INSOLVENCY COUNSELLING DISCLOSURE AND ASSIGNMENT FORM FORMULAIRE DE DÉCLARATION ET DE NOMINATION AUX FINS DES CONSULTATIONS EN MATIÈRE D'INSOLVABILITÉ Name of the trustee Trustee Given Names Trustee Family or Company Name License number of the trustee Numéro de licence du syndic Name of consumer debtor or bankrupt Debtor Given Names Debtor family name Address of the LIT's office where the LIT finalized the debtor's assessment If true, Insolvency Counselling will be provided Internally by the LIT or an Employee of the LIT. If false, Insolvency Counselling will be provided Externally by a third-party BIA Insolvency Counsellor or an LIT outside the firm. This group is optional to allow for cases where this schedule must be filed after the fact (ie. retroactively). Its use will be enforced for estates filed after October 1, 2018. Signed At Name of the counsellor Counsellor Given Names Counsellor Family or Company Name Registration number of the counsellor Numéro de registration du conseiller External third-party organization's name (if applicable) the exception requested by the consumer debtor/bankrupt pursuant to 1.1 or 2.0 above is, or is not, feasible and appropriate. Signed At Provide any additional information related to the form.