Unclaimed Dividends
(See form Form RA1 for other remittance types)
PDF and Word versions
Please 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.
Estate Name
OSB District Office No. and Estate No.
Date
YYYY/MM/DDTrustee Firm and Address
Telephone No.
Fax No.
Contact Name
Name of Trustee:
Trustee License Number:
Total Remittance Amount
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
Receiver General for Canada, to:
Office of the Superintendent of Bankruptcy
(Headquarter)
235 Queen St. – Via Mail Room
Ottawa, Ontario, Canada K1A 0H5
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
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