crovve soberrria · crovve soberrria flmi crowe soberman inc. member crowe horwath international 2...
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Crovve Soberrriaflmi Crowe Soberman Inc.Member Crowe Horwath International
2 St. Clair Avenue East, Suite 1100
Toronto, ON M4T2T5
416929 2500
416929 2555 Fax
www crowesoberman.com
District of OntarioDivision No: 09Court No: 31-OR-208137-TEstate No: 31 -458122
NOTICE OF BANKRUPTCY AND FIRST MEETING OF CREDITORS(Subsection 102(1))
In the matter of the bankruptcy ofFASTCORP COMPUTERS LTD.
of the City of Torontoin the Province of Ontario
TAKE NOTICE THAT:
1. A bankruptcy order was made against FASTCORP COMPUTERS LTD. on the 17th
day of March 2016 and the undersigned, CROWE SOBERMAN INC., wasappointed as Trustee of the estate of the bankrupt by the Official Receiver, subjectto affirmation by the creditors of the trustee’s appointment or the substitution ofanother trustee by the creditors.
2. The first meeting of creditors of the bankrupt will be held on:
Date: May 18, 2016Time: 2:00 PMPlace: Office of the Trustee
2 St. Clair Ave. East, Suite 1100Toronto, ON, M4T 2T5
3. To be entitled to vote at the meeting, a creditor must lodge with the trustee, beforethe meeting a proof of claim and, where necessary, a proxy.
4. Enclosed with this notice is a form of proof of claim and a form of general proxyand a list of creditors with claims amounting to 25 dollars or more showing theamounts of their claims.
5. Creditors must prove their claims against the estate of the bankrupt in order toshare in any distribution of the proceeds realized from the estate.
Dated at the City of Toronto, Ontario, this May 6,2016.
CRQ1E SOBERMAN INC.Tru(tee in Bankruptcy of the Estate ofFASTCORP COMPUTERS LTD.
APR-01-2006 23:03 From:4169737440 pg: 1’2
Industry Canada Industrie CanadaOffice of the Superintendent Bureau dii surintondantof Bankruptcy Canada des faillites CanadaDisLrict of ONTARIODivision No. 09 - TorontoCourt No. 31-OR—208137-TEstate No. 31-458122
j the MaLLet of the Bankruptcy of:FASTCORP COMPUTEES T,Tfl.
Debtor
CRONE SOBERMAN iNC.L.i caused Insolvency Trus tee
ORDINARY ADMINISTRATION
Security: $0Date of Bankruptcy: March 15. 2016Meeting of Creditors:
Chair: Desiqnar.ed Person: RONALD PAUL HAILER
CERTIFICATE OF TTTNG OF BANKRUPTCY ORDER - Sect ion 43I, the undersigned. Official Receiver in and for this bankruptcy district, dohereby cerLify, that:
- the at orenamed trusLee, filed for my endorsement, a bankruptcy orderappointing the trustee under section 43 (9) of the Bankruptcy andInsolvency Act, Trustee of the Estate of the aforenamed Debtor;— provisions for the avoidance of certain settlements and preferences whereapplicable, begin before the initial. hankrupLcy event date and end on thedate of bankruptcy, both dates included.
The designated person is required:- to perform all duties imposed upon a bankrupt by the Bankruptcy andInsolvency Act and in par ticular, attend the first meet. ng of creditorsand upon request appear before the Official Receiver f or examination.
The said trustee Is required:- to serve upon the designa ted. per ccii, a copy of the bankruptcy orderbearing the off icial Receiver’s endorsement and where applicable a noticeof examination;
to provide to me, Wi thout delay, security in the aforementioned ‘3rfloont;to send to oh creditors, within five days after the daLe of thetrustee’s appointment, a notice of the bankruptcy; and
- when applicable to call in the prescribed maimer, a first meeting ofcreditors, to be held at the aforementioned time and place or at anyother time and place that may be later requested by the Off icialReceiver -
DaLe: May 2, 2016
‘..H U/P Ofticial Receiver25 St. Cl ir - ue East, 6th floor, Toronto, ONTARIO, M4T lM2, 877/376-9902
Canaa
District of OntarioDivision No. 9 - TorontoCourt No.: 31-OR-208137-TEstate No.:31-OR-208137-T
ONTARIOSUPERIOR COURT OF JUSTICE
IN BANKRUPTCY AND INSOLVENCY
THE HONOURABLE ) TUESDAY THE 15th DAY OFJUSTICE PENNY ) MARCH, 2016
IN THE MAHER OF THE BANKRUPTCY OFFASTCORP COMPUTERS LTD.
OF THE CITY OF TORONTO, IN THE PROVINCE OF ONTARIO
JUDGMENT
THIS APPLICATION made by the Applicant on notice for an Order petitioning
FASTCORP COMPUTERS LTD. into bankruptcy pursuant to section 43 of the
Bankruptcy and Insolvency Act (Canada), was heard this day at Toronto.
ON READING the Application Record of the Applicant creditor, filed, and on
reading the Factum of the Applicant creditor, filed, and on hearing oral testimony from
Ronald HaIler on behalf of the Respondent, and on hearing oral testimony from Moe
Wortzman and David Coutts on behalf of the Applicant creditor, and on hearing
submissions from counsel for the Applicant creditor and from Ronald Hailer, an officer
and director of Fastcorp Computers Ltd., leave for Ronald HaIler to represent the
corporation having been granted,
1
1. IT IS ORDERED AND ADJUDGED that Fastcorp Computers Ltd. is hereby
adjudged bankrupt.
2. THIS COURT ORDERS that Ctowe Soberman Inc. is hereby appointed as the
trustee in bankruptcy of Fastcorp Computers Ltd ..——
I 7
ENTERED AT / INSCRIT A TORONTOON/BOOK NO:LE / DANS LE REGISTRE NO:
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— Form 78 —
Statement of Affairs (Business Bankruptcy) made by an entity(Subsection 49(2) and Paragraph 158(d) of the Act I Subsections 50(2) and 62(1) of the Act)
In the matter of the bankruptcy ofFast Corp Computers Ltd.
of the City of Torontoin the Province of Ontario
To the bankwpt:You are required to carefully and accurately complete this form and the applicable attachments showing the state of your affairs on the date of the bankruptcy, on the
15th day of March 2016. When completed, this form and the applicable attachments will constitute the Statement of Affairs and must be verified by oath or solemndeclaration.
LIABILITIES(as stated and estimated by the officer)
ASSETS(as stated and estimated by the officer)
1. Inventory 0.002. Trade fixtures, etc 0.003. Accounts receivable and other receivables, as per list “E”
Good 0.00Doubtful 68,545.17Bad 0.00Estimated to produce 0.00
4. Bills of exchange, promissory note, etc., as per list “F” 0.005. Deposits in financial institutions 0.006. Cash 0.007. Livestock 0.008. Machinery, equipment and plant 0.009. Real property or immovable as per list “G” 0.0010. Furniture 0.0011. RRSPs, RRIF5, life insurance, etc 0.0012. Securities (shares, bonds, debentures, etc.) 0.0013, Interests under wills 0.0014. Vehicles 0.00
15. Other property, as per list H” 0.00If bankrupt is a corporation, add:
Amount of subscribed capital 0.00
Amount paid on capital 0.00
Balance subscribed and unpaid 0.00
Estimated to produce 0.00
Total assets 0.00
Deficiency 49,968.27
I, Ronald Paul Hailer, of the City of Mississauga in the Province of Ontario, do swear (or solemnly declare) that this statement and the attached lists are to thebest of my knowledge, a full, true and complete statement of my affairs on the 3rd day of May 2016 and fully disclose all property of every description that is in mypossession or that may devolve on me in accordance with the Act.
Alfonsina Frances Dona,a Commissioner etc., Province ofOntario, for Crowe Sobemian ins.,Trustee in Bankrupt’ and its affiliates.Expires May 4. 2018.
i?/Ronald Paul Hailer
District of:
Division No.
Court No.Estate No.
1. Unsecured creditors as per list
Balance of secured claims as per list “B”
Total unsecured creditors
2. Secured creditors as per list
3. Preferred creditors as per list “C
49,968.27
0.00
49,968.27
0.00
0.00
4. Contingent, trust claims or other liabilities as per list “D” 0.00estimated to be reclaimable for
Total liabilities 49,968.27
Surplus NIL
SWORN (or SOLEMNLY DECLARED)before me at the City of Toronto in the Province of of May 2016.
Doria,Province of OntarioMay. 4,2018
Page 1
FORM 78— Continued
List A’Unsecured Creditors
FASTCORP COMPUTERS LTD.
No. Name of creditor Address Unsecured claim Balance of claim Total claim1 CIBC Bankruptcies do TECHCOM Managed Services 6-6150 Hwy 7, P0 Box 487 49,964.27 0.00 49,964.2737-24417 Woodbddge ON L4H 0R62 CRA - Canada Revenue Agency - Tax - Ontario PD Box 5548 1.00 0.00 1.00Attn: do London Taxes Services Office Division Regional 3 -451 Talbot St
Intake Centre for Insol London ON N6A 4R33 Fastcorp Holdings Inc. 80 Richmond Street West, Suite 501 1.00 0.00 1.00
Toronto ON M5H 2M4 Nirek Resources Inc. 80 Richmond Street West, Suite 501 1.00 0.00 1.00
Toronto ON M5H 2A45 Sentemet Phi Gamma Inc. 80 Richmond Street West, Suite 501 1.00 0.00 1.00
Toronto ON M5H 2A4
Total: 49,968.27 0.00 49,968.27
I03-May-2016 (
Date Ronald Paul Halter
Page 2 of 9
District of:Division No.Court No.Estate No.
Ontario09- Toronto
District of: OntarioDivision No. 09 - TorontoCourt No.Estate No.
FORM 78— Continued
ListSecured Creditors
FASTCORP COMPUTERS LTD.
I Amount of I I I Estimated I Estimated
claim INo. Name of creditor Address claim Particulars of security
!Whengiven value of I surplus from I Balance of I
security security I
Total: 0.0( 0.00 0.0C 0.00!
03-May-201 6 t4’Date Ronald Paul Hailer
Page 3 of 9
FORM 78— Continued
ListPreferred Creditors for Wages, Rent, etc.
FASTCORP COMPUTERS LTD.
District of:Division No.CoUrt No.Estate No.
Ontario09-Toronto
03-May-20 16
Date
/ 1
Ronald Paul Hailer
Page 4 of 9
O3May-2O16 i /4ARonald Paul Hailer
District of:Division No.Court No.Estate No.
Ontario09-Toronto
FORM 78 — Continued
ListContingent or Other Liabilities
FASTCORP COMPUTERS LTD.
Date
Page 5 of 9
FORM 78— Continued
List”EDebts Due to the Bankwpt
FASTCORP COMPUTERS LTD.
No. Name of debtor Address and Nature of debt mount of debt Folio of ledgers or When Estimated to Particulars of anyoccupation (good, doubtful, other book where contracted produce securities held for
bad) particulars to be found debt
Fastcorp Holdings Ltd 80 Richmond St West Advances 0.00 01-Jan-2015 0.01 NilSuite 501 32248.36Toronto ON M5H 2A4
0 00
2 Senternet Phi Gamma Inc. 80 Richmond Street Accounts Receivable 0.00 01-]an-2015 0.0 NilWest 36,296.81Toronto ON M5H 2A4
0 00
0.00
Total: 68,545.17 0.01
0.00
03May20l6 tiDate Ronald Paul Hailer
Page 6of9
District of:Division No.Court No.Estate No.
Ontario09-Toronto
FORM 78 — Continued
List F
Bills of Exchange, Promissory Notes, Lien Notes, ChattelMortgages, etc., Available as Assets
FASTCORP COMPUTERS LTD.
Particulars of any propertyName of all promissory,mount of bill Estimated to held as security forNo. acceptors, endorsers, Address Occupation or note, etc. Date when due produce payment of bill or note, etc.mortgagors, and guarantots
Total: 0.00 0.00
//
03-May-2016 ZDate Ronald Paul HaIler
Page 7 of 9
District of:Division No.Court No.Estate No.
Ontario09-Toronto
FORM 78 — Continued
List”G’Real Property or Immovabies Owned by Bankrupt
FASTCORP COMPUTERS LTD.
Description of property Nature of I In whose name Total value Particulars of mortgages,bankrupt interest does title stand hypothecs, orother encumbrances Equity or surplus
(name, address, amount)
Total: 0.00 0.00
03-May-201 6
Date Ronald Paul Hailer
Page 8o9
District of:Division No.Court No.Estate No.
Ontario09-Toronto
FORM 78 — Concluded
ListProperty
FASTCORP COMPUTERS LTD.
FULL STATEMENT OF PROPERTY
Nature of properly Location Details of property Original cost Estimated to produce
(a) Stock-in-trade 0.00 0.00
(b) Trade fixtures, etc. 0.00 0.00
(c) Cash in financial institutions 0.00 0.00
(d) Cash on hand 0.00 0.00
(e) Livestock 0.00 0.00
(f) Machinery, equipment and plant 0.00 0.00
(g) Furniture 0,00 0.00
(h) Life insurance policies, RRSPs, etc. 0.00 0.00
(i) Securities 0.00 0.00
U) Interests under wills, etc. 0.00 0.00
fk) Vehicles 0.00 0.00
(I) Taxes 0.00 0.00
fm) Other 0.00 0.00
Total: 0.00
03-May-2016
_________________________
Date Ronald Paul Hailer
Page 9 019
District of:Division No.Court No.Estate No.
Ontario09 - Toronto
Court No.
File No.
In the matter of the bankruptcy ofFast Corp Computers Ltd.
of the City of Torontoin the Province of Ontario
Form 78 (Bill C-i 2)Statement of affairs (Business bankruptcy)
Crowe Soberman Inc.
2 St. Clair Ave East, Suite 1100Toronto ON M4T 215
Phone: (416) 929-2500 Fax: (416) 929-2555
Crowe Soberman Inc.2 St. Clait Ave East, Suite 1100
Toronto ON M4T 215Phone: (416) 929-2500 Fax: (416) 929-2555
District of: OntarioDivision No, 09 - TorontoCourt No. 31-458122Estate No. 31-458122
-FORM 31-P roof of Claim
(Sections 50.1, 81.5, 81.6, Subsections 65.2(4), 81.2(1), 81.3(8), 81.4(8), 102(2), 124(2), 128(1),and Paragraphs 51(1 )(e) and 66.14(b) of the Act)
In the matter of the bankruptcy ofFast Corp Computers Ltd.
of the City of Torontoin the Province of Ontarto
All notices or correspondence regarding this claim must be forwarded to the following address:
In the matter of the bankruptcy of FASTCORP COMPUTERS LTD. of the City of Toronto in the Province of Ontario and the claim of
________________________________
creditor.
(name of creditor or representative of the creditor), of the city of
________________
in the province of
______________
do hereby certify:
1. That I am a creditor of the above named debtor (or I am
_______________________
(position/title) of
________________________
creditor).
2. That I have knowledge of all the circumstances connected with the claim referred to below.
3. That the debtor was, at the date of bankruptcy, namely the 17th day of Match 2016, 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 anycounterclaims to which the debtor is entitled. (The attached statement of account or affidavit must specify the vouchers or other evidence in support ofthe claim.)
4. (Check and complete approphate category.)
—7 A. UNSECURED CLAIM OF$___________________
(other than as a customer contemplated by Section 262 of the Act)
That in respect of this debt, I do not hold any assets of the debtor as security and(Check appropriate description.)
—7 Regarding the amount of $
________________________,
I claim a hght to a priortty under section 136 of the Act.
f-j Regarding the amount of S , I do not claim a right to a priority.(Set out on an attached sheet details to support poty claim.)
fl B. CLAIM OF LESSOR FOR DISCLAIMER OF A LEASE$___________________
That I hereby make a claim under subsection 65.2(4) of the Act, particulars of which are as follows:(Give full particulars of the claim, including the calculations upon which the claim is based.)
f C. SECURED CLAIM OF$___________________
That in respect of this debt, I hold assets of the debtor valued at$__________________ as security, particulars of which are as follows:
(Give full particulars of the security, including the date on which the security was given and the value at which you assess the security, andattach a copy of the security documents.)
fl D. CLAIM BY FARMER, FISHERMAN OR AQUACULTURIST OF$___________________
That I hereby make a claim under subsection 81.2(1) of the Act for the unpaid amount of $________________
(Attach a copy of sales agreement and delivery receipts.)
Page 1 of 2
FORM 31 — Concluded
fl E. CLAIM BY WAGE EARNER OF$___________________
That I hereby make a claim under subsection 81.3(8) of the Act in the amount of$_________
T—I That I hereby make a claim under subsection 81.4(8) of the Act in the amount of $__________
Fl F. CLAIM BY EMPLOYEE FOR UNPAID AMOUNT REGARDING PENSION PLAN OF $
f—J That I hereby make a claim under subsection 81.5 of the Act in the amount of $__________
F] That I hereby make a claim under subsection 81.6 of the Act in the amount of $__________
El G. CLAIM AGAINST DIRECTOR$________
(To be completed when a proposal provides for the compromise of claims against directors.)That 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.)
f•] H. CLAIM OF A CUSTOMER OF A BANKRUPT SECURITIES FIRM$________
That 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:(Give full particulars of the claim, including the calculations upon which the claim is based.)
5. That, to the best of my knowledge, I
___________(am/am
not) (or the above-named creditor
___________(is/is
not)) related to the debtorwithin the meaning of section 4 of the Act, and
_________(have/has/have
not/has not) dealt with the debtor in a non-arms-length manner.
6. That the following are the payments that I have received from, and the credits that I have allowed to, and the transfers at undervalue within themeaning 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 arerelated 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 dateof the initial bankruptcy event within the meaning of Section 2 of the Act: (Provide details of payments, credits and transfers at undervalue,)
7. (Applicable only in the case of the bankruptcy of an individual.)
El Whenever the trustee reviews the financial situation of a bankrupt to redetermine whether or not the bankrupt is required to makepayments under section 68 of the Act, I request to be informed, pursuant to paragraph 68(4) of the Act, of the new fixed amount or of thefact that there is no longer surplus income.
I request that a copy of the report filed by the trustee regarding the bankrupt’s application for discharge pursuant to subsection 170(1) ofthe Act be sent to the above address.
Dated at
________________________________________,this___________________
day of
_________________________
WitnessCreditor
Phone Number:
___________________
Fax Number:
_____________________
E-mail Address:
___________________
NOTE: If , affidoI is allached, it most have been made before a persen q’Jdihed to bee affidavits.
WANIftGS: Apustee may, pursuant to oubsecton 120(3) of the Act, redeem a security on payment In the secured ureditorof the debt or the vbemof the security as assessed, in a proof of security, by thesecured mentor.
Srvboecbon 201(1) of the Act provides severe penalrins for making any false dater, proof, dedarahon or statement of account
Page 2 of 2
INSTRUCTIONS FOR COMPLETING PROOF OF CLAIM FORM(the claim is on the reverse side)
Checklist for Proof of Claim
This checklist is provided to assist you in preparing the proof of claim form and, ifappropriate, the proxy form in a complete and accurate manner. Please check eachrequirement.
General
• The signature of a witness is required.
• The document must be signed by the individual completing the declaration.
• Provide the complete address where all notices or correspondence are to be forwarded alongwith your phone number, fax number and email address where appropriate.
Notes
• It is permissible to file a proof of claim by fax.
• A creditor may vote either in person or by proxy at any meeting of creditors if the proof of claim isfiled with the trustee prior to the time appointed for the meeting.
• A quorum at any meeting of creditors consists of at least one creditor with a valid proof of claim inattendance in person or by proxy.
• A corporation may vote through an authorized agent or mandatary at meetings of creditors.
• In order for a duly authorized person to have a right to vote, they must be a creditor or be theholder of a properly executed proxy. The name of the creditor must appear in the proxy.
• A creditor who is participating in any distribution from an estate must have filed a proof of claimprior to the distribution being declared.
• In the case of an individual bankrupt, by checking the appropriate box or boxes at the bottom ofthe proof of claim form, you may request that the trustee advise you of any material change in thefinancial situation of the bankrupt or the amount the bankrupt is required to pay into thebankruptcy, and a copy of the trustee’s report on the discharge of the bankrupt.
Paragraph 1
• The creditor must state the full and complete legal name of the individual, company or firm.
• If the individual completing the proof of claim is a representative of the creditor, the individual’sposition or title must be identified.
Paragraph 3
• The amount owing must be set out in paragraph 3.
• A detailed statement of account must be attached to the proof of claim and marked “ScheduleA” and must show the date, number and amount of all invoices or charges, together with thedate, number and amount of all credits or payments. The amount on the statement of accountmust correspond to the amount indicated on the proof of claim.
Paragraph 4
Notes
• Paragraph A applies to ordinary unsecured claims. In addition to recording the amount of theclaim, please indicate whether the claim has a priority pursuant to section 136 of the Act.
• Paragraph B applies to lessor claims in a commercial proposal. Please ensure that the claimapplies to a commercial proposal and, if so, include the full particulars of the claim.
• Paragraph C applies to secured claims. Please indicate the dollar value of the security andattach copies of the security document. In addition, please attach copies of the securityregistration documents, where appropriate.
• Paragraph D applies to inventory claims of farmers, fishermen and aquaculturists. Please notethat such claims apply only to inventory supplied from farmers, fishermen and aquaculturistswithin 15 (fifteen) days of the date of bankruptcy. In addition, please attach copies of anyapplicable sales agreements and delivery slips.
• Paragraph E applies to claims by wage earners. Please note that such claims apply only forunpaid wages owed upon the bankruptcy of an employer or when the employer becomes subjectto a receivership.
• Paragraph F applies to claims by employees for unpaid amounts regarding pension plans.Please note that such claims apply only to unremitted pension contributions outstanding when thesponsoring employer becomes bankrupt or is subject to a receivership.
• Paragraph G applies to claims against directors. Please note that such claims apply only todirectors of corporations that have filed a commercial proposal to creditors that includes acompromise of statutory claims against directors.
• Paragraph H applies to claims of customers of a bankrupt securities firm. Please ensure that theclaim of the customer is for net equity and, if so, include the full particulars of the claim, includingthe calculations upon which the claim is based.
Paragraph 5
• All claimants must indicate whether or not they are related to the debtor, as defined in section 4 ofthe Act, or dealt with the debtor in a non-arms-length manner.
Paragraph 6
• All claimants must attach a detailed list of all payments or credits received or granted asfollows:
o (a) within the three (3) months preceding the initial bankruptcy event (including thebankruptcy or the proposal);
o (b) within the twelve (12) months preceding the initial bankruptcy event (including thebankruptcy or the proposal) in the case where the claimant and the debtor were notdealing at arm’s length.
Proxyholder
Note
The Act permits a proof of claim to be made by a duly authorized representative of acreditor but, in the absence of a properly executed proxy, does not give such anindividual the power to vote at the first meeting of creditors nor to act as the proxyholderof the creditors.
General
• In order for duly authorized persons to have a right to vote, they must themselves be creditors orbe the holders of a properly executed proxy. The name of the creditor must appear in the proxy.
Notes
• A creditor may vote either in person or by proxyholder.
• A proxy may be filed at any time prior to a vote at a meeting of creditors.
• A proxy can be filed with the trustee in person, by mail or by any form of telecommunication.
• A proxy does not have to be under the seal of a corporation unless required by its incorporatingdocuments or its bylaws.
• The individual designated in a proxy cannot be substituted unless the proxy provides for a powerof substitution.
• Bankrupts/debtors may not be appointed as proxyholders to vote at any meeting of their creditors.
• The trustee may be appointed as a proxyholder for any creditor.
• A corporation cannot be designated as a proxyholder.
C
H:\SICT’A.. FORMS & pREcEDENTSFormsAdministration Forms\Proof of claim - lnstructions.doc
District of: OntarioDivision No. 09 - TorontoCourt No. 31-458122Estate No. 31-458122
-FORM 36-Proxy
(Subsection 102(2) and paragraphs 51(1)(e) and 66.15(3)(b) of the Act)
In the matter of the bankruptcy ofFast Corp Computers Ltd.
of the City of Torontoin the Province of Ontario
I,
_________________________________,
of
____________________,
a creditor in the above matter, herebyappoint
___________________________________
of
_______________________________________,
to bemy proxyholder in the above matter, except as to the receipt of dividends,____________ (with or without)power to appoint another proxyholder in his or her place.
Dated at
____________________________________,
this
________
day of
_________________ ________
Witness Individual Creditor
WitnessName of Corporate Creditor
Per
__________________________
Name and Title of Signing Officer
Return To:
Crowe Soberman Inc.
2 St. Clair Ave East, Suite 1100Toronto ON M4T 2T5Phone: (416) 929-2500 Fax: (416) 929-2555
Page 1 of 1