Mailing Address: PERSONAL PROPERTY REGISTRY
Ministry PO Box 9431 Stn Prov Govt
of Finance Victoria BC V8W 9V3 FINANCING STATEMENT
BC Registry Services Location:
Phone No.: 250 356-8609 2nd Floor – 940 Blanshard Street
Please see instructions on reverse.
TYPE OF LENGTH OF REGISTRATION
1 REGISTRATION ( ✔ ) TO INDICATE IF
1 SA PPSA SECURITY AGREEMENT OF YEARS (1 - 25) OR ( ✔ ) FOR INFINITY TRUST INDENTURE
LINE ONLY ( ✔ )
2 SG POSSESSION UNDER S.30 SALE OF GOODS ACT OF YEARS (1 - 25) OR ( ✔ ) FOR INFINITY
3 MH TAX LIEN UNDER S. 35/36 OF THE MANUFACTURED INFINITY
4 LT LAND TAX DEFERMENT LIEN ON MANUFACTURED INFINITY
NOTICE OF MARRIAGE / SEPARATION AGREEMENT
5 FR AFFECTING MANUFACTURED HOME UNDER THE
FAMILY RELATIONS ACT S. 63 INFINITY
SECURED PARTY CODE
OR SECURED PARTY NAME AND
ADDRESS CITY PROV. POSTAL CODE
DEBTOR 1 INDIVIDUAL DEBTOR LAST NAME FULL FIRST NAME SECOND NAME BIRTHDATE
3 Y M D
OR BUSINESS DEBTOR NAME
AND ADDRESS CITY PROV. POSTAL CODE
DEBTOR 2 INDIVIDUAL DEBTOR LAST NAME FULL FIRST NAME SECOND NAME BIRTHDATE
Y M D
BUSINESS DEBTOR NAME
AND ADDRESS CITY PROV. POSTAL CODE
COLLATERAL: TYPE SERIAL NO. / DEPT. OF TRANSPORT NO. YEAR MAKE AND MODEL M. H. REG. NO.
GENERAL OTHER THAN COLLATERAL DESCRIBED ABOVE BY SERIAL NO.
REGISTERING REGISTERING PARTY CODE
Complete OR REGISTERING PARTY NAME AND
statement is to be
mailed to other ADDRESS CITY PROV. POSTAL CODE
than secured party
7 AUTHORIZED NAME OF AGENT (If applicable) PHONE NO.
NAME OF INDIVIDUAL SIGNING SIGNATURE
FIN 627/WEB Rev. 2007 / 3 / 2
FINANCING STATEMENT – GENERAL INSTRUCTIONS
Complete a Financing Statement for each new registration under the following Acts:
• Personal Property Security Act. S.43 • Land Tax Deferment Act. S.7 & 11
• Sale of Goods Act. S.30 • Family Relations Act. S.49
• Manufactured Home Act. S.52/53 Tax Lien
Please type or print clearly.
1 TYPE OF REGISTRATION:
Type an “X” in the appropriate box to indicate the type of Serial No./Dept. of Transport (Canada) No.:
registration that is covered by the Financing Statement. • For collateral types AF, MV, OM & TR, list the last 25
Length of Registration: When registering under the digits of the serial no.
Personal Property Security Act or Sale of Goods Act, select • For collateral type AC give the registration marks
and enter the length of registration from yearly options of assigned by the Dept. of Transport, omitting the hyphen.
1-25 years, or “X” for infinity. • For collateral type BO give the registration or licence no.
assigned by the Dept. of Transport.
Trust: Enter a “T” in the box to indicate if a trust indenture • For collateral type MH that is registered in the
is being registered. Manufactured Home Registry leave the serial no. box
2 SECURED PARTY: • For collateral type MH that is not registered in the
Complete the code, OR full name and mailing address of Manufactured Home Registry, enter the chassis serial no.
the Secured Party. If the security agreement has been of the manufactured home in the serial no. box.
transferred prior to registration, enter the code OR full Year: List the last two digits of the model year.
name and mailing address of the transferee. Make and Model: Describe the make and model of the
vehicle. Where there is no make, enter the manufacturer
3 DEBTOR: and model of the vehicle.
Individual Debtor Name: Manufactured Home Registration No.: Enter the
Name: Enter the full name, including last name, full first manufactured home registration no. assigned by the
name and second name, if any. (Do not use nicknames.) Manufactured Home Registry, or the characters “NR” if
Birthdate: Enter last two digits of the year, first three letters the manufactured home is not registered.
of the month and the day of the month (e.g., 60 APR 01).
Address: Enter the complete mailing address. 5 GENERAL COLLATERAL:
Describe the collateral other than the items described in
Business Debtor Name: the Vehicle Collateral section. The number of characters
Name: Enter the complete business name of the artificial per line, including spaces must not exceed 70.
body. Do not abbreviate unless the abbreviation is part of
the registered name. 6 REGISTERING PARTY:
Address: Enter the complete mailing address. Complete this section only if the registering party is
different from the Secured Party. Complete the code OR
4 VEHICLE COLLATERAL: full name and mailing address of the Registering Party.
Type: Enter the applicable type code from the list below:
7 AUTHORIZED SIGNATURE:
TYPE CODE VEHICLE COLLATERAL The Secured Party OR a person with authority to sign on
AC Aircraft – Registered in Canada behalf of the Secured Party must sign this statement. Type
AF Aircraft – Not Registered in Canada the name(s) of the agent (if applicable), the individual
BO Boat signing the form and a contact phone number above the
MH Manufactured Home signature.
MV Motor Vehicle
OM Outboard Motor
Freedom of Information and Protection of PrivacyAct (FOIPPA):
Personal information provided on this form is collected, used and disclosed under the authority of the FOIPPA and the Sale of
Goods Act, Manufactured Home Act, and the Personal Property Security Act for the purposes of assessment. Questions regarding
the collection, use and disclosure of personal information can be directed to the Executive Coordinator of the BC Registry Services
at 250 356-1198, PO Box 9431 Stn Prov Govt, Victoria BC V8W 9V3.
FIN 627/WEB (Page) 2007 / 3 / 2