Orderly Payment of Debts Regulations (C.R.C., c. 369)

The Court of

of

(Centre or District)

Date 20		Consolidation Order No.	Name of Debtor	Particulars (state if receipt or disbursement, etc.)	Receipt No.	✔	Amount Received		Bank				Cheque No.	✔
									Dr		Cr.

The Court of In re Consolidation Order No.

(Name of Debtor)

of

(District or Centre)

Date 20		Amount Received		Amount Distributed		Other Payments (fees, costs, postage, etc.)			Balance on hand		Disbursements to Creditors
											1		2		3		4		5		6		7		8		9		10
						Particulars	Entry				%		%		%		%		%		%		%		%		%		%

The Court of

of

(District or Centre)

Affidavit No.
Date 20	Property
Name of Debtor	Description	Value		Encumbrances
Address				Amount		Nature
Occupation
Name of Employer	Monthly Living Expenses — Per Affidavit of Debtor
Address				Total Expenses
Name of Debtor’s Spouse or Common-law Partner	Amendments			$
Address	Date	Details		$
Name of Spouse’s or Common-law Partner’s Employer				$
Address				$

Income

Income of Deponent, $ Source
Income of Spouse or Common-law Partner, $ Source
Total Income $ per
(State per week or month)
DEPENDANTS
Name	Relationship	Extend of Dependency	Court Fees Paid (including Costs of Hearings, if any)
			Date 20		Amount Received		Total