Remittance Advice Form—RA1

PDF and Word versions


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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
space to insert date (YYYY/MM/DD) YYY/MM/DD
Trustee Firm and Address space to insert firm name
space to insert address
space to insert address
space to insert address
Telephone No.
space to insert telephone No.
Fax No.
space to insert fax telephone No.
Contact Name
space to insert Contact Name
Name of Trustee: space to insert Name of Trustee
Trustee License Number: space to insert Trustee License Number
Select only one remittance type:
Select here if remittance type is LevyLevy
Select here if remittance type is Registration FeesRegistration Fees
Select here if remittance type is Undistributed AssetsUndistributed Assets
Select here if remittance type is InterestInterest
Select here if remittance type is OtherOther. Please specify (NSF, closed account, untraceable cheque, court costs): space to insert NSF or closed account or untraceable cheque or court costs
Total Remittance Amount: Space to insert Total Remittance Amount


  • 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
Cheques of debtor with amounts
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

Important Notices

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The HTML version of this Form is not the official version. In the event of an inconsistency between the HTML and PDF versions of this Form, the PDF version prevails. Users are required to exercise due diligence with respect to the HTML version.

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