Report of Trustee on Bankrupt's Application for Discharge (Subsection 170(1) of the Act) Date of bankruptcy Date of initial bankruptcy event Marital status of the debtor. Pick from list. Type of employment Number of persons in household family unit, including bankrupt Amount of declared secured liablities Amount of declared preferred liablities Amount of declared unsecured liablities Amount of proven secured liablities Amount of proven preferred liablities Amount of proven unsecured liablities An asset Description of the asset Value as per Statement of Affairs Amount realized Estimate of assets to be realized Total value as per Statement of Affairs Total amount realized Total estimate of assets to be realized Anticipated Rate of Return on Dividends for Preferred Creditors Anticipated Rate of Return on Dividends for Unsecured Creditors 1. Details of the causes of bankruptcy 2a. Available monthly income of the bankrupt at date of bankruptcy. 2b. Available monthly income of the bankrupt at date of this report 3a. Available monthly income of the family unit at date of bankruptcy 3b. Available monthly income of the family unit at date of this report 4a. Was the bankrupt required to pay to the estate an amount established by the Directive on Surplus Income? 4b. Could the bankrupt have made a viable proposal rather than proceeding with bankruptcy? 5a. Did the bankrupt fail to perform any of the duties imposed on the bankrupt under the Act? 5a. Details of failure to perform duties 5b. Can the bankrupt be justly held responsible for any of the facts referred pursuant to section 173 of the Act? 5b. Details of facts for which the bankrupt can be held justly responsible 5c. Did the bankrupt commit any offence in connection with the bankruptcy? 5c. Details of offence(s) 6a. Did the bankrupt ever make a proposal under the Bankruptcy and Insolvency Act? 6a. Details of proposal 6b. Has the bankrupt been bankrupt before either in Canada or elsewhere? 6b. Details of previous bankruptcy 7. Were inspectors appointed in this estate? 7. Details of appointed inspectors if trustee believes inspectors will not approve this report 8a. Is it the intention of the trustee to oppose the bankrupt's discharge? 8a. Details of trustee opposition 8b. Does the trustee have reasonable grounds to believe that a creditor or the Superintendent will oppose the bankrupt's discharge for a reason other than those set out in the Act? 8b. Details of reasonable grounds 9. Did the bankrupt refuse or neglect to receive counselling pursuant to the Directive on Counselling in insolvency matters? 9. Details of refusal or neglect 10. Are there other facts, matters or circumstances that would justify the Court in refusing an absolute order of discharge? 10. Details of other facts, matters or circumstances. 11. Is there other pertinent information? 11. Details of other pertinent information Additional details as required Declaration by trustee for the main form part Appendix A is required when Q4a or Q4b are answered "Yes" A:(1) Monthly amount required by the Directive on Surplus Income A:(2) Amount bankrupt has agreed to pay monthly A: Difference between amounts (1)-(2) A:(3) Amount bankrupt has agreed to pay monthly to repurchase assets A:(3) Details of assets bankrupt has agreed to pay monthly to repurchase A: Total anticipated payments, (2) + (3) B1: Did bankrupt make all required payments? If no, provide details B2: Does amount established to be paid correspond with Directive on Surplus Income? CorrespondWithDirectiveDetails B3: Was the bankrupt made aware of the possibility of requesting mediation? B4: Any amendment or material changes during period of bankruptcy? B4: Details of amendment or material changes B5: Was mediation necessary to determine the amount to be paid by the bankrupt? C6: Recommendation of the trustee Bankrupt to be discharged without conditions Justification for unconditional discharge Bankrupt to be discharged subject to conditions (deemed opposition) NotComplied AmountDisproportionate ChoseBankruptcy Details, including amount and period of payments Description of detail Amount Period Amount to be paid monthly Bankrupt to be discharged after fulfiling obligations under mediation agreement Details, including amount and period of payments Description of detail Amount Period Amount to be paid monthly 7. Does the trustee have reasonable grounds to believe that the debtor agrees to the conditions recommended by the trustee? 8. Was the bankrupt made aware of the possibility of requesting mediation? Declaration of trustee for the appendix Provide any additional information related to the form.