PDF and Word versions
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 (Headquarter), 235 Queen St. – Via Mail Room, Ottawa, Ontario, Canada K1A 0H5
Office of the Superintendent of Bankruptcy (Headquarter), 235 Queen St. – Via Mail Room, Ottawa, Ontario, Canada K1A 0H5
Date
YYY/MM/DD
YYY/MM/DD
Trustee Firm and Address
Telephone No.
Fax No.
Contact Name
Name of Trustee:
Trustee License Number:
Select only one remittance type:
Levy
Registration Fees
Undistributed Assets
Interest
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.
For office use only
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 |