How To Register With The Bia

Description of Form A

Form A: REGISTRATION Against AN Private LICENSED INSOLVENCY TRUSTEE (LIT) LICENCE

(TO Exist COMPLETED Past THE REGISTRANT AND THE LIT)

□ Original □ Amended

Version 1.1

Advisory to LITdue south:

LIT compliance with Directive No. 1R6, Counselling in Insolvency Matters (the Directive) is a licence condition. The accuracy, correctness, and abyss of information provided by signatories to this registration request will be considered by the Role of the Superintendent of Bankruptcy (OSB) for compliance purposes. Reference should be made to the Directive and the Registration Guide in club to ensure all registration requirements are met.

Section i: IDENTIFYING Data OF THE REGISTRANT

Given name(due south):

Terminal name:

Engagement of birth (YYYY-MM-DD):

Registration number (to be completed if the registrant was previously registered under Directive No. 1R4 or Directive No. 1R5):

Piece of work accost of registrant

Address (street number, street name, city, province):

Postal code:

Note: The registrant must provide the LIT with adequate government-issued identification to validate their proper name and date of birth. The OSB does not crave a copy.

SECTION 2: OCCUPATIONAL INFORMATION

Electric current employee of the LIT or LIT firm submitting this request: □ Yes □ No

If yep, duration of employment with the LIT or LIT firm submitting this request:
Years:
Months:

List any other occupation or employer (including LITs) in the past twelve (12) months:

Notation: If yous are cocky-employed or a consultant, provide your business name or indicate that you carry on business under your given name.

1: Employer or business proper name:
From (YYYY-MM-DD):
To (YYYY-MM-DD):
Address (street number, street proper name, city, province):
Postal code:
Job title/description:

two: Employer or business concern name:
From (YYYY-MM-DD):
To (YYYY-MM-DD):
Address (street number, street name, urban center, province):
Postal code:
Job championship/description:

3: Employer or business organisation proper noun:
From (YYYY-MM-DD):
To (YYYY-MM-DD):
Address (street number, street proper name, urban center, province):
Postal code:
Chore title/description:

Required additional SECTION 2 documentation:

Enclose/attach registrant résumé (see mandatory content requirements in the Registration Guide).

SECTION iii: Instruction

(Pursuant to paragraphs ten(a) or 29 of the Directive)

I have:

□ a high school diploma or loftier school equivalency certificate (having passed the General Educational Development (GED) test), plus 1 of:

□ (i) a minimum of three (three) years of relevant practical piece of work experience supporting an LIT or registered BIA Insolvency Counsellor; or

□ (ii) a minimum of xxx (30) credit hours of mail service-secondary study completed in a diploma or degree program from a recognized mail service-secondary institution.

OR,

Pursuant to paragraph 29 of the Directive, I

□ (three) was already registered as a BIA Insolvency Counsellor with the OSB before January 29, 2018; and

□ (iv) have five (5) years of related piece of work experience.

Required boosted Section iii documentation:

If applicative, enclose/attach a copy of transcripts validating (ii)
If applicable, enclose/attach a copy of the approved registration course validating (iii)

SECTION 4: KNOWLEDGE AND Ability TO Deliver BIA INSOLVENCY COUNSELLING

(Pursuant to paragraph 10(b))

I have:

□ a Applied Course on Insolvency Counselling (PCIC) Document

Certificate number:

OR,

□ an Insolvency Counsellor'southward Qualification Form (ICQC) Document.

Required additional SECTION 4 documentation:

Enclose/adhere a copy of the PCIC or ICQC Certificate.

Section 5: EXPERIENCE REQUIREMENT

(Pursuant to paragraph 10(f))

□ I have obtained experience, to the LIT's satisfaction, in providing insolvency counselling in each of the different required insolvency counselling sessions pursuant to this Directive to private bankrupts or consumer debtors. This experience could have been acquired, for example:

(i) by delivering a minimum of ten (x) insolvency counselling sessions under the direct observation of the registering LIT, an LIT of the aforementioned firm as the registering LIT, or a BIA Insolvency Counsellor registered against an LIT'due south licence through the OLAA who already has a minimum of one (1) year of experience in providing insolvency counselling for the registering LIT or for an LIT of the same house equally the registering LIT, or
(ii) by delivering a minimum of ten (ten) insolvency counselling sessions as a BIA Insolvency Counsellor previously registered against an LIT'due south licence through the OLAA, pursuant to this Directive and within thirty-half-dozen (36) months prior to the appointment of the application.

Section 6: REGISTRANT DECLARATION

I, the registrant, adjure to the best of my knowledge and belief that all information and supporting documentation I accept provided in this registration form is accurate, correct, and complete.

I likewise acknowledge and agree that:

the information in this form, and whatsoever enclosed/attached documentation that I provide to the Licensed Insolvency Trustee, may exist validated by the LIT and/or the Function of the Superintendent of Bankruptcy (OSB) for review and compliance validation purposes
if the registration request is validated, my name will be published as being registered confronting the individual and/or corporate licence of the LIT indicated herein; and
the OSB may notify other individual and corporate LITs against whose licence I may be registered, when an LIT'southward registration of my name expires or is canceled.

Registrant signature

Date (YYYY-MM-DD):

Department 7: IDENTIFYING INFORMATION OF THE LIT

Given proper noun(southward):

Last name:

LIT firm:

LIT licence number (individual):

Section 8: INELIGIBILITY

(Pursuant to paragraph eleven of the Directive)

□ I have conducted sufficient due diligence, including documentation review and appropriate enquiry, to determine that the registrant is not ineligible pursuant to paragraph eleven of the Directive.

SECTION ix: KNOWLEDGE OF THE BIA INSOLVENCY COUNSELLING CURRICULUM AND VALIDATION OF COMPETENCY

(Pursuant to paragraphs 10(c-f) of the Directive)

The registrant:

□ has demonstrated, to the LIT's satisfaction, a knowledge of the insolvency counselling curriculum as specified in this Directive and equally personally validated past the LIT. Ane method the LIT could use to validate this knowledge is, for example, by directly observing the individual providing a minimum of ten (10) insolvency counselling sessions pursuant to paragraph x(f) of this Directive.

□ possesses the necessary competencies, is known by the LIT to be of skilful character, and has the capabilities, noesis, skills, and proficiency to provide insolvency counselling in accordance with this Directive as personally validated past the LIT. One method the LIT could utilize to validate these attributes is, for example, past directly observing the private providing a minimum of ten (ten) insolvency counselling sessions pursuant to paragraph ten(f) of this Directive.

SECTION ten: LIABILITY INSURANCE

(Pursuant to paragraph x(g) of the Directive)

The registrant (cheque one):

□ is covered by my professional liability insurance and employee dishonesty (also known as fidelity)insurance; or

□ in the case of a not-employee, has provided me current documentation demonstrating that he or she is covered by acceptable professional person liability insurance of their own.

Required additional Department x documentation:

Enclose/adhere copy of the insurance policy document in the case of a non-employee (see mandatory content requirements in the Registration Guide).

Section xi: Delivery

(Pursuant to paragraph 16 of the Directive)

Where requested by the debtor and circumstances warrant, I will provide for BIA counselling, by exception, at a third-party location in accord with paragraph 16(two), while ensuring that the tertiary-party location(s) meet the definition in paragraph 1 of the Directive.
□ Yes □ No

If yes, the address(es) where the registrant will provide counselling are:
□ Aforementioned equally registrant work address, and/or:

1: Address (street number, street proper noun, city, province):

Postal code:

2: Address (street number, street name, urban center, province):

Postal code:

iii: Address (street number, street proper name, city, province):

Postal code:

SECTION 12: LIT DECLARATION

(Pursuant to paragraphs 9-11 and 29 of the Directive)

I, the Licensed Insolvency Trustee, attest to the best of my knowledge and belief that all information and supporting documentation I have provided in the Bankruptcy and Insolvency Act Insolvency Counsellor (BIA Insolvency Counsellor) Registration Form is accurate, correct, and complete, including that:

the registrant meets registration requirements in Directive No. 1R6; and
I take witnessed the registrant's declaration and have validated their identity.

I undertake to ensure that the Function of the Superintendent of Bankruptcy is notified of whatsoever fabric changes which may impact on registrant eligibility.

Licensed Insolvency Trustee signature

Engagement (YYYY-MM-DD):