Form 79—Statement of Affairs (Bankruptcy/Proposal of an Individual) (New, coming into force in 2024)

Important notice

All estates filed on July 15, 2024 and after must use the version of Form 79, Statement of Affairs (Bankruptcy/Proposal of an Individual), 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.

PDF and Word versions

Form 79

593 KB, 4 pages

Statement of Affairs (Bankruptcy/Proposal of an Individual)

(Subsection 49(2) and paragraph 158(d) of the Act/subsections 50(2) and 62(1) and paragraph 66.13(2)(d) of the Act)

(Title Form 1)

□ Original         □ Amended



Type of assets[1]

Description (Provide details including percentage of interest of the Bankrupt/Debtor and address for real property; provide location for assets located outside of Canada)

Assets located outside Canada

Estimated dollar value of the Bankrupt’s/ Debtor’s interest

Exempt property

Secured amount/liens on the Bankrupt’s/ Debtor’s interest

Estimated net realizable dollar value of the Bankrupt’s/Debtor’s interest[2]

Placeholder (values on this line are for notification only)
















Name of creditor


Account No.

Asset securing the liability

Amount of debt

Placeholder (values on this line are for notification only)

Liability type[3]


























A. Information relating to the affairs of the Bankrupt/Debtor

1.1. Surname: _________________       

1.3. All other surnames (including surname at birth and any surname by which you have been known, if  different from above): ____________       


Given names: ___________

All former given names  (including given names at birth and any given names by which you have been known, if different from above): _________

1.2. Date of birth: ________

2. Address: _____________________________________________________________

3. Marital or civil status (Single; Common-law partner; Married or civil union; Separated; Divorced; Widowed) (Specify month and year of each event if they occurred in the last five (5) years): _________

4. Surname of spouse or common-law                Given names of spouse or common-law

partner: _________________                             partner: _________________

5.1. Employment status (Choose one) (Employed – full-time; Employed – part-time; Employed – Seasonal; Self-employed; Retired; Student; Deceased; Not employed): ______________

5.2. Occupation: _________________

5.3. Name of present or most recent employer: _________________

5.4. Period of employment: ________ to ________

6.1. Total number of persons in household family unit, including bankrupt/debtor (1; 2; 3; 4; 5; 6; 7+ (Please specify) ___): _____

6.2. Number of persons 17 years of age or younger (1; 2; 3; 4; 5; 6; 7+ (Please specify) ___): _____

7.1. In the last six (6) months, have you received professional advice regarding your financial situation other than from the Licensed Insolvency Trustee?                                    □ Yes               □ No

7.2. Name any and all providers of professional financial advice: Surname: _____  Given names: ____

7.3. Name the firm/organization of the individual provider of professional financial advice: ___________

7.4. Address of the firm/organization noted at 7.3: ______________________________

7.5. Total amount paid to date: $_________        7.6. Total remaining amount to be paid: $_________

8. List any business(es) you operated within the last five (5) years                        □ Not applicable

Trade name of business


Nature of business/ Industry

Type of business (Corporation; Partnership; Sole proprietorship)

Percentage of bankrupt’s/ debtor’s interest in business

Period of operation (Date to Date)

Maximum number of employees in the past twelve (12) months








9. Have you previously been bankrupt or made a proposal under the Bankruptcy and Insolvency Act in Canada? If so, provide information on the proceedings.                         □ Yes               □ No

Estate number

Type of proceeding (Bankruptcy; Proposal)

Filing date

Location of the proceeding

Name of trustee or administrator

Date discharge or certificate of full performance was obtained








B. Budget Information: Attach Form 65 to this form

10. Within twelve (12) months prior to the date of the initial bankruptcy event, have you, either in Canada or elsewhere:

10.1. Made payments in excess of the regular payments to creditors?      □ Yes               □ No

10.2. Had any asset seized by a creditor?                                                         □ Yes               □ No

If yes, provide details: _______________________________________________________________

11. Within five (5) years prior to the date of the initial bankruptcy event, have you, either in Canada or elsewhere:

11.1. Sold, disposed of or transferred partially or in full any asset?            □ Yes               □ No

11.2. Made any gifts to relatives or others in excess of $1000?                    □ Yes               □ No

If yes, provide details: _______________________________________________________________

12. Do you expect to receive any sums of money that are not related to your normal income, or any other property within the next twelve (12) months?                                                                  □ Yes               □ No

If yes, provide details: _______________________________________________________________

13. Give reasons for your financial difficulties (Select all that apply and provide details): □ Loss of Income; □ Medical Reasons; □ Business Failure; □ Gambling; □ Addictions other than gambling; □ Relationship Breakdown; □ Tax Liabilities; □ Financial Support of Others; □ Student Debt; □ Legal Matters (Provide details); □ Moving/Relocation Expenses; □ Failed Proposal; □ Financial Mismanagement; □ Other (Please specify).

Provide relevant details:













I, ____________________ (Bankrupt’s/Debtor’s name), of the __________ (city, town or village) of ____________________ in the Province of __________________, do swear (or solemnly declare) that this statement is, to the best of my knowledge, a full, true and complete statement of my affairs on the _____ day of ______________ ______ and fully discloses all transactions and all property of every description that is or was in my possession or that may devolve on me in accordance with the Bankruptcy and Insolvency Act.



before me at _________________ (city, town or village) of _______________,

in the Province of __________________________,

on this _____ day of __________________ ______.




SWORN (or SOLEMNLY DECLARED) remotely by ____________________ (Bankrupt’s/Debtor’s name)

stated as being located in at___________ the (city, town, or village),

in the Province of _________

before me at ________________ (city, town, or village) of _______________,

in the Province of _____________,

on this _____ day of _______________ ______in accordance with provincial Regulation on Administering Oath or Declaration Remotely.



Commissioner of Oaths

for the Province of ________________.





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 line: Cash on hand; Furniture; Personal effects; Cash-surrender value of life insurance policies, RRSPs, etc.; Securities; Intangible assets (intellectual properties, licences, cryptocurrencies, digital tokens, etc.); Principal residence; House; Cottage; Land; Other real or immovable property (Please specify); Automobile; Recreational vehicle; Other motor vehicle; Recreational equipment; Estimated tax refund; Other asset (Please specify).

[2] For a summary administration, indicate net value after deducting the direct realization costs referred to in Rule 128(1).

[3] Choose one option for each line: Mortgage/hypothec over real or immovable property; Bank loans (except real property mortgage); Finance company loans; Credit cards - bank/trust company issuers; Credit cards – stores; Credit cards - other issuers; Taxes – federal; Taxes – other; Student loans; Loans from individuals; Payday loans; Utilities; Future payments agreed to be made to financial adviser other than the Licensed Insolvency Trustee; Other (Please specify).