Form 31—Proof of Claim (New, coming into force in 2024)

Important notice

All estates filed on July 15, 2024 and after must use the version of Form 31, Proof of Claim, issued through Directive No. 8R21, The Bankruptcy and Insolvency Act Forms. All estates filed prior to July 15, 2024 must continue using the pre-2024 version of this Form.

For persons to which the 2009 amendments apply

PDF version

Form 31 – Proof of Claim

615 KB, 4 pages

(Sections 50.1, 81.5, 81.6, subsections 65.2(4), 81.2(1), 81.3(8), 81.4(8), 102(2), 124(2), 128(1), and paragraphs 51(1)(e) and 66.14(b) of the Act)

The creditor’s preference is to receive all notices and correspondence regarding this claim at the following address and/or facsimile number and/or email address (a mailing address must be provided in all cases):

Address: Space to insert address

Facsimile: Space to insert address

Email: Space to insert address

Contact person name or position: Space to insert address

Telephone number for contact person: Space to insert address

In the matter of the bankruptcy (or the proposal or the receivership) of Space to insert name of debtor (name of debtor) of Space to insert city and province of debtor (city and province) and the claim of Space to enter name of creditor, creditor.

I, Space to enter name of creditor or representative of the creditor (name of creditor or representative of the creditor), of Space to enter city and province of creditor or representative of creditor (city and province), do hereby certify:

  1. That I am a creditor of the above-named debtor (or that I am Space to insert position or title (state position or title) of Space to insert name of creditor or representative of creditor (name of creditor or representative of the creditor) and that I am authorized to represent and (if the creditor is a corporation) that I have authority to bind the creditor of the above-named debtor).
  2. That I have knowledge of all of the circumstances connected with the claim referred to below.
  3. That the debtor was, at the date of bankruptcy (or the date of the receivership or, in the case of a proposal, the date of the notice of intention or of the proposal, if no notice of intention was filed), namely the Space to insert day day of Space to insert month Space to insert year, and still is, indebted to the creditor in the sum of $Space to insert amount, as specified in the statement of account (or affidavit) attached and marked Schedule "A", after deducting any counterclaims to which the debtor is entitled. Any debt payable in a currency other than Canadian currency was converted to Canadian currency as of the date of bankruptcy (or the date of the receivership or, in the case of a proposal, the date of the notice of intention or of the proposal, if no notice of intention was filed).
    (The attached statement of account or affidavit must specify the supporting documents or other evidence in support of the claim)
  4. That, to the best of my knowledge, this debt has never been (or this debt has been or part of this debt has been) statute-barred as determined under the relevant legislation.
  5. That payment for this debt by the debtor to the creditor has been due (or has been in default) since the Space to insert day day of Space to insert month Space to insert year, and that the last payment, if any, on this debt by the debtor to the creditor was made on the Space to insert day day of Space to insert month Space to insert year, and/or that the last acknowledgement, if any, of liability for this debt by the debtor to the creditor was made on the Space to insert day day of Space to insert month Space to insert year, as follows:

    (Give full particulars of the claim, including its history, any acknowledgement or legal action)

  6. (Check and complete appropriate category)

Checkbox for Unsecured Claim A. Unsecured Claim of $Space to insert amount

(Other than as a customer contemplated by section 262 of the Act)
That in respect of this debt, I do not hold any assets of the debtor as security and:

 

(Check appropriate description)

 

Checkbox for an amount claimed with no right to a priority Regarding the amount of $Space to insert amount, I do not claim a right to a priority.

Checkbox for claiming an amount with the right to a priority under section 136(1)(d) of the Act Regarding the amount of $Space to insert amount, I claim a right to a priority under section 136(1)(d) of the Act (Complete paragraph 6E below).

Checkbox for claiming an amount with the right to a priority under section 136(1)(d.01) of the Act Regarding the amount of $Space to insert amount, I claim a right to a priority under section 136(1)(d.01) of the Act.

Checkbox for claiming an amount with the right to a priority under section 136(1)(d.02) of the Act Regarding the amount of $Space to insert amount, I claim a right to a priority under section 136(1)(d.02) of the Act.

Checkbox for claiming an amount with the right to a priority under section 136(1)(d.1) of the Act Regarding the amount of $Space to insert amount, I claim a right to a priority under section 136(1)(d.1) of the Act.

Checkbox for claiming an amount with the right to a priority under section 136(1)(e) of the Act Regarding the amount of $Space to insert amount, I claim a right to a priority under section 136(1)(e) of the Act.

Checkbox for claiming an amount with the right to a priority under section 136(1)(f) of the Act Regarding the amount of $Space to insert amount, I claim a right to a priority under section 136(1)(f) of the Act.

Checkbox for claiming an amount with the right to a priority under section 136(1)(g) of the Act Regarding the amount of $Space to insert amount, I claim a right to a priority under section 136(1)(g) of the Act.

Checkbox for claiming an amount with the right to a priority under section 136(1)(i) of the Act Regarding the amount of $Space to insert amount, I claim a right to a priority under section 136(1)(i) of the Act.

(Set out on an attached sheet details to support priority claim)

Checkbox for Claim of Lessor for Disclaimer of a Lease B. Claim of Lessor for disclaimer of a lease $Space to insert amount

That I make a claim under subsection 65.2(4) of the Act, the particulars of which are as follows:

(Give full particulars of the claim, including the calculations upon which the claim is based)

Checkbox for Secured Claim C. Secured claim of $Space to insert amount

That in respect of this debt, I hold assets of the debtor valued at $Space to insert amount as security, the particulars of which are as follows:

(Give full particulars of the security, including the date on which the security was given and the value at which you assess the security, and attach a copy of the security documents)

A trustee may, pursuant to subsection 128(3) of the Act, redeem a security on payment to the secured creditor of the debt or the value of the security as assessed, in the proof of security, by the secured creditor.

Checkbox for Claim by Farmer, Fisherman or Aquaculturist D. Claim by Farmer, Fisherman or Aquaculturist of $Space to insert amount

That I make a claim under subsection 81.2(1) of the Act for the unpaid amount of $Space to insert amount

(Attach a copy of sales agreement and delivery receipts)

Checkbox for Claim by Wage Earner E. Claim by Wage Earner of $Space to insert amount

Checkbox for making a claim under subsection 81.3(8) of the Act That I make a claim under subsection 81.3(8) of the Act in the amount of $Space to insert amount

Checkbox for making a claim under subsection 81.4(8) of the Act That I make a claim under subsection 81.4(8) of the Act in the amount of $Space to insert amount

Checkbox for Claim by Employee for Unpaid Amount Regarding Pension Plan F. Claim by Pension Plan for unpaid amount of $Space to insert amount

Checkbox for making a claim under subsection 81.5 of the Act That I make a claim under section 81.5 of the Act in the amount of $Space to insert amount

Checkbox for making a claim under subsection 81.6 of the Act That I make a claim under section 81.6 of the Act in the amount of $Space to insert amount

Checkbox for Claim Against Director G. Claim against Director $Space to insert amount

(To be completed when a proposal provides for the compromise of claims against directors)

That I make a claim under subsection 50(13) of the Act, the particulars of which are as follows:

(Give full particulars of the claim, including the calculations upon which the claim is based)

Checkbox for Claim of a Customer of a Bankrupt Securities Firm H. Claim of a Customer of a Bankrupt Securities Firm of $Space to insert amount

That I make a claim as a customer for net equity as contemplated by section 262 of the Act, the particulars of which are as follows:

(Give full particulars of the claim, including the calculations upon which the claim is based)

  1. That, to the best of my knowledge, I am (or the above-named creditor is) (or am not or is not) related to the debtor within the meaning of section 4 of the Act, and have (or has) (or have not or has not) dealt with the debtor in a non-arm’s-length manner.
  2. That the following are the payments that I have received from the debtor, the credits that I have allowed to the debtor, and the transfers at undervalue within the meaning of section 2 of the Act that I have been privy to or a party to with the debtor within the three months (or, if the creditor and the debtor are related within the meaning of section 4 of the Act or were not dealing with each other at arm’s length, within the 12 months) immediately before the date of the initial bankruptcy event within the meaning of section 2 of the Act:
    (Provide details of payments, credits and transfers at undervalue)
  3. (Applicable only in the case of the bankruptcy of an individual)

    Checkbox to request to be informed of the new fixed amount or of the fact that there is no longer surplus income Whenever the trustee reviews the financial situation of a bankrupt to redetermine whether or not the bankrupt is required to make payments under section 68 of the Act, I request to be informed, pursuant to subsection 68(4) of the Act, of the new fixed amount or of the fact that there is no longer surplus income.

    Checkbox to request a copy of the report I request that a copy of the report filed by the trustee regarding the bankrupt’s application for discharge pursuant to subsection 170(1) of the Act be sent to the above address.

Warning:

Subsection 201(1) of the Act provides for the imposition of severe penalties in the event that a creditor or a person claiming to be a creditor makes any false claim, proof, declaration or statement of account.

   

Dated at Space to insert city, this Space to insert day day of Space to insert month and year.

Space to insert signature of creditor or representative
Signature of creditor or representative

   

note:

If an affidavit is attached, it must have been made before a person qualified to take affidavits.

 Report a problem
Date modified: