Province of QUEBEC SUPERIOR COURT District of Quebec “Bankruptcy and Insolvency”

Province of QUEBEC
District of Quebec
Division No: 08-Joliette
Court No: 705-11-009595-142
Estate No : 41-1930099
SUPERIOR COURT
“Bankruptcy and Insolvency”
IN THE MATTER OF THE PROPOSAL OF:
9096-0733 QUEBEC INC. (having done business
under the name of Auberge du Lac Taureau), a body
duly incorporated according to law, having its principal place
of business at 1200 chemin de la Baie du Milieu, in the City of
Saint-Michel-des-Saints, Province of Quebec, J0K 3B0.
- and -
DEBTOR
PRICEWATERHOUSECOOPERS INC.
TRUSTEE
NOTICE OF BANKRUPTCY AND FIRST MEETING OF CREDITORS
(Subsection 102(1) of the Act)
Take notice that:
1.
9096-0733 Quebec Inc. is deemed to have filed an assignment on the 3rd day of March 2015, and the
undersigned, PricewaterhouseCoopers Inc. (Christian Bourque, CPA, CA, CIRP), was appointed as
trustee of the estate of the bankrupt by the official receiver, subject to affirmation by the creditors of
the trustee's appointment or substitution of another trustee by the creditors.
2. The first meeting of creditors of the bankrupt will be held on March 27, 2015, at 2:30 p.m. at the office
of the Trustee, at 1250 Rene-Levesque Blvd. West, Suite 2800, Montreal, Quebec.
3. To be entitled to vote at the meeting, a creditor must lodge with the trustee, before the meeting, a
proof of claim and, where necessary, a proxy.
4. Enclosed with this notice is a proof of claim form, proxy form and list of creditors showing the
amounts of their claims.
5. Creditors must prove their claims against the estate of the bankrupt in order to share in any
distribution of the proceeds realized from the estate.
DATED AT MONTREAL, this 10th day of March 2015.
PRICEWATERHOUSECOOPERS INC.
Trustee
Christian Bourque, CPA, CA, CIRP
Trustee in charge of the estate
PricewaterhouseCoopers Inc.
1250 René-Lévesque Boulevard West, Suite 2800, Montréal, Quebec, Canada H3B 2G4
T: +1 514 205 5000, F: +1 514 205 5694, www.pwc.com/ca
District de:
Québec
No division:
08- Joliette
No cour:
705-11-009539-140
i:i modifié
original
No dossier:
-- FORMULAIRE 78 -Bilan - faiflite d'entreprise ddposée par une entité
(paragraphe 49(2), alinéa 1 58d) et paragraphes 50(2) et 62(1) de Ia Loi)
Dans laffaire de la faillite de 9096-0733 Québec inc.
corporation légalement constituée, ayant sa principale place d'affaires au
1200, chemin de Ia Bale du milieu, dans Ia yule de Saint-Michedes-Saints,
district de Joliette, dans Ia province de Québec, JOK 3B0.
Au failf:
Vous êtes tenu de remplir avec soin et exactitude le present formulaire et les annexes applicables indiquant Ia situation de vos atfaires ala date de votre faillite le 2
mars 2015. Une toe remph. ce formulaire et les listes annexées. constituent votre bilan, qui dolt Stre vdrifd sous serment ou par une declaration solennelle.
PASS IF
(tel que ddclaré et estimé par I'officier)
1. Crdanciers non garantis: voir liste A ........
ACTIF
(tel que déclaré et estime par l'officier)
1,969190.14
Equilibre de reclamations garantis: voir liste B".......
Créanciers non garantis total......................
0.00
1. Inventaire.
0.00
3. Creanciers
privilégies: voir liste C
0
.00
4. Dettes éventuelles, reclamations de tiducie ou autres
(voir liste D)pouvant être réclamées pour une somme de. .
Totaldu passif ..................................
Surplus
0.00
3. Comptes a recevoir et autres créances: voir iste E
1,969,190.14
2. Créanciers garantis: voir iste B ...................
0.00
2. Amenagements .................................
Bonnes .............
0.00
Douteuses ................
0.00
Mauvaises ................
0.00
Estimation des créances qui peuvent être réalisées
4.Lettres de change, billets
0.00
1,969,190.14
NIL
0.00
a ordre, etc., voir liste F ......
0.00
5. DepOts en institutions tinancéres ....................
0.00
6. Especes .....................,,.,,,,.,........,
0.00
7.Bétail ..........................................
0.00
8. Machines, outillage et installation ...................
0.00
9. Immeubles et biens reels: voir liste G ................
0.00
10.Ameublement ..................................
0.00
11.REER, FERR, Assurances-vie etc ..................
0.00
12.Valeurs mobiflOres(actions, obligations, debentures etc
0.00
13. Droits en vertu de testaments .....................
0.00
14.Véhicules .....................................
0.00
15.Autres biens: voirliste H .........................
0.00
Si le failli est une personne morale, ajoutez:
Montant du capital souscrit
0.00
Montantdu capital paye
0.00
Solde souscrit et impayé ......................
0.00
Estimation du solde qui peut être réalisé
0.00
Total de l'actif
0.00
...,....,,.....,
Deficit ........................
1,969,190.14
Je, Mario Goum, de Samt-MicheI-des-Sants en Ia province de Québec, étant dOment assermenté (ou ayant ddclaré solennellement) declare que Ic bilan qui
sue et les hstes annexees sont, a ma connaissance, un relevé complet, véridique et entier de mes aftaires en ce 2 mars 2015, et indiquent au complet tous mes
bens de queique nature qu'ils soient, en ma possession et réversibles, tels que définis par Ia Loi.
ASSERMENTE (ou declare solennellement)
devant mol Ic 2 mars 2015, a Montréal en Ia province de Cu
L
Catherine N y67'Cônmissaire a l'Assermentation
pour Ia proj
Expire 1025)
Page 1
Dans l'affaire de la faillite de / In the matter of the bankruptcy of
9096-0733 Québec Inc.
Liste des créanciers / Creditors List
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
Créanciers / Creditors
Non garantis / Unsecured
9124-6033 Québec Inc. (Les Forestiers St-Michel)
9154-1896 Québec inc.
Activins Importations
AGENCE DU REVENU DU CANADA
Agence Tannins Inc.
ALIMENTATION D.M. ST-GEORGES INC.
Ally Crédit Canada Limitée
Amusement Rive-Nord
ASSOCIATION DES RESTAURATEURS DU QUÉBEC
Association l'agrotourisme
ATR Associes du Québec
BELL Canada
BELL EXPRESSVU c/o Special Billing
Blanc ou Rouge
Booking.com
BRASSERIE LABATT LTEE
BURO PLUS
C.S.S.T.
CAFE LANAUDIERE INC.
CANOE
CARL BELLEROSE
CERTILAB
CHAMBRE DE COMMERCE HAUTE-MATAWINIE
Chez Louis
COMMISSION SCOLAIRE DES SAMARES
Communications Michel Julien
Confédération des syndicats nationaux
CORPO MÉDIA INC.
Crédit Bail Clé Ltée
Croix Bleue Medavie
Développement Économique du Canada
Diversey Canada, Inc.
E.B.J.
ÉRABLIERE LA SEVERIE INC.
F.C.M.Q.
Gagnon Cantin Lachapelle
Génératrice Drummond
GLOBAL INTERNET
GOLF ST-MICHEL-DES-SAINTS
Groupe TVA inc. A/S Service des finances
HOTELLERIE CHAMPETRE
Info-Média.ca
IQWARE
Kubota Canada Ltée
Kubota Canada Ltée
L'Alchimiste
La Forfaiterie
LA MAISON DU GIBIER INC.
LA TERRE DES BISONS
Lavacom Distribution
Le Lutin Atikamek
Linde Canada Limitée M2193
Location d'outils MGM Inc.
Lussier Cabinet d'Assurances
Marc Prudhomme
MARCEL CHAMPAGNE ELECTRIQUE
MARIO GOUIN
MICHEL RONDEAU RÉFRIGÉRATION
MINISTRE DES FINANCES
MINISTRE DU REVENU DU QUÉBEC
Motoneiges.ca Inc.
MUNICIPALITÉ ST-MICHEL-DES-STS
NEOPOST
Orkin Canada Corporation
OTIS CANADA INC.
Québec Références
Raymond Chabot Grant Thornton, S.E.N.C.R.L.
RECEVEUR GÉNÉRAL DU Canada
RONA DE LA HAUTE MATAWINIE
Roy Laporte Inc.
SATELCOM
Satelcom Internet
Services Conseil ARH Inc.
Services Conseils MarCom Décisions Inc
SHAW DIRECT
Socan
Société d'assurance-dépôts du Canada
Société des attractions touristiques du Québec
Société Roucet inc.
Solutions D'Affaires MPEX
Superieur Propane
Syndicat des travailleurs (euses) de l'Auberge du lac Taureau
TELUS MOBILITÉ
TOURISME LANAUDIÈRE
Adresse / Address
631, rue Brasard, St-Michel-des-Saints QC J0K 3B0
1200 Chemin Baie du Milieu, Saint-Michel-des-Saints QC J0K 3B0
277 Boul. Labelle C.P. 125, Rosemere QC J7A 2H3
2250 rue St-Olivier, A/S Section du C.A.R.I., Trois-Rivières QC G9A 4E9
980, Guertin, Granby QC J2J 0G4
110, rue brassard, Saint-Michel-des-Saints QC J0K 3B0
PO Box 3190, station D, Étobicoke ON M9A 0C2
813, Basile Routhier, Repentigny QC J6A 7V2
6880, Louis-H. Lafontaine, Montréal QC H1M 2T2
4545 Ave. Pierre de Coubertin, Montreal QC H1V 0B2
1575 Boul. De l'avenir Bur. 330, Laval QC H7S 2N5
c.p. 8713 succ. centre-ville, Montréal QC H3C 3P6
5115, Creekbank road, 3rd loor, Mississauga ON L4W 5R1
40, Omer-Deserres, local 109, Blainville QC J7C 5H2
PO Box 4090 Stn A, Toronto ON M5W 0E9
2505, rue Senkus, Lasalle QC H8N 2X8
576, rue St-Viateur, Joliette QC J6E 3B6
432, de Lanaudière, Joliette QC J6E 3L9
23, rue Rivest, Joliette QC J6E 7Y8
298 de Martigny Ouest Suite 100, St-Jerome QC J7Y 4C9
261, rue Saint-Jacques, Saint-Michel-des-Saints QC J0K 3B0
154, Visitation, Joliette QC J6E 4N3
521, rue Brassard, Saint-Michel-des-Saints QC J0K 3B0
222, place du Marché du Nord, Montréal QC H2S 1A1
4671, rue Principale, Saint-Félix-de-Valois QC J0K 2M0
728, Pierre-Piché, Boucherville QC J4B 3H5
289, rue De Villemure, 2e étage, St-Jérôme QC J7Z 5J5
3216, boul. Tachereau, cp:36028, Greenfield Park QC J4V 3N7
2200, rue de la Sidbec Sud, bureau 202, Trois-Rivières QC G8Z 4H1
C.P. 1330, succursale B, Montréal QC H3B 3K9
2290, avenue Pierre Péladeau, bureau 410, Laval QC H7T 3B3
P.O. box number 15218, station A, Toronto ON M5W 1C1
20, Gauthier Sud, Joliette QC J6E 4J4
961, rue Brassard, Saint-Michel-des-Saints QC J0K 3B0
4545, Pierre de Coubertin, C.P.1000 succ.M, Montreal QC H1V 3R2
37 Place Bourget Sud Bur. 301, Joliette QC J6E 5G1
2997, Watt, Québec QC G1X 3W1
4640, boul. Wilfrid-Hamel, bureau: 211, Québec QC G1P 2J9
220, chemin Mont Trinité, Saint-Michel-des-Saints QC J0K 3B0
C.P. 10, Succ. C, Montréal QC H2L 4J8
467, Notre Dame, bureau 208, Repentigny QC J6A 2T3
1220, Beauharnois, suite 354, Montréal QC H4N 1J5
5255, boul. Henri-Bourassa Ouest, suite 425, Montréal QC H4R 2M6
5900, 14th Ave, Markham ON L3S 4K4
5900, 14th Ave, Markham ON L3S 4K4
681, Marion, Joliette QC J6E 8S3
107, 1ère Avenue, Stoneham QC G3C 0L3
585, rue de l'Argon, Charlesbourg QC G2N 2G7
6855, Parkinson, Rawdon QC J0K 1S0
180, des Rossignols, Sherbrooke QC J1R 0M9
781 Route St-Joseph, St-Emilie-de-L'Energie QC J0K 2K0
C.P. 11451, Montréal QC H3C 5K3
8380, rue Brassard, Saint-Michel-des-Saints QC J0K 3B0
750a, rue Notre-Dame, Berthierville QC J0K 1A0
361, chemin de la Place-des-Cèdres, Saint-Michel-des-Saints QC J0K 3B0
121, St-Maurice Ouest, Saint-Michel-des-Saints QC J0K 3B0
100, rue Beaulac, Saint-Michel-des-Saints QC J0K3B0
320, durand, Saint-Michel-des-Saints QC J0K 3B0
12, rue Saint-Louis, Québec QC G1R 5L3
1265, boul. Charest Ouest, Québec QC G1N 4V5
13, des sapins, Sainte-Luce QC G0K 1P0
441, rue Brassard, Saint-Michel-des-Saints QC J0K 3B0
150, Steelcase road West, Markham ON L3R 3J9
650, boulevard Industriel, unité 2, Blainville QC J7C 5Y7
po box 57445 station A, Toronto ON M5W 5M5
316, Lamoureux, Ste-Sophie QC J5J 2K8
1610, rue Bellefeuille, bureau 400, Trois-Rivières QC G9A 6H7
11, rue Laurier, Phase III, Place du Portage, Gatineau QC K1A 0S5
630, rue Brassard, Saint-Michel-des-Saints QC J0K 3B0
386, boul. Manseau, Joliette QC J6E 3E1
271, rue Beauséjour, Saint-Michel-des-Saints QC J0K 3B0
271, rue Brassard, Saint-Michel-des-Saints QC J0K 3B0
54, 9ième rue, Roxoboro QC H8Y 1J5
168, Prince Albert, Otterburn Park QC J3H1L3
p.o. box 2530 stn M, Calgary AB T2P 0C2
a/s RMS, an iQor Company, 7171, rue Jean-Talon Est, bureau 300, Montreal QC H1M 3N2
50, rueO'Connor, 17e étage, Ottawa ON K1P 6L2
4545, Pierre-de-Coubertin, Montréal QC H1V 0B2
20, rue des manoirs, suite 202, Charlemagne QC J5Z 5H3
1131 boulevard, Pie XI Sud, Québec QC G3K 1J9
C.P. 2875 Suite M, Calgary AB T2P 5G1
1200 chemin Baie du Milieu, Saint-Michel-des-Saints QC J0K 3B0
C.P.11049, succ Centre Ville, Montréal QC H3C 4Y5
3568, rue church, Rawdon QC J0K 1S0
Montant /
Amount
185 000,00
1,00
380,79
100 300,94
584,73
23 710,89
34 343,00
468,00
255,82
109,23
758,78
1 520,85
3 335,38
1 138,09
243,00
11 851,55
2 304,43
276,95
1 599,43
3 449,26
3 414,69
155,22
188,56
2 929,35
10 310,95
172,41
1,00
1 724,63
11 330,00
489,54
80 960,00
6 000,06
402,41
1 080,00
1 589,63
241,44
2 827,00
457,60
84,00
20 845,37
10 657,23
476,00
574,88
16 047,00
16 263,00
330,41
2 535,20
11 029,41
2 610,07
526,42
460,00
248,85
218,45
8 007,28
930 000,00
2 191,83
3 675,87
1 089,24
59,25
208 099,45
402,41
19 482,00
703,52
402,41
1 747,47
80,43
10 213,01
33 593,44
3 248,05
3 106,63
3 997,22
10 198,00
1 805,03
414,04
128,71
1 704,83
88 949,00
4 029,87
781,65
434,00
1,00
1,00
172,97
10 167,66
5
Dans l'affaire de la faillite de / In the matter of the bankruptcy of
9096-0733 Québec Inc.
Liste des créanciers / Creditors List
85
86
87
88
Total
Créanciers / Creditors
Vertisoft Inc.
Viandes Lauzon Div. De Colabor
VISA DESJARDINS
YVON BORDELEAU PORTES & FENETRES
Adresse / Address
990, boul. Pierre-Roux Est, Victoriaville QC G6T 0K9
2715, rue Reading, Montréal QC H3K 1P7
#ref.:4530 9200 3853 6000, C.P. 8601, Succ. Centre-ville, Montréal QC H3C 3V2
440, rue Ste-Thérèse, Saint-Michel-des-Saints QC J0K 3B0
Montant /
Amount
8 177,60
24 588,58
8 546,19
177,60
1 969 190,14
6
Reserved for Administration
Secured :
Privileged :
Unsecured :
PROOF OF CLAIM
Original:
(see instructions on page 3)
Collocated on:
Amendment:
Initials
IN THE MATTER OF THE BANKRUPTCY OF:
9096-0733 Québec Inc., of the city of Saint-Michel-des-Saints, province of Quebec (referred to in this form as “the debtor”)
and the claim of
, (referred to in this form as “the creditor”).
All notices or correspondence regarding this claim must be forwarded to the creditor at the following address:
(attention)
(civic number and street)
(city, province, postal code and country)
Telephone:
Fax:
Email address:
I,
residing in the city of
(name of individual completing this form)
in the Province of
If an officer of the company, state
position or title.
, do hereby certify that:
1.
 I am the creditor of the above-named debtor or  I am
of
2.
The attached statement of account or
affidavit must specify the vouchers
or other evidence in support of the
claim.
3.
Check and complete the appropriate
category.
4.
I have knowledge of all the circumstances connected with the claim referred to below.
The debtor was, at the date of bankruptcy, namely the 3rd day of March 2015, and still is, indebted to the
creditor in the sum of $
, as specified in the statement of account
(or affidavit) attached and marked Schedule “A”, after deducting any counterclaims to which the debtor is
entitled.
A
Check appropriate description. Set
out an attached sheet details to
support priority claim.
Give full particulars of the claim,
including the calculations upon
which the claim is based.
(name of creditor or its representative)
(state position or title)
.
B

Unsecured claim of $
(Other than a customer contemplated by Section 262 of the Act). In respect of this debt,
I do not hold any assets of the debtor as security and:
(i)
 Regarding the amount of $
(ii)
 Regarding the amount of $
, I claim a right to a priority under section
136 the Act.
Claim of lessor for disclaimer of a lease of $
.
I hereby make a claim under subsection 65.2(4) of the Act, particulars of which are as follows:

, I do not claim a right to a priority.
.
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.
C
Attach a copy of sales agreement and
delivery receipts.
D

Claim by farmer, fisherman, or aquaculturist of $
I hereby claim under subsection 81.2(1) of the Act for the unpaid amount of $
.
.
Give full particulars of any wage
earner’s claim, including the
calculations upon which the claim is
based.
E

(i)
or
(ii)
Claim by wage earner of $
 I hereby make a claim under subsection 81.3(8) of the Act in the amount of $
.
 I hereby make a claim under subsection 81.4(8) of the Act in the amount of $
.
Give full particulars of any
employee’s claim, including the
calculations upon which the claim is
based.
F

(i)
or
(ii)
Claim by employee for unpaid amount regarding pension plan of $
 I hereby make a claim under subsection 81.5 of the Act in the amount of $
,
 I hereby make a claim under subsection 81.6 of the Act in the amount of $
.
To be completed when a proposal
provides for the compromise of
claims against directors. Give full
particulars of the claim, including
the calculations upon which the
claim is based.
G

Claim against director of $
.
I hereby make a claim under subsection 50(13) of the Act, particulars of which are as follows:
Give full particulars of the claim,
including the calculations upon
which the claim is based.
H

Secured claim of $
In respect of this debt, I hold assets of the debtor valued at $
as security, particulars of which are as follows:
.
.
.

Claim of a customer of a bankrupt securities firm of $
.
I hereby make a claim as a customer for net equity as contemplated by section 262 of the Act,
particulars of which are as follows:
.
Chose the right formulation for your
situation by checking it and striking
the non desired portion.
5. To the best of my knowledge,  I or  the above-named creditor  am/is or  am/is not related to the
debtor within the meaning of section 4 of the Act, and  have/has or  have/has not dealt with the debtor
in a non-arm’s-length manner.
Provide details of payments, credits
and transfers at undervalue.
6. The following are the payments that I have received from, the credits that I have allowed to, and the transfers
at undervalue within the meaning of subsection 2(1) 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 subsection 2(1) of the Act:
.
Applicable only in the case of the
bankruptcy of an individual.
7.  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.
Must be signed and witnessed.
8.
Notes:
DATED AT______________________this _____th day of
, 201_____.
(signature of witness)
(signature of individual completing this form)
(name of witness, print)
(name of individual completing this form, print)
All references to “the Act” refer to the Bankruptcy and Insolvency Act.
If an affidavit is attached, it must have been made before a person qualified to take affidavits.
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.
Warnings: 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 a proof of security, by the secured creditor.
Subsection 201(1) of the Act provides severe penalties for making any false claim, proof, declaration or statement of account.
If there are any questions in completing the proof of claim, please write or call the office of the trustee.
PRICEWATERHOUSECOOPERS INC.
1250 René-Lévesque Boulevard West, Suite 2800
Montréal, Quebec H3B 2G4
Attention: Mrs Valery Leclerc
Telephone: (514) 205-5001 ext. 1573
Fax: (514) 205-5694
Email: [email protected]
GENERAL PROXY
I,
hereby appoint
, of
(name of creditor)
, a creditor in the above matter,
(name of town or city)
, of
(name of proxy)
(company or firm)
, to be my proxy
holder in the above matter, except as to the receipt of dividends,  with power to appoint another proxyholder in his or her place or  without power
to appoint another proxyholder in his or her place.
DATED AT
, this
th
day of
,201
(Signature of witness)
(Signature of the creditor or its authorized representative)
(Name of witness, print)
(Name of creditor of the creditor or its authorized representative, print)
.
2
Instructions for completing proof of claim forms
Every creditor shall prove his claim, and a creditor who does not prove his claim is not entitled to share in any distribution of the amounts from the
realization of the assets. Claims not completed correctly in every respect will be returned.
In completing the attached form, your attention is directed to the marginal notes on the form and to the following requirements:
Proof of Claim:
1.
The form must be completed and signed by an individual and not by a corporation. If you are acting for a corporation or other person, you must
state the capacity in which you are acting, such as, Credit Manager, Treasurer, Authorized Agent, etc.
2.
The person signing the form must have knowledge of the circumstances in connection with the claim.
3.
The date appearing at this paragraph is the one at which amounts owed are to be calculated. A Statement of Account containing details of the claim
as well as the correct name of the debtor must be attached and marked “A”.
4.
The nature of the claim must be indicated by ticking the type of claim which applies, e.g. ticking the box:
A
indicates the claim is unsecured and
indicates that the creditor is not claiming any priority
indicates the creditor is claiming preferred status under section 136 of the Act. Details to support the priority claim must be set out on an
attached schedule.
B
indicates a claim of landlord for disclaimer of a lease under subsection 65.2(4) of the Act. Details to support this claim must be set out on an
attached schedule.
C
indicates the claim is secured and the value at which the creditor assesses the security must be inserted. Details of each item of security held
should be attached as a separate schedule and submitted with a copy of the chattel mortgage, conditional sales contract, security agreement,
etc.
D
indicates that the creditor is a farmer, fisherman or aquaculturist who supplied goods within fifteen (15) days prior to the date of
receivership or bankruptcy and has not yet been paid for those goods.
E
E(i)
indicating that the creditor is a former employee of the debtor:
The claim of a clerk, servant, travelling salesperson, labourer or worker who is owed wages, salaries, commissions or compensation by a
bankrupt for services rendered during the period beginning on the day that is six (6) months before the date of the initial bankruptcy event
and ending on the date of the bankruptcy is secured, as of the date of the bankruptcy, to the extent of $2,000 — less any amount paid for
those services by the trustee or by a receiver — by security on the bankrupt’s current assets on the date of the bankruptcy.
E(ii)
The claim of a clerk, servant, travelling salesperson, labourer or worker who is owed wages, salaries, commissions or compensation by a
person who is subject to a receivership for services rendered during the six (6) months before the first day on which there was a receiver in
relation to the person is secured, as of that day, to the extent of $2,000 — less any amount paid for those services by a receiver or trustee —
by security on the person’s current assets that are in the possession or under the control of the receiver.
F
indicates the claim by employee for unpaid amount regarding pension plan under subsection 81.5 and 81.6 of the Act. Details to support this
claim must be set out on an attached schedule:
under subsection 81.5 of the Act, if it is a Bankruptcy
under subsection 81.6 of the Act, if it is a Receivership
Details to support this claim must be set out on an attached schedule.
A(i)
A(ii)
F(i)
F(ii)
G
indicates the claim is against a director under subsection 50(13) of the Act. It is applicable only in the case of a proposal which provides for
the compromise of claims against directors. Details to support this claim must be set out on an attached schedule.
H
(applies only to bankruptcies of security firms) indicating that the creditor is a customer of the bankrupt securities firm.
5.
The person signing the form must indicate (by checking the appropriate box and striking out what is not applicable) whether the creditor and the
debtor are related. Section 4 of the Act defines persons related to a debtor. If the creditor is related by blood or marriage to the debtor, the creditor
should consider itself to be a related person. If the debtor is a corporation, a creditor would be related if it was a shareholder or if the creditor was
controlled by the same shareholders as the debtor.
6.
The person signing the form must provide full details of all payments and credits received from or allowed to the debtor during the period indicated.
Leaving a blank will indicate that there were no such payments and credits.
7.
In the case of the bankruptcy of an individual, tick the box if desired.
8. The person signing the form must insert the place and date and the signature must be witnessed.
General Proxy:
If it is desired to appoint a proxy, the proxy form must be completed and signed by the creditor; if the creditor is a corporation, the proxy form must be
signed by an authorized representative (who is not necessarily the individual signing the proof of claim form) and must be witnessed.
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