Important notice
All estates filed on July 15, 2024 and after must use the version of Form 78, Statement of Affairs (Corporate Bankruptcy/Proposal), 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
221 KB, 4 pages
Statement of Affairs (Corporate Bankruptcy/Proposal)
(Subsection 49(2) and paragraph 158(d) of the Act/subsections 50(2) and 62(1) of the Act)
(Title Form 1)
Original Amended
To the bankrupt/debtor:
You are required to carefully and accurately complete this form and the applicable attachments showing the state of your affairs on the date of your bankruptcy / date of filing your proposal (or, if applicable, notice of intention) on the _____ day of _____________ ________. When completed, this form and the applicable attachments will constitute your Statement of Affairs and must be verified by oath or solemn declaration by a duly authorized director, if the bankrupt/debtor is a corporation, or by yourself, in other cases.
Give reasons for the bankrupt’s/debtor’s financial difficulty (Select all that apply and provide details):
□ Negative market conditions; □ Foreign Exchange Fluctuations; □ Economic Downturn; □ Poor Financial Performance; □ Legal Matters (Provide details); □ Lack of Working Capital/Funding; □ Competition; □ Legislated or Regulatory Restrictions; □ Natural Disaster; □ Increased Cost of Doing Business; □ Overhead Increasing; □ Faulty Infrastructure or Business Model; □ Unsuccessful Marketing Initiatives; □ Personal Issues; □ Poor Management; □ Faulty Accounting; □ Tax Liabilities; □ Labour; □ Other (Please specify).
Provide relevant details: ___________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________
Assets(totals from the list of assets as stated and estimated by bankrupt/debtor) |
Liabilities(totals from the list of liabilities as stated and estimated by bankrupt/debtor) |
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1. Cash on hand |
$______ |
1. Secured creditors |
$______ | |
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2. Deposits in financial institutions |
$______ |
2. Preferred creditors, securities, and priorities |
$______ | |
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3. Accounts receivable and other receivables |
$______ |
3. Unsecured creditors |
$______ | |
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Total amount |
$_____ |
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4. Contingent, trust claims or other liabilities estimated to be provable for |
$______ |
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Estimated realizable value |
$_____ |
$______ |
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4. Inventory |
$______ |
Total liabilities |
$______ | |
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5. Trade fixtures, etc. |
$______ |
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6. Livestock |
$______ |
Surplus |
$______ | |
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7. Machinery and equipment |
$______ |
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8. Real property or immovables |
$______ |
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9. Furniture |
$______ |
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10. Intangible assets (intellectual properties, licences, cryptocurrencies, digital tokens, etc.) |
$______ |
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11. Vehicles |
$______ |
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12. Securities (shares, bonds, debentures, etc.) |
$______ |
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13. Other property |
$______ |
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Total of lines 1 to 13 |
$______ |
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If the bankrupt/debtor is a corporation, add: |
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Amount of subscribed capital |
$_____ |
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Amount paid on capital |
$_____ |
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Balance subscribed and unpaid |
$_____ |
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Estimated to produce |
$_____ |
$______ |
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Total assets |
$______ |
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Deficiency |
$______ |
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Total value of assets located outside Canada included in lines 1 to 13 |
$_____ |
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List of Assets
Arrange by Nature of asset and number consecutively.
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No. |
Nature of asset[1] |
Address/ |
Asset located outside Canada |
Details |
Percentage of bankrupt’s/debtor’s interest |
Total value of the bankrupt’s/debtor’s interest |
Estimated realizable value |
Equity or surplus |
Placeholder (values on this line are for notification only) |
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Total |
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____________________________ ____________________
Bankrupt/Debtor Date
List of Liabilities
Names to be arranged in alphabetical order.
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No. |
Name of creditor or claimant |
Address |
Nature of liability[2] |
Details |
Date given/ incurred |
Amount of claim |
Asset securing the liability |
Ground for the right to a priority[3] |
Estimated surplus or (deficit) from security |
Placeholder (values on this line are for notification only) |
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Unsecured |
Secured |
Preferred/ Priorities |
Contingent, trust claims or other liabilities |
Total amount of claim |
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Total |
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__________________________ __________________
Bankrupt/Debtor Date
I, ______________________ (affiant’s name) __________ (affiant’s title with the bankrupt/debtor corporation), of the _____________ (city, town or village) of __________________________ in the Province of __________________, do swear (or solemnly declare) that this statement and the attached lists are, to the best of my knowledge, a full, true and complete statement of the affairs of the bankrupt/debtor corporation on the _____ day of ______________ ______ and fully disclose all property of every description that is in the possession of the bankrupt/debtor corporation or that may devolve on the bankrupt/debtor corporation in accordance with the Act.
SWORN (or SOLEMNLY DECLARED)
before me at ____________________ (city, town or village),
in the Province of _________________,
on this _____ day of _______________ ______.
Or
SWORN (or SOLEMNLY DECLARED) remotely by ____________________ (affiant’s name) _______ (affiant’s title with the bankrupt/debtor corporation)
stated as being located in at _______________ the _______ (city, town, or village),
in the Province of _________
before me at _______________ the _______ (city, town, or village),
in the Province of _____________,
on this _____ day of _______________ ______ in accordance with provincial Regulation on Administering Oath or Declaration Remotely.
______________________ ______________________
Commissioner of Oaths Signature of the affiant
for the Province of _________ for the bankrupt/debtor corporation
Note: If a copy of this Form is sent electronically by means such as email, the name and contact information of the sender, prescribed in Form 1.1, must be added at the end of the document.
[1] Choose one option for each item: Cash on hand; Deposits in financial institutions; Accounts receivable and other receivables; Inventory; Trade fixtures, etc.; Livestock; Machinery and equipment; Residential rental property; Commercial building; Industrial building; Land; Immovable industrial equipment; Other real property; Furniture; Intangible assets (intellectual properties, licences, cryptocurrencies, digital tokens, etc.); Vehicles; Securities (shares, bonds, debentures, etc.); Bills of exchange, promissory note, etc.; Tax refunds; Other personal property.
[2] Choose one option for each item: Accounts payable; Owed rent; Owed wages; Severance pay; Corporate taxes; Sales taxes; Employee source deductions; Litigation/legal costs and awards; Subordinated debenture; Bills of exchange; Promissory notes; Lien notes; Mortgages or hypothec on real or immovable property; Chattel mortgages or movable hypothec; General Security Agreement; Intercompany loans; Bank loans (except real property mortgage); Finance company loans; Shareholder loans; Shares and subscribed capital; Other claim or liability.
[3] Choose one option for each item with a preferred or priority amount: Unpaid supplier; Farmer, fisherman or aquaculturist; Owed wages; Unpaid amount regarding pension plan; Municipal taxes; Rent; Customer of a bankrupt securities firm; Deemed trust in favour of the Crown; Priming charges and interim financing; Environmental liabilities; Other.