Notice of Bankruptcy and First Meeting of Creditors

FRANÇAIS AU DOS
PROVINCE OF QUEBEC
District of Quebec
Division No.: 01 – Laval
Court No.: 540-11-007708-128
128
Estate No.: 41-1677725
SUPERIOR COURT
“In
In Bankruptcy and Insolvency
Insolvency”
IN THE MATTER OF THE BANKRUPTCY OF
OF:
7691041 CANADA INC. (doing business under the name of
La Capsule Sportive), a body duly incorporated according to
law, having its principal place of business at 3154 Industriel
Blvd., in the City of Laval, Province of Quebec, H7L 4P7 and
its five (5)) places of business located in the Province of
Quebec.
DEBTOR
- and PRICEWATERHOUSECOOPERS INC.
TRUSTEE
NOTICE OF BANKRUPTCY AND FIRST MEETING OF CREDITORS
(Subsection 102(1) of the Act)
Take notice that:
1.
7691041 CANADA INC. (doing business under the name of La Capsule Sportive) filed an assignment
on the 14th day of February 2013,
2013 and the undersigned, PricewaterhouseCoopers Inc.
nc. ((Philippe Jordan,
CPA, CMA,
A, CIRP, trustee in charge),
charge) 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
other trustee by the creditors.
2. The first meeting of creditors of the bankrupt will be held on March 18, 2013, at 2:0
2:00 p.m. at the Office
of the Superintendant of Bankruptcy, at Room 1071, 10th Floor, Sunlife Building, 1155 Metclafe Street,
Montréal, 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 with claims
amounting to $25 or more showing
showi the amounts of their claims.
5. Creditors must prove their claims against the estate of the bankrupt
bankrupt in order to share in any
distribution of the proceeds realized from the estate.
DATED AT MONTREAL, this 20th day of February 2013.
PRICEWATERHOUSECOOPERS INC.
Trustee
Philippe Jordan, CPA, CMA,
A, CIRP
Trustee in charge of the estate
PricewaterhouseCoopers Inc.
1250 René-Lévesque
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:
06 - Laval
No cour:
540-11-007708-128
No dossier:
41-1 677725
orginai
J
modifié
FORMULAIRE 78_
Bilan - faillite d'entreprise déposée par une entté
(paragraphe 49(2), ahnda 1 58d) et paragraphes 50(2) et 62(1) de Ia Loi)
Dans !'affaire de Ia proposition de 7691041 Canada Inc.,
personne morale légalement constituée ayant sa principale
place d'affaires au3154, boul. lndustriel, dans Ia
yule de Lava!, district de Lava!, province de Québec H7L 4P7 et
ses treize (13) places d'affaires situées dans Ia province de Québec.
Au failli:
Vous Stes tenu de remplir avec soin et exactitude le present formulaire et les annexes applicables indiquant Ia situation de vos affaires ala date de votre faillite le 14
février 2013. Une fois rempli, ce formulaire et las listes annexées, constituent votre bilan, qui doitêtre vérifé sous sermentou par une declaration solennelle.
PASSIF
(tel que declare et estimé par l'officier)
ACTIF
(tel que déclaré et estimé par l'officier)
1. Créanciers non garantis: voir liste A...............,,
971868,23
Equilibre de reclamations garantis: voir liste "B
1. Inventaire
867,333.80
2. Amenagements..................................
728928.11
181,711,00
3. Comptes a recevoir et autres créances: voir liste E
Créanciers non garants total.......................
1700796.34
2. Créanciers garantis: voir liste B ......................
0.00
3. Créanciers privileges: voir liste C...................
0,00
Bonnes ..................
0.00
Douteuses.........,,.,,,,
0.00
Mauvaises ................
0.00
Estimation des créances qui peuvent étre réalisées
0.00
4.Lettres de change, billets a ordre, etc., voir liste F
4. Dettes éventuelles, reclamations de fiducie ou autres
(voir liste D)pouvant Otre réclamées pour une somme de. ,
0.00
0.00
5. Depots en institutions financieres,,,,.,.,,..,,,,...,,
0.00
6.Especes .......................................
Total du passif ..................................
0.00
1700,796.34
Surplus .......................................
N
IL
7.Bétail ..........................................
0.00
8. Machines, outillage et installation
0.00
9. Immeubles et biens reels : voir liste G ................
0.00
10.Ameublement ..................................
106,950.00
11.REER, FERR, Assurances-vie etc ..................
0.00
12.Valeurs mobiileres(actions, obligations, debentures etc
0.00
13.Droits en vertu de testaments
0.00
........,.,,..,,,.,
29,659,00
14. Vehicules .......,.....,.,........,,.,,,,,,,,,,
15.Autres biens : voir liste H
125,365.00
,,...........,.,,..,,
Si le failli est one personne morale, ajoutez
Montant du capital souscrit
0.00
Montant du capital paye
0.00
Solde souscrit et impaye ......................
0.00
Estimation du solde qui peut être réalisé
0.00
Totaldel'actif ..................
Deficit
,.,,,,,,,.....,,.,,.,..,
1,311,018.80
389,777.54
Je, Claude Lesperance, de Terrebonne en Ia province de Québec, étant dOment assermenté (ou ayant déclaré solennellement) declare qua le bilan qul suit et
les listes annexées sont, a ma connaissance, un releve complet, veridique et entier de mes affaires en ce 14 février 2013, et indiquent au complet tous mes biens de
quelque nature qu'ils soient, en ma possession et réversibles, tels que définis par Ia Loi.
ASSERMENTE (ou declare solenneIlement)
devant moi le l4février 2013, a Montreal err1a province de Québec.
lsaI) Leveille, Commissaire a l'Assermentation
pour Ia province de Québec
Expire le 15 nov 2013
,
'
/
,/
Page 1
Claude Lpérance
PricewaterhouseCoopers Inc.
Liste des créanciers / Creditors List
Dans l'affaire de la faillite de / In the matter of the bankruptcy of
7691041 CANADA INC.
(faisant affaire sous le nom de / doing business under the name of La Capsule Sportive )
Nom / Name
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
Créanciers garantis / Secured Creditors
4341562 Canada inc
CIBC
REEBOK Canada (div. Adidas Canada Ltd)
Sport Maska inc.
VW Credit Canada inc.
Total créanciers garantis / Total Secured Creditors
Créanciers non garantis / Unsecured Creditors
9130-1168 Québec inc,
9180-8998 Quebec inc
Accolade Group Inc.
ADCOGROUP WORLD INC.
Adidas Canada Limited
Aéroport de Montréal
AGENCE DU REVENU DU CANADA
Aménagement Westcliff Ltée
Association des Marchands Promenades Outaouais
Audet Williams Inc.
Autocars Orléans Express inc.
Bulletin
C.S.S.T.
Carrefour Multisports
Carrefour Richelieu Realties Ltd
Chapdelaine & Frère Inc.
Christine A. Appleby Design
Comité de gestion de la taxe scolaire lIle Montréal
Corlite inc.
CSG Broderie Internationale Inc.
CT Copieur
Elder's home Renovation
Employés
Entretien avandgardiste
Extincteurs Nationex inc.
Fox Head Canada Inc.
Galeries Rive Nord Limited Partnership
Headrush (Media Brand U)
Hubrid
Hunter
Immeubles Carrefour Richelieu ltee
Imprimerie HFD Infographie
Invanhoe Cambridge Inc.
JF Sports Canada
KDI Group Inc.
Les Entreprises Electriques K.W.H.
Les Galeries de Terrebonne
Les Immeubles du Carrefour Richelieu Ltd
Les immeubles industriels Starparc ltee
Les Promenades de l'Outaouais (Oxford)
Les Rivières Shopping Ctr. Ltd.
Levy Pilotte S.E.N.C.R.L/LLP
Location Centre-Eaton de Montréal inc.
Mighty Mac Production Canada inc.
Ministère du Revenu du Québec
Mint Green Group Inc.
Multidev Technologies inc.
New Era Cap Canada
Niagara River Trading Company
NIKE CANADA CORP.
No Limits Sportswear inc.
Oakley Canada inc.
Oberfeld Snowcap inc.
Outerstuff Canada ULC
Place Laurier Holdings Inc.
PUMA Canada inc.
Purolator inc
RCI Environnement Inc.
Refrico Ltée
Serrurier A.B.L. Inc.
Sher-Wood
Spherika
Spiegel Sohmer inc
Sport Art Collection
Sports Industry Credit Association
Studio Interactif We Are Inc.
Surveillance Digital
TSN Radio 990
Uline Canada Corporation
Under Armour Canada inc.
VF Imagewear Inc.
Ville de Laval
Ville de Rimouski
Visua Scan inc.
Total Créanciers non garantis / Total Unsecured Creditors
TOTAL
Attention
Sylvie Guérin
Attn: RECOUVREMENT
Me Pierre Audet
Danielle Martineau
Centre de perception fiscale
Louise Gauthier
Michel Hurd
Adresse / Address
Montant / Amount
($)
Michel Saucier; 44 rue du Chêne; Vaudreuil-sur-le-Lac QC J7V 8P3
1155 René-Lévesque W, Suite 1400; Montréal QC H3B 3Z4
3400 Raymond-Lasnier; Montreal QC H4R 3L3
3400, Raymond Lasnier; Ville St-Laurent QC H4R 3L3
4865 Marc-Blain St., Suite 300; Ville St-Laurent QC H4R 3B2
300,000.00
347,341.27
28,161.36
53,424.48
1.00
728,928.11
Bureau 1000; 2700, boul. Laurier; Québec QC G1V 4J9
1260 University, suite 100; Montreal QC H3B 3B9
66 West Beaver Creek Rd.; Richmond Hill ON L4B 1G5
5400 Armand Frappier; St-Hubert QC J3Z 1G5
8100 Highway 27; Woodbrigde ON L4H 3N2
Bureau 1000; 800, Place Leigh-Capreol; Dorval QC H4Y 0A5
305, boul. René-Lévesque Ouest; Montréal QC H2Z 1A6
40 rue Évangeline; Granby QC J2G 8K1
1100, blvd Maloney Ouest; Gatineau QC J8T 6G3
434, rue Saint-Pierre, 2e étage; Montréal QC H2Y 2M5
bureau 1000; 740 Notre-Dame Ouest; Montreal QC H3C 3X6
490 Boul. Montpellier; Saint-Laurent QC H4N 2G7
C.P. 11493 Succ. Centre-Ville; Montreal QC H3C 5S1
3095 Aut Laval Ouest; Laval QC H7P 4W5
Suite 2600; 600 de Maisonneuve blvd.O.; Montreal QC H3A 3J2
4809. rue Henri-Julien; Entrepreneur Général; Montreal QC H2T 2E2
8560 boul. Pie-IX; Montreal QC H1Z 4G2
C.P. 11071 succ Centre-Ville; Montreal QC H3C 5A9
910, Bégin; St-Laurent QC H4M 2N5
2365, 46e Avenue; Lachine QC H8T 3C9
3457 BOUL. Industriel; Laval QC H7L 4S3
2105 Campbell Avenue, Suite 7; Dorval QC H9P 1L2
5,741.06
15,889.79
48,939.46
586.37
20,833.98
8,369.61
1.00
6,927.85
695.02
0.00
2,055.16
3,954.13
1.00
2,769.23
18,418.34
64,605.90
919.80
262.83
112.11
517.39
425.45
258.69
44,327.44
1,407.35
246.91
11,764.73
9,000.24
11,908.55
1,954.58
10,973.12
919.80
643.86
4,636.60
2,062.97
13,809.95
1,254.41
6,777.66
6,289.30
1,758.77
10,011.92
6,436.34
13,509.57
17,182.70
27,601.03
1.00
67,195.79
689.85
132,475.27
13,175.22
105,046.62
10,835.70
6,620.87
34,492.52
40,421.34
11,295.72
41,495.13
98.46
145.42
801.88
106.92
3,561.51
32.19
18,396.00
2,132.92
0.00
21,270.38
1,526.64
5,633.78
886.51
26,180.24
19,536.90
125.00
889.39
37.09
971,868.23
2487 Avenue Dollard; Lasalle QC H8S 1S2
5965 Av. Papineau; Montreal QC H2G 2W7
58 Aero Drive NE, Unit 113; Calgary AB T2E 8Z9
100, boul. Brien; Repentigny QC J6A 5N4
Porte 7.117; 1751 rue Richardson; Montreal QC H3K 1G6
1310 rue Sauve Est app.209; Montreal QC H2C 2A1
Suite 2204; 5530, rue St-Patrick; Montreal QC H4E 1A8
7077 boul. Newman; Lasalle QC H8N 1X1
1331 Rue Bergar; Laval QC H7L 4Z7
1001 Square Victoria, Suite C500; Montreal QC H2Z 2B5
6217, Nick Adams Rd.; Greely ON K4P 1H2
1-845, Lagimodiere Blvd; Winnipeg MB R2J 3M2
860 Renoir; Brossard QC J4X 2H4
1185 boul. Moody; Terrebonne QC J6W 3Z5
600 rue Pierre-Caisse bureau 2500; St-Jean-sur-Richelieu QC J3A 1M1
Chantale Francoeur; 3420 boul. Industriel; Laval QC H7L 4R9
600 de Maisonneuve Ouest, Bur 510; Montreal QC H3A 3J2
Administration; 4225, boul. Des Forges; Trois-Rivières QC G8Y 1W2
5250 Decarie # 700; Montreal QC H3X 3Z6
Bureau 4-123; 705, St-Catherine Ouest; Montreal QC H3B 4G5
5555 Cypihot; Ville St-Laurent QC H4S 1R3
Secteur des faillites R23CPF; 1600, boul. René-Lévesque Ouest, 3e étage; Montréal QC H3H 2V2
2315, rue Cohen; St-Laurent QC H4R 2N7
Suite 600; 685, Cathcart; Montreal QC H3B 1M7
Suite 102; 6205 A, Airport Rd.; Mississauga ON L4V 1E1
4611 Victoria Ave.; Niagara Falls ON L2E 4B5
PO Box 2692 Postal Station A; Toronto ON M5W 2N7
68 West 5th Ave; Vancouver BC V5Y 1H6
2660, rue Diab; Ville St-Laurent QC H4S1E8
8000 boul. Décarie suite 290; Montreal QC H4P 2S4
201 Bridgeland Avenue; Toronto ON M6A 1Y7
Bureau 1000; 2700, boul. Laurier; Québec QC G1V 4J9
2315, rue Cohen; St-Laurent QC H4R 2N7
P.O. Box 1100 Etobicoke Post Stn A; Etobicoke ON M9C 5K2
9501 Boul Ray Lawson; Anjou QC H1J 1L4
8580 chemin Darnley suite 103; Montreal QC H4T 1M4
484-A rue Notre-Dame; Repentigny QC J6A 2T7
2745, boul. Sherwood; Sherbrooke QC J1K 1E1
159 rur Jean-Talon ouest suite 301; Montreal QC H2R 2X2
1255 rue Peel bureau 1000; Montreal QC H3B 2T9
35, East Beaver Creek Rd #1A; Richmond Hill ON L4B 1B3
800-245 Victoria Avenue; Westmount QC H3Z 2M6
305 rue Bellechasse, bureau #401; Montreal QC H2S 1W9
Suite 125; 1804, boul. Le Corbusier; Laval QC H7S 2N3
1310 Avenue Greene suite 300; Montreal QC H3Z 2B5
Box 3500 - RPO Streetsville; Mississauga ON L5M 0S8
Postal Station A; P.O. Box 46135; Toronto ON M5W 4K9
Postal Station A; P.O. Box 57139C; Toronto ON M5W 5M5
1333 boul Chomedey bureau 601; Laval QC H7V 3S4
Case postale 710; 205, Avenue de la Cathédrale; Rimouski QC G5L 7C7
9066, Pascal-Gagnon; Montreal QC H1P 2X4
1,700,796.34
Reserved for Administration
Secured :
Privileged :
Unsecured :
PROOF OF CLAIM
Original:
(see instructions on page 3)
Amendment:
Initials
Collocated on:
IN THE MATTER OF THE BANKRUPTCY OF:
7691041 Canada Inc. (doing business under the name of La Capsule Sportive),
Sportive of the city of Laval, 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
(state position or title)
.
(name of creditor or its representative)
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 14th day of February 2013
2013, 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.
B

Unsecured claim of $
(Other than a customer contemplated by Section 262 of the Act)
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
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
npaid 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
emplated 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: Mr. Vincent Chevalier
Telephone: (514) 205-5001 ext. 1857
Fax: (514) 205-5694
Email: [email protected]
GENERAL PROXY
I,
, of
, a creditor in the above matter,
(name of creditor)
(name of town or city)
hereby appoint
, of
(name of proxy)
, to be my proxy
(company or firm)
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
A(i)
A(ii)
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.
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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