Statement of Affairs (Business Bankruptcy) (Paragraph 158(d) of the Act) Date of Bankruptcy 1. Sum of unsecured creditor liabilities from List A 2. Sum of secured creditor liabilities from List B 3. Sum of preferred creditor liabilities from List C 4. Sum of contingent, trust claims and other liabilites from List D Total Liabilities (Sum of 1-4) Surplus Declaration of bankrupt sworn before commissioner 1. Assets in inventory 2. Assets in trade fixtures etc. 3. Sum of good receivables from list E 3. Sum of doubtful receivables from list E 3. Sum of bad receivables from list E 3. Sum of estimated to produce from list E 3. Sum of Good, Bad, Doubtful and Estimated receivables 4. Sum of bills of exchange, promissary notes, lien notes, chattel mortgages etc. from List F 5. Sum of deposits in financial institutions 6. Sum of cash 7. Sum of value of livestock 8. Sum of value of machinery, equipment and plant 9. Sum of equity/surplus in real property from list G 10. Sum of value of furniture 11. Sum of value of RRSPs, RRIFs, life insurance etc. 12. Sum of value of securities (shares, bonds, debentures ...) 13. Sum of value of interests under wills 14. Sum of value of vehicles 15. Other Property description and value as per List H Description of other property Dollar value of other property 15. Sum of value of other property as per List H Additional information if Bankrupt is a corporation If a corporation, amount of subscribed capital If a corporation, amount paid on capital If a corporation, balance subscribed and unpaid on capital. If a corporation, estimated to produce. Whether or not a corporation, the total of above assets. Deficiency amount List A, unsecured creditors details. Name of this unsecured creditor Address of creditor Amount of this creditor's claim Detail Line Number List B, secured creditors details. Name of this secured creditor Address of creditor Amount of this creditor's claim Particulars of security When given Estimated value of security Estimated surplus from security Balance of claim unsecured List C, a preferred creditor detail for wages, rents ... Name of preferred creditor Address of preferred creditor Nature of this preferred claim Period during which this preferred claim accrued Amount of this preferred claim Amount payable in full Difference ranking in full Ranking from Act Line item number List D, a contingent or other liability detail. Name of creditor Address of creditor Amount of liability or claim Amount expected to rank for dividend Date when liability was incurred Nature of liability Line item number List E, a debt due to the bankrupt List E, a debt due to the bankrupt Name of debtor who owes debts to the bankrupt. Address of debtor Nature of debt Amount of debt (good) Amount of Debt Doubtful Amount of Debt Bad Name of folio of ledgers or other book where particulars are to be found Date when the debt was contracted Estimated to produce Particulars of any securities held for this debt. Detail line item number List F, a bill of exchange, promissory note, lien note, chattel mortgage ... available as assets. Name of all promissory, acceptors, endorsers, mortgagors and guarantors Address of debtor Amount of bill, note ... Date when bill,note ... is due Estimated to produce Particulars of property held as security for payment of bill, note ... Detail line item number List G, a detail of real property owned by bankrupt Description of real property Nature of bankrupt's interest in the property In whose name does title to the real property stand Total value of the property Particulars of mortgages, hypothecs or other encumbrances. (Name, Address, Amount) Equity or surplus Line item number. Optional but recommended. List H, a detail of other property that is the bankrupt's or may devolve to the bankrupt in accordance with section 67 of the Act and that are not included in any other list. Nature of an other property Location of property Details of property Original cost of property Amount property is estimated to produce Line item number, optional but recommended Provide any additional information related to the form.