Resources for Debtors
Affidavit Form for Debtors

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Electronic version: Affidavit (Microsoft Word Format, 25 kb)

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Printable version: Affidavit (PDF Format, 8 kb)

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In the matter of the claim for an unclaimed asset or assets held in trust by the Receiver General, I swear or say under penalty of perjury:

1. That I am the debtor to whom the funds held are payable;
2. That I have knowledge of all the circumstances connected with this claim;
3. That I have reason to believe that the Receiver General for Canada holds in trust an unclaimed asset in my name in the amount of $ __________;
4. That I have not been reimbursed by a third party and the amounts are still owed to me;
5. That I am entitled to request the payment of the unclaimed asset held in trust pursuant to subsection 154(1) of the Bankruptcy and Insolvency Act; and
6. That I claim the unclaimed asset pursuant to subsection 154(2) of the Bankruptcy and Insolvency Act.
7. That I once resided at the following address: __________________________________________.

Sworn before me in the city of _________ in the province of __________ this day of ____________, 20___.

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