Request for Mediation Made by Trustee (Subsections 68(6), 68(7) and 170.1(5)) Name Of Trustee Trustee Given Names Trustee Family or Company Name BankruptName Date Assignment was made There is disagreement as to the amount of surplus income to be paid by the bankrupt. Subsection 68(6) The name and address of the creditor who made a written request to proceed with the mediation process. Subsection 68(7) Name Address The bankrupt does not agree with the discharge recommendation of the trustee. Subsection 170.1(4) 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. The name and address of the creditor who is opposed to the discharge of the bankrupt on a ground referred to in paragraph 173(1)(m) or (n) of the Act. Name Address The name, address, phone numbers of all involved parties. Name Address Phone Signed at location and date Trustee Provide any additional information related to the form.