Unclaimed Funds Claim Form Individual Creditor

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Unclaimed Funds Claim Form Individual Creditor Powered By Docstoc
					                                Unclaimed Funds Claim Form
                                     Individual Creditor

Estate name, estate number or claim number:
(Note: Name or number appearing in the Unclaimed Funds Database)

Individual Creditor Information:

    Name:
    Current address:
    City:
    Province:
    Postal code:
    Phone: ( )       -         ext.        (daytime)       (    )     -       (evening)
    Email:

        Attached proof of address
        (Note: Provide proof of the address appearing in the Unclaimed Funds Database — it may not be
        your current address.)

If you are an authorized third party making a claim on behalf of the individual
creditor, provide the following information:

    Name:
    Address:
    City:
    Province:
    Postal code:
    Phone: ( )         -       ext.        (daytime)       (    )     -       (evening)
    Email:

        Attached Power of Attorney or will authorizing you to make this claim on behalf
        of the aforementioned individual creditor.


Forward the completed form, the required documentation, an affidavit and a cheque or
money order for $30 (payable to the Receiver General for Canada) to:

Office of the Superintendent of Bankruptcy
Business and Financial Services
Heritage Place
155 Queen Street, 4th Floor
Ottawa ON K1A 0H5

				
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posted:3/26/2013
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