Address:

   Note:

   If an affidavit is attached, it must have been made before a person qualified to take affidavits.

   Warnings:

   A trustee may, pursuant to subsection 128(3) of the Act, redeem a security on payment to the secured creditor of the debt or the value of the security as assessed, in a proof of security, by the secured creditor.

   Subsection 201(1) of the Act provides severe penalties for making any false claim, proof, declaration or statement of account.

   Note:

   If a copy of this Form is sent electronically by means such as email, the name and contact information of the sender, prescribed in Form 1.1, must be added at the end of the document