000011088
25 AUG 1945 MATTHEW H JOHNSON
P 10

716 MAIN STREET EAST
TIMMINS ONT P4N 8L8

MATT'S COPY CENTRE

BANK OF ONTARIO
10 QUEEN STREET EAST ONT P5N 6L3 TIMMINS

BANK OF ONTARIO
(LORNE DREW)

1985 MALIBU MP3789E005729911N CHEVROLET

716 MAIN STREET EAST 28

28 Page 29 30
23

Part II PPSA Registration
Financing Change Statement – Form 2C
How to Complete a Form 2C

The Form 2C is used to record amendments and changes to the file. The parts of the form which must be completed depend on the type of change being made.

General Information

Registration numbers are assigned in accordance with the rules on page 7. If a registration is more than one page, see page 7 for instructions.

If a motor vehicle schedule is attached, place an "X" in the box marked "Motor Vehicle Schedule Attached".

Five key pieces of information are required to be entered on every 2C:
1. Reference file number – Part 1; Line 21

The number entered in this space is extremely important as it identifies which registration is being amended or changed. The following rules must be followed in order to ensure that the 2C links to its correct registration:

Account No. (if applicable) / No de compte (si pertinent) Registration Account Code / Code du compte d'enregistrement Motor Vehicle Schedule attached /
Liste des véhicules automobiles annexée

x

Reference File Number (see reverse) / No de dossier de référence (voir au verso)

Page /
Page

Total Pages /
N bre de pages

OF /
DE

Sequence / Séquence
Registration No. (for office use only) / No d'enregistrement (usage interne) YYYY / AAAA MM / MM DD / JJ Time / Heure Branch / Bureau 29

29 Page 30 31
24

Part II PPSA Registration

If an incorrect number has been referenced and the number is not on file, the financing change statement will not link to a registration and forms a family of its own. The new file number assigned to one unlinked registration does not replace the file number of the family being referenced. It is a number which applies to the unlinked registration only and
should not be used.

2. Reference Debtor Name
Line 23
Line 24

The debtor name entered above is used to confirm the accuracy of the number entered on line 21. For this reason, the debtor name entered must exactly match the debtor name previously recorded, even if that name was previously incorrectly entered. Although there may be more than one debtor of record, enter the name of only one debtor. If the transaction being recorded is a debtor's transfer or partial transfer of collateral, enter the transferor's name.

If an amendment is being registered, enter the debtor name as it was set out on the financing statement or financing change statement being amended. If the amendment is being made to indicate that a financing statement should or should not have been designated as a caution filing, enter the debtor name as it was set out on the financing statement.

In all other cases, the registrant has the choice of entering the debtor name as it appears on the financing statement or any financing change statement to which this financing change statement relates.

Use line 23 to enter the name of an individual debtor, and line 24 to enter the name of a business debtor.

Debtor Name (as recorded). Complete line 23 or 24 but not both / Nom du débiteur (tel qu'inscrit). Remplir la ligne 23 ou 24 mais pas les deux.
Individual Debtor / Transferor / Débiteur particulier / Cédant / First Given name / Premier prénom Surname / Nom de famille

Business Debtor /
Transferor /
Débiteur commercial /
Cédant

Line 24 cont'd / Ligne 24 (suite)

Initial /
Initiale 30

30 Page 31 32
25

Part II PPSA Registration

If the length of an individual's first given name (including punctuation marks and spaces) is longer than 19 characters or if the length of an individual's surname (including punctuation marks and spaces) is longer than 22 characters or both, enter only the first 19 or 22 characters or both, as the case may be, on line 23.

3. Letter for Change Code – Part 1; Line 22

The letter for change code entered in this space tells the computer system what type of change is being made. The change code legend is as follows:

A Amendment
B Renewal
C Discharge
D Assignment by Secured Party
E Transfer by Debtor
F Partial Discharge
G Assignment of the Security Interest in Part of the Collateral by Secured Party
H Transfer of Part of the Collateral by Debtor
J Other Change

Instructions for these specific changes follows.
4. Secured Party/ Registering Agent
Line 16
Line 17

Enter the name and address of one of the secured parties or, if there is a registering
agent, enter either the name and address of the registering agent or of one of the secured
parties. It is mandatory that the postal code be included in the address entered. If the
address is a foreign one, the equivalent of the Canadian postal code, if any, must be
entered.

Registering Specific Types of Changes
Each type of change that can be registered using a 2C requires that, in addition to the five
key pieces of information outlined above, other information also be entered on the form.
Specific instructions for each type of change are outlined below.

Registering Agent (if other than Secured Party / Lien Claimant) /Agent d'enregistrement (si autre que le créancier garanti / créancier privilégié)
Address / Adresse City, etc. / Ville, etc. Postal Code / Code postal Prov. / Prov.
Name / Nom

Enter Letter for Change (see reverse) /
Indiquer la lettre -code de modification (voir au verso) 31
31 Page 32 33
26
Part II PPSA Registration
Renewals
To register a renewal, enter the letter "B" in the letter for change box on line 22 of Part 1.
Enter in the following box on that line, the additional number of years the renewal should
add to the total registration period (i. e., the original registration period and any previous
renewals). Note that the effect of a renewal is to add to the registration period the number
of years indicated by the renewal except for registrations that extend to consumer goods.
Thus, a financing statement registered for 8 years and renewed at any time prior to its
expiry for 2 years, will be effective for a total of 10 years.

Where a registration does not extend to consumer goods, it may be renewed in increments
of 1-25 years, or a renewal may be made for a perpetual period. The expiry date of
the registration will be reflected on the related verification statement. (See Portion of the
Guide dealing with the form 3C and verification statement).

Registrations may only be renewed in increments of 1-5 years if the collateral is or
includes consumer goods. This renewal will only be effective for the number of years
indicated on the renewal statement calculated from the time it is registered. Thus, a
financing statement registered for three years and renewed on its first anniversary for 4
years, will be effective for a total of 5 years (one plus 4 years). As the System will not
calculate the expiry date in this manner, the recipient of a verification statement relating
to a PPSA registration which extends to consumer goods should ignore the expiry date
on that verification statement.

NOTE that once a registration expires or is discharged, it is no longer effective and thus
cannot be renewed. However, the security interest that was the subject of the expired or
discharged registration may be perfected again by registering a new financing statement
(1C Form). Registrants should note that their priority might be affected in these situations.

In every case, where a financing statement has been registered and all of the obligations
under the security agreement to which the registration relates have been performed or
some of those obligations have been performed and it is agreed to release part of the
collateral, any person with an interest in the collateral covered by the registration may
deliver a written notice to the secured party demanding a signed financing change
statement recording the discharge or partial discharge, be given to him/ her at the place
set out in the notice.

To register, a discharge, enter the letter "C" in the letter for change box on line 22 of
Part 1.

To register a partial discharge, enter the letter "F" in the letter for change box on line 22 of
Part 1. Note as well, that it may be necessary to complete Part 5 of the financing change
statement. (DO NOT use a form 3C to register a partial discharge).

If the released collateral in a partial discharge includes a motor vehicle that was previously
indexed by vehicle identification number – i. e., was described on a motor vehicle
schedule or either of lines 11 or 12 of a financing statement or financing change statement
– that motor vehicle MUST be described again on lines 11 or 12. If there are more 32
32 Page 33 34
27
Part II PPSA Registration
than two such motor vehicles, the remaining motor vehicles should be described on a
motor vehicle schedule. The registrant must not proceed to the motor vehicle schedule
without first describing two motor vehicles, one on each of lines 11 and 12. For detailed
instructions on how to properly describe a motor vehicle on lines 11 and 12 and the motor
vehicle schedule, refer to page 18.

The registrant does not have to describe other motor vehicles on the financing change
statement. If, however, the registrant chooses to do so, and wants these motor vehicles
to be indexed by vehicle identification number, the registrant must describe them as
provided for on lines 11 and 12. If the registrant is merely providing a general description
of motor vehicles, the registrant may enter the description on lines 13-15 as long as the
motor vehicle identification numbers are not included in the description.

Other types of collateral may be described on lines 13-15.
Transfers by Debtor of Collateral
Where a debtor transfers all of its interest in collateral, enter the letter "E" in the letter for
change box on line 22 of Part 1. If a debtor transfers its interest in only part of the collateral,
enter the letter "H" in the letter for change box on line 22 of Part 1.

Part 3 of the financing change statement MUST be completed for both complete and
partial transfers.

Enter the CORRECT NAME of the transferee on line 02/ 05 if the tranferee is a natural
person, and on line 03/ 06 if the transferee is an artificial body/ business debtor. (Entry of
the Ontario Corporation Number of a business debtor is optional). If known, the date of
birth of a natural person must be entered. As well, the address of the transferee, including
the postal code (if any), must, if known, be entered on line 04/ 07.

For tranfers of part of the collateral, it may also be necessary to complete Part 5 of the
financing change statement. If the part of the collateral transferred includes a motor
vehicle that was previously indexed by vehicle identification number – i. e., was described
on a motor vehicle schedule or either of lines 11 or 12 of a financing statement or financing
change statement – that motor vehicle MUST be described again on lines 11 or 12. If
there are more than two motor vehicles, the remaining motor vehicles should be described
on a motor vehicle schedule. The registrant must not proceed to the motor
vehicle schedule without first describing two motor vehicles, one on each of lines 11 and
12. For detailed instructions on how to properly describe a motor vehicle on lines 11 and
12 and the motor vehicle schedule, refer to page 18.

The registrant does not have to describe other motor vehicles on the financing change
statement. If, however, the registrant chooses to do so, and wants these motor vehicles

Surname / Nom de famille
Ontario Corporation No. / No matricule de la personne
morale en Ontario

Postal Code / Code postal

Individual Debtor /
Transferee/
Débiteur particulier /
Cessionnaire

First Given Name / Premier prénom

Business Debtor /
Transferee /
Débiteur
commercial /
Cessionnaire

Line 03/ 06 cont'd / Ligne 03/ 06 (suite)

Address / Adresse City, etc. / Ville, etc. Prov. / Prov.

Initial /
Initiale
Date of Birth / Date de naissance D /J M /M YYYY / AAAA 33
33 Page 34 35
28
Part II PPSA Registration
to be indexed by vehicle identification number, the registrant must describe them as
provided for on lines 11 and 12. If the registrant is merely providing a general description
of motor vehicles, the registrant may enter the description on lines 13-15 as long as the
motor vehicle identification numbers are not included in the description. Other types of
collateral may be described on lines 13-15.

Assignments
Where a secured party assigns its interest in collateral, enter the letter "D" in the letter for
change box on line 22 of Part 1. If a secured party assigns its interest in only part of the
collateral, enter the letter "G" in the letter for change box on line 22 of Part 1. Part 4 of the
financing change statement MUST be completed for both complete and partial assignments.

On line 29, enter the name of the assignor as recorded on the statement to which this
financing change statement relates. Enter the name of the assignee on line 08, and the
address of the assignee on line 09 – it is mandatory that the postal code be included. If
the address is a foreign one, the equivalent of the Canadian postal code, if any, must be
entered.

Note that the authorized signature, while mandatory, may be that of the assignor or
assignee.

With respect to a partial assignment, it may also be necessary to complete Part 5 of the
financing change statement. Where the secured party's security interest in part of the
collateral has been assigned and that collateral includes a motor vehicle that was
previously indexed by vehicle identification number – i. e., was described on a motor
vehicle schedule or either of lines 11 or 12 of a financing statement or financing change
statement – that motor vehicle MUST be described again on lines 11 or 12. If there are
more than two motor vehicles, the remaining motor vehicles should be described on a
motor vehicle schedule. The registrant must not proceed to the motor vehicle schedule
without first describing two motor vehicles, one on each of lines 11 and 12. For detailed
instructions on how to properly describe a motor vehicle on lines 11 and 12 and the motor
vehicle schedule, refer to page 18.

The registrar does not have to describe other motor vehicles on the financing change
statement. If, however, the registrant chooses to do so, and wants these motor vehicles
to be indexed by vehicle identification number, the registrant must describe them as
provided for on lines 11 and 12. If the registrant is merely providing a general description
of motor vehicles, the registrant may enter the description on lines 13-15 as long as the
motor vehicle identification numbers are not included in the description.

Other types of collateral may be described on lines 13-15.
Note: If a secured party's interest is assigned prior to the registration of a financing
statement:
a) a financing statement may be registered showing the assignee as the
secured party; or

Assignor (as recorded) /Cédant (tel qu'inscrit)
Secured Party / Lien Claimant / Assignee / Créancier garanti / Créancier privilégié / Ayant droit
City, etc. / Ville, etc. Postal Code / Code postal Prov. / Prov. Address / Adresse 34
34 Page 35 36
29
Part II PPSA Registration
b) a financing statement may be registered showing the assignor as the
secured party prior to registering a financing change statement recording
the assignment.

"Other Changes"
Regulations made pursuant to the PPSA indicate "Other Changes" to be either a subordination
or a seizure of a security interest. In either instance, the secured party must enter
the letter "J" in the letter for change box on line 22 of Part 1, and must then complete Part
2 of the financing change statement.

On lines 25-28 the type of change and particulars of the change must be recorded. For
example, if the seizure of a security interest is being recorded, lines 25-28 may indicate:

"By virtue of a writ of execution entered out of the Supreme Court of Ontario, the
Sheriff of the District of Algoma has seized the interest of ABC Company in a
chattel mortgage for $1500 in debt and $300 in costs."

NOTE that in the case of a seizure, the signature required on the financing change
statement is the sheriff's.

Amendments
To correct an error or omission made in a registered financing statement or financing
change statement, or to amend such statements in a way not elsewhere provided for,
enter an "A" in the letter for change box on line 22 of Part 1. (Note that to correct a reference
file number that has been erroneously entered on a form 2C, a special procedure is
outlined later in this Guide).

Part 2 of the financing change statement must be completed. On lines 26-28, in the area
entitled "Enter below Reasons for Amendment/ Other Change Description", the reasons
for amendment must be set out briefly and accurately.

Where necessary, enter any new or corrected information on the appropriate line.

Types of Amendment
1. Substitution
A substitution occurs where there is already a line of information recorded in the System
and it is necessary to substitute a new line of information to correct or update the old
information.

For example, an error may have been made in transcribing the address of the secured
party onto a financing statement or financing change statement. This may be indicated by
entering the following on lines 26-28.

"The incorrect address was entered on line 09 of registration number
19970703160700152621."

The registrant would then enter the correct address on line 09 of form 2C.

Specify Other Change here /Préciser l'autre modification ici

Enter below Reasons for Amendment / Other Change Description /Motifs de correction à écrire ci-dessous / Description de l'autre modification 35
35 Page 36 37
30
Part II PPSA Registration
Another example of a substitution is a debtor name change. Where a debtor has changed
its name, the following is one description which could be entered in the "Reasons for
Amendment":

"The debtor name on line 02 of the financing statement has changed."
The debtor's new name would then be entered on line 02/ 05 of the financing change
statement.

NOTE: A substitution is not actually made in the System. It is made only notionally. The
new information is added to the file.

2. Addition
An addition will add a line of information to a registered financing statement or financing
change statement.

For example, the registrant may have entered on the statement the information relating
to only one debtor when in fact there were two debtors. This may be indicated by entering
on lines 26-28.

"Information relating to a second individual debtor was omitted from lines 05 and
07 of Registration Number 19991221100900124110."

The registrant must then enter the necessary information – birth date, CORRECT NAME
and address of the debtor – on lines 02/ 05 and 04/ 07 of form 2C.

3. Deletion
A deletion will remove a line of information from a registered financing statement or
financing change statement.

For example, the registrant may have described two motor vehicles on lines 11 and 12
when there was a security interest in only one of the vehicles. It was therefore only necessary
to describe one motor vehicle. This would be indicated by entering on lines 26-28:

"The motor vehicle described on line 11 of Registration Number
19940916142700462601 is deleted as no security interest was taken in that
vehicle."

NOTE: A deletion is not actually made in the System. It is made only notionally. The
direction to delete is recorded on the file.

4. Caution Filing
To indicate that a registration number should or should not have been designated as a
caution filing, the registrant must explain the situation on lines 26-28.

Note that if a registration was erroneoulsy designated as a caution filing, the date of birth
of any individual debtor MUST be added if it was not previously indicated. The complete
debtor name( s) with the correct date of birth must be entered on line 02/ 05.

5. Other Amendments
Where an amendment is of a kind other than those described above, simply enter the
reasons for amendment on lines 26-28. Where appropriate, enter any new information on
the correct line of form 2C. 36
36 Page 37 38
31
Part II PPSA Registration
For example, a registrant may have entered a registration period of 18 years on a financing
statement when the proper period was 10 years. This may be indicated by entering on
lines 26-28:

"The registration period was incorrectly entered on line 01 of Registration
Number 19980609141800221256."

The registrant would then enter the appropriate registration period on line 22, in the box
entitled "Type in Total Correct Registration Period". This box is to be used only to reduce
the registration period. Increases in the registration period must be treated as renewals.
As a further example, a registrant may have incorrectly designated the statute with
respect to which the registration was made. In the last box of line 01 of this form, the
registrant must enter a "P". On lines 26-28, the registrant would indicate:

"This amendment is made as the statute with respect to which this registration
relates was incorrectly designated on line 01 of Registration Number
19910307140200022589.

An amendment to correct the statute under which a registration was made may require
that other amendments be recorded. For example, if amending to change a registration
under the RSLA to one under the PPSA and the "R" registration had nothing entered in
the collateral classification area on line 10, an amendment must also be made to the
collateral classification area on line 10. Line 10 would, therefore, have to be totally
redone.

Re: Incorrect Reference File Number/ Registration Number
If the incorrect reference file number or registration number has been entered on line 21
of a form 2C, it is sufficient to correct the error by properly completing and registering
another form 2C. The registrant should be sure to enter the information as it should have
been entered on the original form 2C, taking special care to enter the correct reference
file number or registration number in the "Reference File Number" box.

If the form 2C with the incorrect reference file number or registration number was registered
to record a change of debtor name or the transfer of a debtor's interest in all or part
of the collateral, it is suggested that the registrant ALSO register a form 2C designated as
an "amendment". The registrant must complete the general parts of this additional form
2C as outlined earlier in this Guide, taking care to enter the correct reference file number
or registration number in the "Reference File Number" box. The registrant should also
indicate on lines 26-28:

"The incorrect reference file number/ registration number was entered on Financing
Change Statement number 19961012111300431298 which recorded a
change of debtor name/ transfer of collateral."

Registration of the amendment will serve to indicate that a timely registration of the
change of debtor name or transfer of a debtor's interest in all or part of the collateral was
made.

Corporation Securities Registration Act
The CSRA was repealed on October 10, 1989. Since then, the following information with
respect to undischarged registrations filed under the CSRA have been available in the
System:

(a) the name of the debtor as shown in the registration under the former Act;
(b) the registration number under the former Act; and 37
37 Page 38 39
32
Part II PPSA Registration
(c) the following notation:
This registration was made under the Corporation Securities Registration
Act (R. S. O. 1980, c. 94) or a predecessor thereof. A copy of the
instrument is available for inspection in the offices of the Ministry of
Government Services located at:

375 University Avenue, 2nd Floor
Toronto, Ontario
M5G 2M2

Certain provisions in the PPSA apply to CSRA registrations. Specifically, a secured party
may record a discharge, partial discharge, assignment, partial assignment, subordination
or amendment. Further, a secured party must record any change in debtor name
within the time limits prescribed by the PPSA (see ss. 48( 3) and 78( 6)).

A secured party recording any of the above changes must:
(1) Complete the General Portions of the form 2C as outlined earlier in this Guide, to the
extent that they are applicable (beginning at page 23). Pay particular attention to the
instructions with regard to "Line 21 and the Reference File Number";

(2) If registering a partial discharge, note that the description of released collateral is
optional, but if described, the collateral should be described on lines 13-15;

(3) If registering an assignment or partial assignment, refer to and follow the specific
instructions outlined earlier in this portion of the Guide with respect to "Assignments",
to the extent they are applicable. With respect to the assignments of the secured
party's interest in part of the collateral, a description of the collateral included in the
assignment is optional, but if described, the collateral must be described on lines
13-15;

(4) If registering a subordination, refer to and follow the specific instructions outlined
earlier in this portion of the Guide with respect to "Other Changes" to the extent that it
deals with subordination; and

(5) If registering an amendment, refer to and follow the specific instructions outlined in
this portion of the Guide with respect to "Amendments" to the extent that they are
applicable.

Sample Fact Situation and Completed Financing Change Statement/ Form 2C
(The beginning of this fact situation is at the end of the discussion on Financing
Statements/ Form 1C).

Matt becomes seriously ill four years later and is advised by his doctor to retire to warmer
climes. He sells his business to his niece, Lisa. Prior to doing so, he informs Mr. Drew of
this new development and obtains the Bank's consent to the transfer of all of the collateral
to Lisa.

Within 15 days of the transfer, the Bank registers the following financing change statement.
The Bank first confirms that Lisa's address is 5510 Birch Avenue, Timmins, postal
code P8R 1L1. The Bank also checks Lisa's birth certificate which indicates her name is
Lisa Vernon, and that she was born on March 4, 1962. There was no second given name
set out on the birth certificate. 38
38 Page 39 40
33
Part II PPSA Registration
Part
6
/
Partie

Financing Change Statement / Change Statement État de modification du financement / État de modification
Sequence / Séquence

Ministry of Ministère de
Consumer and la Consommation
Commercial Relations et du Commerce

Account No. (if applicable) / No de compte (si pertinent) Registration Account Code / Code du compte d'enregistrement

Registration No. (for office use only) / No d'enregistrement (usage interne) YYYY / AAAA MM / MM DD / JJ Time / Heure Branch / Bureau
01
Caution
Filing /
Avertissement

Motor
Vehicle
Schedule
attached /
Liste des
véhicules
automobiles
annexée
Page /
Page

Total
Pages /
N bre de
pages
OF/

DE x x

PPSA-P
RSLA-R

Debtor Name (as recorded). Complete line 23 or 24 but not both /
Nom du débiteur (tel qu'inscrit). Remplir la ligne 23 ou 24 mais pas les deux. 23

24

Individual Debtor / Transferor / Débiteur particulier / Cédant / First Given name / Premier prénom Surname / Nom de famille
Business
Debtor /
Transferor /
Débiteur
commercial/
Cédant

Line 24 cont'd / Ligne 24 (suite)

21 Reference File Number (see reverse) / N
o de dossier de référence (voir au verso)

Part
1
/
Partie

Page No. of page to be amended/
No de la page à corriger
OR
OU

Amendments Only / Corrections seulement
22
Type 'X' if no specific page is to be amended /
Taper 'X' s'il n'y a pas de page précise à corriger x

Enter Letter for Change (see reverse) /
Indiquer la lettre -code de modification (voir au verso) Type in Total Correct Registration Period (for reduction only)/
Indiquer la période totale exacte d'enregistrement (en cas de diminution seulement)

Amendments Only / Corrections seulement Enter Number of Additional Years if Renewal (see reverse) / Indiquer le nombre d'années
supplémentaires s'il s'agit d'un renouvellement (voir au verso)

25
Specify Other Change here /Préciser l'autre modification ici

Part
2
/
Partie

28
27
26
Enter below Reasons for Amendment / Other Change Description /Motifs de correction à écrire ci-dessous / Description de l'autre modification

Individual Debtor /
Transferee/
Débiteur particulier /
Cessionnaire

02/
05

03/
06

First Given Name / Premier prénom Surname / Nom de famille
Business Debtor /
Transferee /
Débiteur
commercial /
Cessionnaire

Line 03/ 06 cont'd / Ligne 03/ 06 (suite) Ontario Corporation No. / No matricule de la personne morale en Ontario

Address / Adresse City, etc. / Ville, etc. 04/
07
Postal Code / Code postal Prov. / Prov.

29
Assignor (as recorded) /Cédant (tel qu'inscrit)

Part
4
/
Partie

09
08
Secured Party / Lien Claimant / Assignee / Créancier garanti / Créancier privilégié / Ayant droit

Part
3
/
Partie

City, etc. / Ville, etc. Postal Code / Code postal Prov. / Prov. Address / Adresse
10 Section 1: Collateral Classification / Classification des biens grevés Section 2: Type 'X' if motor vehicle
included /
Taper 'X' si véhicule
automobile inclus.

Section 3: Principal Amount Secured /
Amount of the Lien / Montant principal garanti /
Montant du privilège

Section 4:
Date of Maturity / Date d'échéance D /J M /M YYYY / AAAA

Type 'X' if no Fixed Date of
Maturity/ Taper 'X' si la
date d'échéance n'est pas
déterminée.
OR/
OU x x

Consumer
Goods/
Biens de cons.

x

Inventory /
Stock

x x x

Equipment /
Matériel
Accounts /
Comptes
Other /
Autre

Type 'X' in appropriate box or boxes.
Taper 'X' dans la (les) case( s) appropriée( s)

Part
5
/
Partie

12
11
Motor Vehicle Description /Description du véhicule automobile Year /
Année Make / Marque Vehicle Identification No. / No d'identification du véhicule Model/ Modèle

If more than two vehicles, continue on the Motor Vehicle Schedule (Form 4C). S'il y a plus de deux véhicules automobiles, utiliser la Liste des véhicules automobiles (formule 4C).
14
13
General Collateral Description / Description générale du bien grevé

Registering Agent / Secured Party / Lien Claimant /Agent d'enregistrement / Créancier garanti / Créancier privilégié
Address / Adresse City, etc. / Ville, etc.
17
Postal Code / Code postal Prov. / Prov.

Name / Nom
16

15

x

Name and Signature of Secured Party / Lien Claimant OR Name of Secured Party / Lien Claimant AND Name and Signature of Agent of Secured Party / Lien Claimant. Nom et signature du créancier garanti / créancier privilégié OU Nom du créancier garanti / créancier privilégié ET nom et signature de l'agent du créancier garanti / créancier privilégié.

Initial / Initiale
Initial / Initiale Date of Birth / Date de naissance D /J M /M YYYY / AAAA

$ .00

10552( 09/ 98) This form must not be reproduced for registration purposes. Cette formule ne doit pas être reproduite aux fins d'enregistrement. Central Office Copy / Exemplaire du bureau central
Authorized

Signature
Signature
autorisée

39
39 Page 40 41
34
Part II PPSA Registration
Form 3C and Verification Statement
The following discussion on the form 3C and verification statement applies to both the
PPSA and the RSLA.

For every financing statement/ claim for lien (form 1C) and financing change statement/
change statement (form 2C or 3C) registered, a form 3C and verification statement is
generated by the System. When a financing statement/ claim for lien is registered, a form
3C and verification statement is mailed to the secured party/ lien claimant or to the
registering agent (if shown) whose name appears on page one of the registration. When
a financing change statement/ change statement is registered, it is sent to the secured
party, lien claimant or registering agent who registered the financing change statement/
change statement.

A form 3C and verification statement is perforated and can be separated into two parts.
Form 3C
The form 3C is a financing change statement/ change statement which is used to register
a complete discharge or a renewal. Some of the information on this form will be completed
before it is mailed to the appropriate parties. (See above). Included in the completed
information is a reference file number (line 31). If a form 1C is registered or a form
2C or 3C is registered referencing a form 1C, the reference file number will be the file
number located at the upper right-hand corner of the form 1C. If a form 2C is registered
referencing an A or B series form or a CSRA registration, the reference file number will be
a number assigned by the Registrar for that family of registrations.

A Form 3C may be used by a registrant to register a renewal or a complete discharge
BUT ONLY with respect to the family designated by the reference number pre-printed on
it. It may not be used to register a partial discharge.

See instructions page 6.
Line 01

See instructions page 7.
Line 31
The reference file number has been entered by the Registrar.

Account No. (if applicable) / No de compte (si pertinent) Registration Account Code / Code du compte d'enregistrement
31 Reference File Number No de dossier de référence
Sequence / Séquence
Registration No. (for office use only) / No d'enregistrement (usage interne) YYYY / AAAA MM / MM DD / JJ Time / Heure Branch / Bureau 40
40 Page 41 42
35
Part II PPSA Registration
Line 31

Enter a "B" if registering a renewal, and a "C" if registering a discharge. Note that a
secured party or lien claimant is obliged, in certain circumstances, to register a financing
change statement or a change statement designated as a discharge within a specific
time period. For an explanation of the mandatory discharge requirements under:

(i) the PPSA, see page 26 of this Guide; and
(ii) the RSLA, see page 54 of this Guide.

If registering a renewal, enter the number of additional years to be added to the total
registration period. Note that the effect of a renewal is to add to the registration period the
number of years indicated by the renewal except for registrations that extend to consumer
goods. Thus a financing statement registered for 8 years and renewed at any time
prior to its expiry for 2 years, will be effective for a total of 10 years. Similarly, a claim for
lien registered for 1 year and renewed at any time prior to its expiry for 2 years will be
effective for a total of 3 years.

Under the PPSA, where a registration does not extend to consumer goods, it may be
renewed in increments of 1-25 years, or a renewal may be made for a perpetual period.
The expiry date of the registration will be reflected on the related verification statement.
(See discussion relating to verification statements that follows).

Registrations may only be renewed in increments of 1-5 years if the collateral is or
includes consumer goods. The renewal will only be effective for the number of years
indicated on the renewal statement calculated from the time it is registered. Thus, a
financing statement registered for three years and renewed on its first anniversary for 4
years, will be effective for a total of 5 years (one plus 4 years). As the System will not
calculate the expiry date in this manner, the recipient of a verification statement relating
to a PPSA registration which extends to consumer goods should ignore the expiry date
on that verification statement.

Under the RSLA, registrations may only be renewed for a period of "1" or "2" years as
total registration period of a claim for lien cannot exceed 3 years. The expiry date of the
registration will be reflected on the related verification statement.

Note that a PPSA registration that expires or is discharged is no longer effective and,
therefore, cannot be renewed. The security interest that was the subject of the expired or
discharged registration may, however, be perfected again by the registration of a new
financing statement.

Note that should the registration period of a claim for lien expire or if the claim for lien is
discharged, the non-possessory lien to which the claim for lien relates is also discharged
and cannot be revived as an interest.

Enter Number of Additional Years if Renewal (see reverse) / Indiquer le nombre d'années supplémentaires s'il s'agit d'un
renouvellement (voir au verso)

Renewal (B) OR Discharge (C) / Renouvellement (B) OU Mainlevée (C) 41
41 Page 42 43
36
Part II PPSA Registration
Line 32
Line 33

The reference debtor name has been entered by the Registrar.
Line 33

If previously provided by the registrant, the Ontario Corporation number will be entered
by the Registrar.

Line 09/ 17
Enter the name and address of one of the secured parties, one of the lien claimants or of
the registering agent, if any. It is mandatory that the postal code be included in the
address entered. If the address is a foreign one, the equivalent of the Canadian postal
code, if any, must be entered.

This section must be completed or else no verification statement can be produced.

Verification Statement
The verification statement reproduces the information set out on the financing statement/
claim for lien or financing change statement as it has been transcribed onto the central
computer file. It provides the registrant with a means to verify that the recorded information
is accurate.

Individual Debtor (as recorded)
Débiteur particulier (tel qu'inscrit) 32

33

First Given Name / Premier prénom Surname / Nom de famille
Business Debtor (as recorded)
Débiteur commercial (tel qu'inscrit)

Ontario Corporation No. / No matricule de la personne morale en Ontario

Initial / Initiale

Ontario Corporation No. / No matricule de la personne morale en Ontario
08/
16

Secured Party / Lien Claimant / Registering Agent / Créancier garanti / Créancier privilégié / Agent d'enregistrement

09/
17

City, etc. / Ville, etc. Postal Code / Code postal Prov. / Prov. Address / Adresse 42
42 Page 43 44
37
Part II PPSA Registration
The verification statement will contain an expiry date and may contain courtesy notices.
The expiry date will indicate the date on which the registration will expire. IGNORE this
date for PPSA registrations which extend to consumer goods.

Courtesy notices are intended to notify the registrant of irregularities made in the completion
of the registered financing statement/ claim for lien or financing change statement/
change statement. It is recommended that in every case, upon receipt, the registrant
compares the verification statement – whether or not courtesy notices are indicated –
with a copy of the financing statement/ claim for lien or financing change statement/
change statement AND with any supporting documentation such as a security agreement
or invoice.

NOTE that the System will generate courtesy notices in certain situations. If, for example,
a registrant has misspelt a debtor's name or has miscopied the vehicle information
number, a courtesy notice will not be provided.

Examples of Courtesy Notices
a) REFERENCE FILE NUMBER DOES NOT EXIST
This indicates that no form 1C exists on file with which the provided reference file
number can be matched. The System cannot find the number referred to which
means that the registration has expired, been discharged or has been incorrectly
referred to.

b) VIN MISSING
This indicates that a motor vehicle description has been set out on a line designated
for a motor vehicle description but the vehicle identification number box
has been left blank.

c) DEBTOR DATE OF BIRTH INVALID
This indicates that the registrant has provided a date of birth that is not a valid
date, for example, February 30, 1970.

NOTICE TO SECURED PARTIES: The PPSA requires that a secured party deliver to
each debtor either a copy of the registered financing statement or financing change
statement OR a copy of the verification statement within 30 days of the date of registration.
Failure to do so may result in a penalty to the secured party. 43
43 Page 44 45
38
Part II PPSA Registration
Sample Fact Situation and Completed Financing Statement/ Form 3C
(The beginning of this fact situation is at the end of the discussion on Financing Statements/
Form 1C at page 21 and at the end of the discussion on Financing Change
Statements/ Form 2C at page 32).

Five years after acquiring her uncle's business, Lisa finds she still has difficulty making it
into a profitable venture. With the technological advances made, some of her equipment
is now outdated. Lisa is certain that if she had the necessary capital to modernize the
business and its premises, she could turn a handsome profit. She meets with Dr. Drew,
manager at the Bank of Ontario, and successfully obtains further financing. The Bank
extends a further $15,000.00 on the security of the same collateral pursuant to a future
advance clause in the security agreement. The security agreement is amended by
extending the maturity date for an additional six years.

The Bank finds it necessary to register a renewal of six years and registers the following
financing change statement.

Financing Change Statement / Change Statement État de modification du financement / État de modification
Account No. (if applicable) / No de compte (si pertinent) Registration Account Code / Code du compte d'enregistrement

10553( 12/ 98)
This form must not be reproduced for registration purposes.
Cette formule ne doit pas être reproduite aux fins d'enregistrement. Central Office Copy / Exemplaire du bureau central Detach here / Détacher ici

Sequence / Séquence
Registration No. (for office use only) / No d'enregistrement (usage interne) MM / MM DD / JJ Time / Heure Branch / Bureau

01
Registered Under (office use only)
Enregistré aux termes de (usage interne)

31 Reference File Number No de dossier de référence Renewal (B) OR Discharge (C) / Renouvellement (B) OU Mainlevée (C) Enter Number of Additional Years if Renewal (see reverse) / Indiquer le nombre d'années supplémentaires s'il s'agit d'un renouvellement (voir au verso)

YYYY / AAAA

Individual Debtor (as recorded)
Débiteur particulier (tel qu'inscrit) 32

33

First Given Name / Premier prénom Surname / Nom de famille
Business Debtor / Transferee (as recorded/
Débiteur commercial /Cessionnaire (tel qu'inscrit)

Ontario Corporation No. / No matricule de la personne morale en Ontario

Initial / Initiale

08/
16

Secured Party / Lien Claimant / Registering Agent / Créancier garanti / Créancier privilégié / Agent d'enregistrement

09/
17

City, etc. / Ville, etc. Postal Code / Code postal Prov. / Prov. Address / Adresse

Authorized Signature / Signature autorisée
Name and Signature of Secured Party/ Lien Claimant OR Name of Secured Party/ Lien Claimant
AND Name and Signature of Agent of Secured Party/ Lien Claimant. / Nom et signature du
créancier garanti/ créancier privilégié OU Nom du créancier garanti/ créancier privilégié ET nom et
signature de l'agent du créancier garanti/ créancier privilégié

Ministry of Ministère de
Consumer and la Consommation
Commercial et du Commerce
Relations

Form Formule 3C10553( 12/ 98) 44
44 Page 45 46
39
Part II PPSA Registration
Financing Change Statement / Change Statement État de modification du financement / État de modification
Account No. (if applicable) / No de compte (si pertinent) Registration Account Code / Code du compte d'enregistrement

10553( 12/ 98)
This form must not be reproduced for registration purposes.
Cette formule ne doit pas être reproduite aux fins d'enregistrement. Central Office Copy / Exemplaire du bureau central Detach here / Détacher ici

Sequence / Séquence
Registration No. (for office use only) / No d'enregistrement (usage interne) MM / MM DD / JJ Time / Heure Branch / Bureau

01
Registered Under (office use only)
Enregistré aux termes de (usage interne)

31 Reference File Number No de dossier de référence Renewal (B) OR Discharge (C) / Renouvellement (B) OU Mainlevée (C) Enter Number of Additional Years if Renewal (see reverse) / Indiquer le nombre d'années supplémentaires s'il s'agit d'un renouvellement (voir au verso)

YYYY / AAAA

Individual Debtor (as recorded)
Débiteur particulier (tel qu'inscrit) 32

33

First Given Name / Premier prénom Surname / Nom de famille
Business Debtor / Transferee (as recorded/
Débiteur commercial /Cessionnaire (tel qu'inscrit)

Ontario Corporation No. / No matricule de la personne morale en Ontario

Initial / Initiale

08/
16

Secured Party / Lien Claimant / Registering Agent / Créancier garanti / Créancier privilégié / Agent d'enregistrement

09/
17

City, etc. / Ville, etc. Postal Code / Code postal Prov. / Prov. Address / Adresse

Authorized Signature / Signature autorisée
Name and Signature of Secured Party/ Lien Claimant OR Name of Secured Party/ Lien Claimant AND
Name and Signature of Agent of Secured Party/ Lien Claimant. / Nom et signature du créancier
garanti/ créancier privilégié OU Nom du créancier garanti/ créancier privilégié ET nom et signature de
l'agent du créancier garanti/ créancier privilégié

000011097
SAM J PARKER
C

SUPPLIES PLUS
788 MAPLE BLVD ONT N7O 1A1 OSHAWA

SUPPLIES PLUS INC
(ARNOLD HARRISSON)
SUPPLIES PLUS
788 MAPLE BLVD
OSHAWA ON N7O 1A1

Ministry of Ministère de
Consumer and la Consommation
Commercial et du Commerce
Relations

Form Formule 3C10553( 12/ 98)

SAMPLE FACT SITUATION AND COMPLETED CHANGE STATEMENT FORM 3C
The beginning of this fact situation is at the end of the discussion on Claims for Lien/ Form
1C at page 50 and at the end of the discussion on Change Statements/ Form 2C at page
59).

One year after the claim for lien was originally registered, Sam was able to pay off the full
amount of the lien. Within 30 days of payment, Supplies Plus Inc. registered the following
change statement. 45
45 Page 46 47
40
Part II PPSA Registration
Motor Vehicle Schedule – Form 4C
The following instructions for the completion of the motor vehicle schedule apply to both
registrations made under the PPSA and the RSLA.

A motor vehicle schedule is never registered alone – it is always registered along with
either a financing statement/ claim for lien or financing change statement/ change statement.
Consequently, a motor vehicle schedule is always one page of a multiple page
registration which requires that the registrant complete the page number designation on
line 01 of each of the pages registered. On line 00 of the motor vehicle schedule is a box
entitled "Reference File No". The registrant must set out in this box:

(i) the file number from the form 1C if a financing statement/ claim for lien is
being registered; or

(ii) the reference file number from line 21 of the form 2C if a financing
change statement/ change statement is being registered.

If a motor vehicle schedule is attached, be sure to enter an "X" in the box entitled "Motor
Vehicle Schedule Attached" on line 01 of the form 1C or 2C.

The motor vehicle schedule should be used when describing more than two motor
vehicles as provided for on lines 11 and 12 of the financing statement/ claim for lien or
financing change statement/ change statement. It is formatted in exactly the same
manner as lines 11 and 12 of those statements.

To complete any one of lines 41-56 of form 4C:
(i) follow the instructions provided for the completion of lines 11 and 12 of a
financing statement if the motor vehicle schedule is registered as part of
a financing statement or financing change statement. (See page 18 of
this Guide);

(ii) follow the instructions provided for the completion of lines 11 and 12 of a
claim for lien if the motor vehicle schedule is registered as part of a claim
for lien or change statement. (See page 47 of this Guide).

See instructions page 6.

It is essential that a registrant accurately enter the file number in the space provided for
recording a reference file number when filling out a form 2C or a form 4C. The reference
file number is system generated and is pre-printed on the form 3C.

NOTE: If, when registering a claim for lien, more than one statement is used, i. e., it is a
multiple page registration consisting of two or more claim for lien forms, the file number
for the registration is the file number on the first page. Ignore the file number on the
second and subsequent claim for lien forms.

Disregard the caution filing box as it is not relevant to a registration under the RSLA.
Line 01

See instructions page 7.

File No / No de dossier
000000067

Account No. (if applicable) / No de compte (si pertinent) Registration Account Code / Code du compte d'enregistrement

Caution
Filing /
Avertissement

x

Page /
Page

Total
Pages /
N bre de
pages

OF/
DE 47
47 Page 48 49
42
Part III RSLA Registration
Line 01

An "X" must be entered if a motor vehicle schedule is submitted with the claim for lien.
Such a schedule should be used when it is necessary to describe more than two motor
vehicles as provided for on lines 11 and 12 of the claim for lien.

Note that if a motor vehicle schedule is submitted the registration will be a multiple page
registration.

See instructions page 7.
Line 01
This section identifies the statute with respect to which a registration is being made. If
registering a claim for lien under the Repair and Storage Lien Act, enter an "R" in this box.
If an interest is being registered under the Personal Property Security Act, enter a "P" in
this box and refer to the portion of this Guide that deals with PPSA registrations for
instructions on how to complete this form.

Enter the number of years for which the claim for lien is to be effective. Enter whole years
only, from 1-3 inclusive.

Complete the debtor's date of birth by entering the day, the month, and then the year. The
month must be shown as one of: JAN JANV FEB FEV MAR MARS APR AVR MAY MAI
JUNE JUN JUIN JULY JUL JUIL AUG AOUT SEPT SEP OCT NOV DEC.

For example, for a debtor born June 12, 1961 enter 12 JUN 1961, 12 JUNE 1961 or
12 JUIN 1961.

Motor
Vehicle
Schedule
attached /
Liste des
véhicules
automobiles
annexée

x

PPSA-P (see reverse)
RSLA-R (voir au verso)

Registration Period (reverse)
Période d'enregistrement( verso)

Sequence / Séquence YYYY / AAAA MM / MM DD / JJ Time / Heure Branch / Bureau
Registration No. (for office use only) / No d'enregistrement (usage interne)

Date of Birth / Date de naissance D /J M /M YYYY / AAAA 48
48 Page 49 50
43
Part III RSLA Registration
Line 02

Enter the name of the person against whom the lien is claimed on the individual debtor
name line.

Enter an individual debtor's first given name in the first box, the initial of the second given
name, if any, in the next box, and the debtor's surname in the last box. BE CERTAIN
THAT THE NAME THAT IS ENTERED IS THE DEBTOR'S CORRECT NAME. An
individual debtor's correct name may be determined by reference to a birth certificate, a
certificate of citizenship, or other appropriate document. (See Appendix "D" for guidelines).

The initial of the second given name is used to differentiate between names such as
WILLIAM J. SMITH and WILLIAM B. SMITH, as well as to differentiate between
WILLIAM SMITH and WILLIAM J. SMITH. If an individual has a second given name, the
initial must be entered.

For example, if the debtor's name is William Herman Joseph Smith, it must be entered as
WILLIAM H. SMITH.

If a registrant is uncertain which of an individual's names is the first given name and which
is the surname, the registrant may wish to set the name out in two ways – one setting the
names out in one order and one setting them out in reverse order.

If the length of an individual's first given name (including punctuation marks and spaces)
is longer than 19 characters or if the length of an individual's surname (including punctuation
marks and spaces) is longer than 22 characters or both, enter only the first 19 or 22
characters or both, as the case may be, and the initial of the second given name, if any,
on line 02. Then, enter the entire first given name and surname, including the initial of the
second given name, if any, on line 13, 14 or 15 of the General Collateral Description
portion of this form.

DO NOT USE:
– Nicknames or abbreviations, for example, do not use "Tom" for "Thomas" or "MJ"
for "Mary Jane". (Of course, "MJ" or "Tom" must be used if that is really the
correct name).

– "Jr." or "Sr." or other designations to differentiate between generations.
– Titles, for example, do not use Mr. Mrs. Miss Ms. Dr. or Rev.
If the debtor's correct name is not entered, an enquirer who subsequently searches
against the correct name may be misled. The PPSA provides that a registration may be
invalidated where a reasonable person is likely to be misled materially by an error or
omission.

NOTE: If the name of an individual person is entered on line 02, DO NOT complete line
03. If another name is to be recorded, use either line 05 if the name is that of an individual
person or line 06 if the name is that of an artificial body/ business debtor.

First Given Name / Premier prénom Surname / Nom de famille Initial / Initiale 49
49 Page 50 51
44
Part III RSLA Registration
Line 03

Enter the business debtor's name in full. A debtor who is not a natural person is considered
an artificial body, and will be identified on the business debtor name line. MAKE
CERTAIN THAT THE NAME ENTERED IS THE CORRECT NAME. An artificial body's
correct name may be determined by reference to an appropriate constituting document,
such as, for example, a company's articles of incorporation. (See Appendix "C" for further
details). Note that for certain types of artificial bodies/ business debtors the name required
to be entered may be the name of a person who is not a debtor (for example, the
name of a corporation signing the security agreement on behalf of a debtor which is an
unincorporated association).

Only one debtor name should be entered on the two lines of space provided. The second
line of space has been provided to accommodate debtor names which are more than 66
characters.

NOTE: If line 02 has NOT been used to record the name of an individual person, use line
03 to record the name of an artificial body/ business debtor. If line 02 or 03 has been used
and a second name is to be recorded, use either line 05 if the name is that of an individual
person or line 06 if the name is that of an artificial body/ business debtor. (If a third name is
to be recorded, complete an additional form as an additional page).

TRADE NAMES: Where a debtor is carrying on business under a business or trade
name, the name of the debtor must be entered, and the business or trade name may be
entered.

If a business or trade name is set out, it must be set out on line 03 or line 06.
Therefore, if William J. Smith is carrying on business as ABC Restaurant, enter WILLIAM
J. SMITH on line 02 and ABC RESTAURANT on line 06 OR WILLIAM J. SMITH on line
05 and ABC RESTAURANT on line 03.

If ABC Company Limited is carrying on business as Smith Enterprises, enter ABC
COMPANY LIMITED on line 03 and SMITH ENTERPRISES on line 06 OR ABC COMPANY
LIMITED on line 06 and SMITH ENTERPRISES on line 03.

The following are examples of business or trade names incorrectly entered. DO NOT
enter a business or trade name as:

WILLIAM J. SMITH CARRYING ON BUSINESS AS ABC RESTAURANT
ABC RESTAURANT OWNED AND OPERATED BY WILLIAM J. SMITH SMITH
ENTERPRISES A DIVISION OF ABC COMPANY LIMITED SMITH ENTERPRISES
AFFILIATE OF ABC COMPANY LIMITED

ENGLISH/ FRENCH CORPORATE NAMES: The Ontario Business Corporations Act
provides that a corporation may set out its name in its articles of incorporation in an
English form, a French form, an English form and a French form, or a combined English
and French form and it may be legally designated by any such name.

If a corporation has both an English and a French form of its name, BOTH names must
be entered on the financing statement. DO NOT enter both on the same line. Enter one
form of the name on a business debtor name line, and the other form of the name on the

Business Debtor /
Débiteur
commercial
(Complete lines 02 &
04 or lines 03 & 04 /
Compléter les lignes
02 et 04 ou les lignes
03 et 04)

Line 03 cont'd / Ligne 03 (suite) 50
50 Page 51 52
45
Part III RSLA Registration
other business debtor name line. Thus enter one form of the name on line 03 and the
other form of the name on line 06. The order in which the names are entered is irrelevant.

In every other case, on the appropriate business debtor name line, enter the corporate
name as it appears in the articles of incorporation. Thus, enter a French name in French
an English name in English, and a combined English and French name in the combined
form.

Every Ontario company has a unique number assigned to it by the Companies Branch of
the Ministry of Consumer and Commercial Relations. The registrant has the option of
entering this number on the financing statement.

On this line, enter the debtor's address – it is mandatory that the postal code be included.
If the address is a foreign one, the equivalent of the Canadian postal code, if any, must be
entered.

"Address" is not defined, save for the requirement that a postal code be included. If it
were defined and the wrong one inadvertently given, it could jeopardize the validity of the
registration. It is up to the registrant to decide whether the mailing address or residence
address or some other address should be used.

The primary purpose for which the address is likely to be used is to help to identify the
debtor.

If the name of an individual person is entered on line 05, DO NOT enter the name of an
artificial body/ business debtor on line 06. If line 05 is to be completed, complete it in
accordance with the instructions for line 02.

Ontario Corporation No.
No matricule de la personne
morale en Ontario

Address / Adresse City, etc. / Ville, etc. Postal Code / Code postal Prov. / Prov.

Business Debtor /
Débiteur
commercial
(Complete lines 05 &
07 or lines 06 & 07 /
Compléter les lignes
05 et 07 ou les lignes
06 et 07)

Line 06 cont'd / Ligne 06 (suite)

Individual Debtor /
Débiteur particulier

First Given Name / Premier prénom Surname / Nom de famille Date of Birth / Date de naissance D /J M /M YYYY / AAAA Initial / Initiale 51
51 Page 52 53
46
Part III RSLA Registration
If line 05 has NOT been used to record the name of an individual person, use line 06 to
record the name of an artificial body/ business debtor. If line 06 is to be completed,
complete it in accordance with the instructions for line 03.

If the address to be recorded on line 07 is the same as that recorded on line 04, leave line
07 blank. Do not type in "AS ABOVE" or "SAME". If line 07 is to be completed, complete it
in accordance with the instructions for line 04.

Enter the name of the lien claimant.
There is no search capability against the names of lien claimants. Therefore, this line is
not formatted in the same way as line 02 or 05. If there is not enough space to enter a lien
claimant's name, certain words may be abbreviated. For example, the Ontario Business
Corporations Act treats "Limited" and "Ltd" as equivalent.

On this line, enter the address of the lien claimant – it is mandatory that the postal code
be included. If the address is a foreign one, the equivalent of the Canadian postal code, if
any, must be entered.

"Address" is not defined, save for the requirement that a postal code be included. The
primary purpose for which the address is likely to be used is to contact the secured party
for additional information.

Disregard the collateral classification section as it is not relevant to a registration under
the RSLA.

Address / Adresse City, etc. / Ville, etc. Postal Code / Code postal Prov. / Prov. (Complete if different from line 04 /Compléter si différente de la ligne 4)
Secured Party / Lien Claimant /
Créancier garanti / Créancier privilégié

Address / Adresse City, etc. / Ville, etc. Postal Code / Code postal Prov. / Prov.

Section 1: Collateral Classification / Classification des biens grevés
Consumer Goods/
Biens de cons.

x x

Inventory /
Stock

x x x

Equipment /
Matériel
Accounts /
Comptes
Other /
Autre

Type 'X' in appropriate box or boxes.
Taper 'X' dans la (les) case( s) appropriée( s)

Section 2:
Type 'X' if motor
vehicle included /
Taper 'X' si véhicule
automobile inclus.

x 52
52 Page 53 54
47
Part III RSLA Registration
Enter an "X" if any lien in the claim for lien extends to a motor vehicle. Otherwise, leave
this section blank.

Check the definition of motor vehicle in the Glossary at the front of this Guide.
Line 10

The amount of the lien MUST be entered, and if the registration relates to more than one
article, the total amount for all of the repairs, storage and repairs must be entered. Round
off to the nearest dollar as the form has been pre-printed to show the cents values as .00.
Note that any interest owing for repair and storage charges should not be included in this
amount because a lien claimant is not entitled to a lien for interest on the amount owing
with respect to an article. (There is a limited exception for interest on money advanced by
a storage company. See clause 4( 1)( b) of the RSLA.)

Disregard the section dealing with date of maturity as it is not relevant to a registration
under the RSLA.

Line 12
If a lien is being claimed against a motor vehicle, it must be described on line 11 or 12,
and if there are more than two motor vehicles, the remaining motor vehicles should be
described on a motor vehicle schedule/ form 4C. The registrant must not proceed to the
motor vehicle schedule without first describing two motor vehicles, one on each of lines
11 and 12.

If a motor vehicle is described, the Regulations require,
a) the last four digits of the model year, if any, MUST be given (if none,
leave blank),

Motor Vehicle Description /Description du véhicule automobile Year /
Année Make / Marque Vehicle Identification No. / No d'identification du véhicule Model/ Modèle

Section 3:
Principal Amount Secured /
Amount of the Lien /
Montant principal garanti /
Montant du privilège

$ .00

Section 4: Type 'X' if no Fixed Date of
Maturity /
Taper 'X' si la
date d'échéance
n'est pas
déterminée.

OR/
OU x

Date of Maturity / Date d'échéance D /J M /M YYYY / AAAA 53
53 Page 54 55
48
Part III RSLA Registration
b) the make of the motor vehicle or the name of the manufacturer MUST be
given,

c) the model, if any, MUST be given (if none, leave blank), and
d) the motor vehicle identification number MUST be given.
For most manufactured automobiles, the above information will be relatively easy to
provide and must be given. For other types of vehicles, there may be no model year or
model, in which event the spaces must be left blank. There may be no make in which
event the name of the manufacturer must be entered (even if it is "homemade").

Note that for the purposes of a motor vehicle description, the Regulations define a
"vehicle identification number" as meaning,

"the number that the person who constructed the motor vehicle affixed to it for
identification purposes."

For all new automobiles sold in Canada after 1982, this number is made up of a unique
combination of 17 letters and numerals. While other motor vehicles have vehicle identification
numbers, they are not required to conform to this standard.

To ensure that the correct vehicle identification number is entered, copy the vehicle
identification number from the vehicle itself. Do not rely on the vehicle identification
number printed on the vehicle permit or "ownership".

If the incorrect vehicle identification number is entered, an enquirer who subsequently
searches against the correct vehicle identification number may be misled. The RSLA
provides that a registration may be invalidated where a reasonable person is likely to be
misled materially by an error or omission.

If a lien is being claimed against an article other than a motor vehicle, the lien claimant
MUST describe the article or articles on line 13-15. The description must be sufficient to
enable the articles to be identified.

General Collateral Description (PPSA optional) / Description générale du bien grevé (PPSA facultatif) 54
54 Page 55 56
49
Part III RSLA Registration
Line 16
Line 17

The name and address of the registering agent, if other than the lien claimant, may be
entered. If entered, it is mandatory that the postal code be included. If the address is a
foreign one, the equivalent of the Canadian postal code, if any, must be entered.

"Registering Agent" means the person who is acting as agent for the lien claimant when
submitting the financing statement for registration. It does not include a clerk or other
employee of the lien claimant.

Registering Agent (if other than Secured Party / Lien Claimant) /Agent d'enregistrement (si autre que le créancier garanti / créancier privilégié)
Address / Adresse City, etc. / Ville, etc. Postal Code / Code postal Prov. / Prov.
Name / Nom 55
55 Page 56 57
50
Part III RSLA Registration
Sample Fact Situation and Completed Claim for Lien
Sam is a travelling salesman from St. Catharines. He drives to all parts of Ontario trying
to promote a line of aluminum hockey sticks. Business is very bad.

Sam was involved in a serious car accident during a blinding November snowstorm. His
car required extensive repairs amounting to $2000.00.

These repairs were done at 'J. B. Fix-It-Garage', owned and operated by J. B. Jones of
599 King Street West, Oshawa N2A 1B6.

Sam did not have the money to pay J. B. for the repairs, but they reached an agreement
with respect to payments. J. B. was thus willing to release the car to Sam, but wanted to
protect himself in the event of non-payment. Therefore, J. B. gathered the information
necessary to register a claim for lien.

J. B. did as follows:
(1) He copied the vehicle identification number from the car itself;
(2) He asked to see Sam's birth certificate which set out Sam's full name as Sam
James Parker, and his date of birth as January 11, 1935;

(3) He determined Sam's address to be 969 Oak Avenue, St. Catharines; postal
code L9L 7R4; and

(4) He requested that Sam sign an acknowledgement of indebtedness.
J. B. then registered the following claim for lien on November 29, 1992, and entered a
registration period of two years as he expected full payment to be made by that time. 56
56 Page 57 58
51
Part III RSLA Registration
Authorized
Signature
/

Financing Statement / Claim for Lien État de financement / Demande de privilège
Debtor
/
Débiteur

Sequence / Séquence
Ministry of Ministère de
Consumer and la Consommation
Commercial Relations et du Commerce

Account No. (if applicable) / No de compte (si pertinent) Registration Account Code / Code du compte d'enregistrement

Registration No. (for office use only) / No d'enregistrement (usage interne) YYYY / AAAA MM / MM DD / JJ Time / Heure Branch / Bureau File No / No de dossier
01
Caution
Filing /
Avertissement

Motor
Vehicle
Schedule
attached /
Liste des
véhicules
automobiles
annexée
Page /
Page

Total
Pages /
N bre de
pages
OF/

DE x x

PPSA-P (see reverse)
RSLA-R (voir au verso)
Registration Period (reverse)
Périoded'enregistrement( verso)

Individual Debtor /
Débiteur particulier 02

03

Date of Birth / Date de naissance D /J M /M YYYY / AAAA First Given Name / Premier prénom Surname / Nom de famille Initial / Initiale
Business Debtor /
Débiteur
commercial (Complete lines 02 &

04 or lines 03 & 04 /
Compléter les lignes
02 et 04 ou les lignes
03 et 04)

Line 03 cont'd / Ligne 03 (suite) Ontario Corporation No.
No matricule de la personne
morale en Ontario

Address / Adresse City, etc. / Ville, etc.

04
Postal Code / Code postal Prov. / Prov. Debtor

/
Débiteur

Individual Debtor /
Débiteur particulier 05

06

First Given Name / Premier prénom Surname / Nom de famille
Business Debtor /
Débiteur
commercial (Complete lines 05 &

07 or lines 06 & 07 /
Compléter les lignes
05 et 07 ou les lignes
06 et 07)

Line 06 cont'd / Ligne 06 (suite)

Address / Adresse City, etc. / Ville, etc.
07
Postal Code / Code postal Prov. / Prov.

Secured
Party
/
Lien

Claimant Créancier garanti
/
Créancier
privilégié

08 Secured Party / Lien Claimant / Créancier garanti / Créancier privilégié
Address / Adresse City, etc. / Ville, etc.
09
Postal Code / Code postal Prov. / Prov.

Agent
/
Agent

Registering Agent (if other than Secured Party / Lien Claimant) /Agent d'enregistrement (si autre que le créancier garanti / créancier privilégié)

Address / Adresse City, etc. / Ville, etc.
17
Postal Code / Code postal Prov. / Prov.

Name / Nom

Name and Signature of Secured Party / Lien Claimant OR Name of Secured Party / Lien Claimant AND Name and Signature of Agent of Secured Party / Lien Claimant. Nom et signature du créancier garanti / créancier privilégié OU Nom du créancier garanti / créancier privilégié ET nom et signature de l'agent du créancier garanti / créancier
privilégié.

16
15
14
13 General Collateral Description (PPSA optional) / Description générale du bien grevé (PPSA facultatif)

10

If PPSA, Section 1 must be completed.
If PPSA and only Consumer Goods, Sections 3 & 4 must also be completed.

If RSLA, Section 3 must be completed.

Section 1: Collateral Classification / Classification des biens grevés Section 2:
Type 'X' if motor
vehicle included /
Taper 'X' si véhicule
automobileinclus.

Section 3: Principal Amount Secured /
Amount of the Lien /
Montant principal garanti /
Montant du privilège

$ 2000 .00
Type 'X' if no
Fixed Date of
Maturity /
Taper 'X' si la
date d'échéance
n'est pas
déterminée.

OR/
OU x x

Consumer
Goods/
Biens de cons.

x x

Inventory /
Stock

x x x

Equipment /
Matériel
Accounts /
Comptes
Other /
Autre

Type 'X' in appropriate box or boxes.
Taper 'X' dans la (les) case( s) appropriée( s)

Collateral
/
Biens

Date of Birth / Date de naissance D /J M /M YYYY / AAAA Initial / Initiale
Date of Maturity / Date d'échéance D /J M /M YYYY / AAAA
12
11
Motor Vehicle Description /Description du véhicule automobile Year /
Année Make / Marque Vehicle Identification No. / No d'identification du véhicule Model/ Modèle

(Complete if different from line 04 /Compléter si différente de la ligne 04)

10551( 10/ 98) This form must not be reproduced for registration purposes.
Cette formule ne doit pas être reproduite aux fins d'enregistrement. Central Office Copy / Exemplaire du bureau central

Ontario Corporation No.
No matricule de la personne
morale en Ontario

969 OAK AVENUE 57
57 Page 58 59
52
Part III RSLA Registration
Change Statement – Form 2C
How to Complete a Form 2C
The Form 2C is used to record amendments and changes to the file. The parts of the form
which must be completed depend on the type of change being made.

Registration numbers are assigned in accordance with the rules on page 7.
If a registration is more than one page, see page 7 for instructions.

If a motor vehicle schedule is attached, place an "X" in the box marked "Motor Vehicle
Schedule Attached".

Five key pieces of information are required to be entered on every 2C:
1. Reference file number – Part 1; Line 21

The number entered in this space is extremely important as it identifies which registration
is being amended or changed.

The reference file number is the pre-printed 9 digit file number which is situated on the top
left corner of the Form 1C being referenced.

Account No. (if applicable) / No de compte (si pertinent) Registration Account Code / Code du compte d'enregistrement
Page /
Page

Total
Pages /
N bre de
pages

OF/
DE

Motor
Vehicle
Schedule
attached /
Liste des
véhicules
automobiles
annexée

x

Reference File Number (see reverse) / No de dossier de référence (voir au verso)

Sequence / Séquence
Registration No. (for office use only) / No d'enregistrement (usage interne) YYYY / AAAA MM / MM DD / JJ Time / Heure Branch / Bureau 58
58 Page 59 60
53
Part III RSLA Registration
2. Reference Debtor Name

The debtor name entered above is used to confirm the accuracy of the number entered
on line 21. For this reason, the debtor name entered must exactly match the debtor name
previously recorded, even if that name was previously incorrectly entered. Although there
may be more than one debtor of record, enter the name of only one debtor.

In all cases, the registrant has the choice of entering the debtor name as it appears on the
claim for lien or any change statement to which this change statement relates.

Use line 23 to enter the name of an individual debtor, and line 24 to enter the name of a
business debtor.

If the length of an individual's first given name (including punctuation marks and spaces)
is longer than 19 characters or if the length of an individual's surname (including punctuation
marks and spaces) is longer than 22 characters or both, enter only the first 19 or 22
characters or both, as the case may be, on line 23.

The letter for change code entered in this space tells the computer system what type of
change is being made. The change code legend is as follows:

A – Amendment
B – Renewal
C – Discharge
D – Assignment by Lien Claimant
F – Partial Discharge

Specific instructions on how to complete this form for each of the above changes follows.
4. Lien Claimant/ Registering Agent
Line 16

Debtor Name (as recorded). Complete line 23 or 24 but not both /
Nom du débiteur (tel qu'inscrit). Remplir la ligne 23 ou 24 mais pas les deux.
Individual Debtor / Transferor / Débiteur particulier / Cédant / First Given name / Premier prénom Surname / Nom de famille

Business
Debtor /
Transferor /
Débiteur
commercial/
Cédant

Line 24 cont'd / Ligne 24 (suite)

Initial /
Initiale

Registering Agent (if other than Secured Party / Lien Claimant) /Agent d'enregistrement (si autre que le créancier garanti / créancier privilégié)
Address / Adresse City, etc. / Ville, etc. Postal Code / Code postal Prov. / Prov.
Name / Nom

Enter Letter for Change (see reverse) /
Indiquer la lettre -code de modification (voir au verso) 59
59 Page 60 61
54
Part III RSLA Registration
Enter the name and address of one of the lien claimants or, if there is a registering agent,
enter either the name and address of the registering agent or of one of the lien claimants.
It is mandatory that the postal code be included in the address entered. If the address is a
foreign one, the equivalent of the Canadian postal code, if any, must be entered.

Registering Specific Types of Changes
Each type of change that can be registered using a 2C requires that, in addition to the five
key pieces of information outlined above, other information also be entered on the form.
Specific instructions for each type of change are outlined below.

Renewals
To register a renewal, enter the letter "B" in the letter for change box on line 22 of Part 1.
Enter in the following box on that line, the additional number of years the renewal should
add to the total registration period (i. e., the original registration period and any previous
renewals). Note that the effect of a renewal is to add to the registration period the number
of years indicated by the renewal. Thus, a claim for lien registered for 1 year and renewed
at any time prior to its expiry for 2 years, will be effective for a total of 3 years.

Registrations may only be renewed for a period of "1" or "2" years as the total registration
period of a claim for lien cannot exceed three years. If the original registration period was
three years, no renewal may be registered.

Should the registration period of a claim for lien expire or if the claim for lien is discharged,
the non-possessory lien to which the claim for lien relates is also discharged
and cannot be revived as an interest.

Discharges
To register a discharge, enter the letter "C" in the letter for change box on line 22 of Part 1.
To register a partial discharge, enter the letter "F" in the letter for change box on line 22 of
Part 1. It is mandatory that the released article or articles be described in Part 5. (DO
NOT use a form 3C to register a partial discharge).

If the article released in a partial discharge is a motor vehicle, it MUST be described on
lines 11 or 12. If there are more than two such motor vehicles, the remaining motor
vehicles should be described on a motor vehicle schedule. The registrant must not
proceed to the motor vehicle schedule without first describing two motor vehicles, one on
each of lines 11 and 12. For detailed instructions on how to properly describe a motor
vehicle on lines 11 and 12 and the motor vehicle schedule, refer to page 47.

If articles other than motor vehicles are released in a partial discharge, they MUST be
described on lines 13-15. The description must be sufficient to enable the articles to be
identified. 60
60 Page 61 62
55
Part III RSLA Registration
THE RSLA ENUMERATES CIRCUMSTANCES IN WHICH A LIEN CLAIMANT MUST
REGISTER A CHANGE STATEMENT TO RECORD A DISCHARGE.

The lien claimant MUST register this change statement within 30 days after:
(1) payment of the amount of the lien claimed is made to the lien claimant;
(2) payment of the amount of the lien claimed is made into court pursuant to Part IV
of the Act;

(3) the order of a court discharging a lien; and
(4) a claim for lien was registered, if there was a change of ownership of a motor
vehicle and the claim for lien was not registered before the change of ownership
occurred.

Also, the lien claimant must register a change statement to record a partial discharge
within 30 days after receiving a written request, from any person, for a change statement
recording a release, where the lien claimant has agreed to release some but not all of the
articles in a claim for lien.

Failure to comply with the discharge rules may result in a penalty to the lien claimant.
Assignments
Where a lien claimant assigns its non-possessory lien in all articles, enter the letter "D" in
the letter change box on line 22 of Part 1. Part 4 of the change statement MUST be
completed.

On line 29, enter the name of the assignor as recorded on the claim for lien or change
statement to which this change statement relates. Enter the name of the assignee on line
08, and the address of the assignee on line 09 – it is mandatory that the postal code be
included. If the address is a foreign one, the equivalent of the Canadian postal code, if
any, must be entered.

NOTE: If a lien claimant assigns its non-possessory lien prior to the registration of a
claim for lien:

a) a claim for lien may be registered showing the assignee as the lien
claimant; or

b) a claim for lien may be registered showing the assignor as the lien
claimant prior to registering a change statement recording the assignment.

Assignor (as recorded) /Cédant (tel qu'inscrit)
Secured Party / Lien Claimant / Assignee / Créancier garanti / Créancier privilégié / Ayant droit
City, etc. / Ville, etc. Postal Code / Code postal Prov. / Address / Adresse 61
61 Page 62 63
56
Part III RSLA Registration
Amendments
To correct an error or omission made in a registered claim for lien or change statement, or
to amend such statements in a way not elsewhere provided for, enter an "A" in the letter
for change box on line 22 of Part 1. (Note that to correct a reference file number that has
been erroneously entered on a form 2C, a special procedure is outlined later in this
Guide).

Part 2 of the financing change statement must be completed. On lines 26-28, in the area
entitled "Enter below Reasons for Amendment/ Other Change Description", enter:

(i) the reasons for amendment briefly and accurately, and
(ii) the number of the line, if any, to which the amendment relates.
Where necessary, enter any new or corrected information on the appropriate line.
NOTE: It is essential that the Reasons for Amendment set out with sufficient clarity
exactly what is being amended. Where the amendment relates to a claim for lien
to which other change statements are already referenced, the registrant must
clearly link the amendment being made to the correct member of the family. (See
"Linking of Registrations" on page 5 for an explanation of the concept of "Family").
It is recommended that this link be made by quoting the registration number
of the statement being amended in the Reasons for Amendment section of the
form 2C.

Types of Amendment
1. Substitution
A substitution occurs where there is already a line of information recorded in the System
and it is necessary to substitute a new line of information to correct or update the old
information.

For example, an error may have been made in transcribing the address of the lien
claimant onto a claim for lien or change statement. This may be indicated by entering the
following on lines 26-28:

"The incorrect address was entered on line 09 of registration number
19950703160700152621."

The registrant would then enter the correct address on line 09 of form 2C.
As well, a registrant may have entered the wrong amount when completing the "Amount
of the lien" section on line 10 of the claim for lien. This may be indicated by entering on
lines 26-28:

"On line 10 of Registration Number 19910606152000291146 the 'Amount of the
lien' was incorrectly set out."

The registrant would then complete line 10 of form 2C. Note that this requires the registrant
to complete every relevant section of line 10, including the section in which the error
was originally made. This is because all of line 10 is considered to be substituted and not
just one section of it.

NOTE: A substitution is not actually made in the System. It is made only notionally. The
new information is added to the file. 62
62 Page 63 64
57
Part III RSLA Registration
2. Addition
An addition will add a line of information to a registered claim for lien or change statement.

For example, the registrant may have entered on the claim for lien or change statement
the information relating to only one debtor when in fact there were two debtors. This may
be indicated by entering on lines 26-28:

"Information relating to a second individual debtor was omitted from lines 05 and
07 of Registration Number 19901221100900124116."

The registrant must then enter the necessary information – birth date, CORRECT NAME
and address of the debtor – on lines 02/ 05 and 04/ 07 of form 2C.

If there are no blank lines on a registered claim for lien or change statement on which a
new line of information can be inserted, the registrant must indicate in Part 1 that no
specific page of the claim for lien or change statement is to be amended.

For example, the registrant may have entered on the claim for lien or change statement
information relating to only two debtors when in fact there were three debtors. The
registrant would then enter on lines 26-28:

"The name and address of a business debtor were omitted from lines 03 and 04
of Registration Number 19961104131100330667."

The registrant must enter the CORRECT NAME and the address of the debtor on lines
03/ 06 and 04/ 07 of form 2C.

3. Deletion
A deletion will remove a line of information from a registered claim for lien or change
statement.

For example, the registrant may have described two motor vehicles on lines 11 and 12
when it was only necessary to describe one motor vehicle. This would be indicated by
entering on lines 26-28:

"The motor vehicle described on line 11 of Registration Number
20020916142700462601 is deleted as no lien is claimed on that vehicle."

NOTE: A deletion is not actually made in the System. It is made only notionally. The
direction to delete is recorded on the file.

4. Other Amendments
Where an amendment is of a kind other than those described above, simply enter the
reasons for amendment on lines 26-28, being sure to indicate the line number, if any, that
is being amended. Where appropriate, enter any new information on the correct line of
form 2C.

For example, a registrant may have entered a registration period of 3 years on a financing
statement when the proper period was 2 years. This may be indicated by entering on
lines 26-28:

"The registration period was incorrectly entered on line 01 of Registration
Number 19980609141800221256."

The registrant would then enter the appropriate registration period on line 22, in the box
entitled "Type in Total Correct Registration Period". This box is to be used only to reduce 63
63 Page 64 65
58
Part III RSLA Registration
the registration period. Increases in the registration period must be treated as renewals.
As a further example, a registrant may have incorrectly designated the statute with
respect to which the registration was made. In the last box of line 01 of this form, the
registrant must enter a "R". On lines 26-28, the registrant would indicate:

"This amendment is made as the statute with respect to which this registration
relates was incorrectly designated on line 01 of Registration Number
19910307140200022589.

An amendment to correct the statute under which a registration was made may require
that other amendments be recorded. For example, if amending to change a registration
under the PPSA to one under the RSLA and the "P" registration had a "10" entered in
Registration Period box, an amendment must also be made to reduce the total registration
period.

Re: Incorrect Reference File Number
If the incorrect reference file number has been entered on line 21 of a form 2C, it is
sufficient to correct the error by properly completing and registering another form 2C. The
registrant should be sure to enter the information as it should have been entered on the
original form 2C, taking special care to enter the correct reference file number or registration
number in the "Reference File Number" box. 64
64 Page 65 66
59
Part III RSLA Registration
Sample Fact Situation and Completed Change Statement/ Form 2C
(The beginning of this fact situation is at the end of the discussion on Claims for Lien/
Form 1C).

Shortly after reaching this agreement with Sam, J. B. Jones, owner and operator of "J. B.
Fix-It Garage" is in financial difficulties. J. B. reached an agreement with some of his
creditors. J. B. assigned to these creditors some of the accounts owing to him and any
non-possessory liens associated with these accounts.

Among the accounts and related non-possessory liens J. B. assigned to Supplies Plus
Inc., was that of Sam J. Parker.

Supplies Plus Inc., of 788 Maple Blvd in Oshawa, registered the following change
statement. 65
65 Page 66 67
60
Part III RSLA Registration
Part
6
/
Partie

Financing Change Statement / Change Statement État de modification du financement / État de modification
Sequence / Séquence

Ministry of Ministère de
Consumer and la Consommation
Commercial Relations et du Commerce

Account No. (if applicable) / No de compte (si pertinent) Registration Account Code / Code du compte d'enregistrement

Registration No. (for office use only) / No d'enregistrement (usage interne) YYYY / AAAA MM / MM DD / JJ Time / Heure Branch / Bureau
01
Caution
Filing /
Avertissement

Motor
Vehicle
Schedule
attached /
Liste des
véhicules
automobiles
annexée
Page /
Page

Total
Pages /
N bre de
pages
OF/

DE x x

PPSA-P
RSLA-R

Debtor Name (as recorded). Complete line 23 or 24 but not both /
Nom du débiteur (tel qu'inscrit). Remplir la ligne 23 ou 24 mais pas les deux. 23

24

Individual Debtor / Transferor / Débiteur particulier / Cédant / First Given name / Premier prénom Surname / Nom de famille
Business
Debtor /
Transferor /
Débiteur
commercial/
Cédant

Line 24 cont'd / Ligne 24 (suite)

21 Reference File Number (see reverse) / N
o de dossier de référence (voir au verso)

Part
1
/
Partie

Page No. of page to be amended/
No de la page à corriger
OR
OU

Amendments Only / Corrections seulement
22
Type 'X' if no specific page is to be amended /
Taper 'X' s'il n'y a pas de page précise à corriger x

Enter Letter for Change (see reverse) /
Indiquer la lettre -code de modification (voir au verso) Type in Total Correct Registration Period (for reduction only)/ Indiquer la période totale exacte d'enregistrement (en cas de
diminution seulement)

Amendments Only / Corrections seulement Enter Number of Additional Years if Renewal (see reverse) / Indiquer le nombre d'années
supplémentaires s'il s'agit d'un renouvellement (voir au verso)

25
Specify Other Change here /Préciser l'autre modification ici

Part
2
/
Partie

28
27
26
Enter below Reasons for Amendment / Other Change Description /Motifs de correction à écrire ci-dessous / Description de l'autre modification

Individual Debtor /
Transferee/
Débiteur particulier /
Cessionnaire

02/
05

03/
06

First Given Name / Premier prénom Surname / Nom de famille
Business Debtor /
Transferee /
Débiteur
commercial /
Cessionnaire

Line 03/ 06 cont'd / Ligne 03/ 06 (suite) Ontario Corporation No. / No matricule de la personne morale en Ontario

Address / Adresse City, etc. / Ville, etc. 04/
07
Postal Code / Code postal Prov. / Prov.

29
Assignor (as recorded) /Cédant (tel qu'inscrit)

Part
4
/
Partie

09
08
Secured Party / Lien Claimant / Assignee / Créancier garanti / Créancier privilégié / Ayant droit

Part
3
/
Partie

City, etc. / Ville, etc. Postal Code / Code postal Prov. / Prov. Address / Adresse
10 Section 1: Collateral Classification / Classification des biens grevés Section 2: Type 'X' if motor vehicle
included /
Taper 'X' si véhicule
automobile inclus.

Section 3: Principal Amount Secured /
Amount of the Lien / Montant principal garanti /
Montant du privilège

Section 4:
Date of Maturity / Date d'échéance D /J M /M YYYY / AAAA

Type 'X' if no Fixed Date of
Maturity/ Taper 'X' si la
date d'échéance n'est pas
déterminée.
OR/
OU x x

Consumer Goods/
Biens de cons.

x

Inventory /
Stock

x x x

Equipment /
Matériel
Accounts /
Comptes
Other /
Autre

Type 'X' in appropriate box or boxes.
Taper 'X' dans la (les) case( s) appropriée( s)

Part
5
/
Partie

12
11
Motor Vehicle Description /Description du véhicule automobile Year /
Année Make / Marque Vehicle Identification No. / No d'identification du véhicule Model/ Modèle

If more than two vehicles, continue on the Motor Vehicle Schedule (Form 4C). S'il y a plus de deux véhicules automobiles, utiliser la Liste des véhicules automobiles (formule 4C).
14
13
General Collateral Description / Description générale du bien grevé

Registering Agent / Secured Party / Lien Claimant /Agent d'enregistrement / Créancier garanti / Créancier privilégié
Address / Adresse City, etc. / Ville, etc.
17
Postal Code / Code postal Prov. / Prov.

Name / Nom
16

15

x

Name and Signature of Secured Party / Lien Claimant OR Name of Secured Party / Lien Claimant AND Name and Signature of Agent of Secured Party / Lien Claimant. Nom et signature du créancier garanti / créancier privilégié OU Nom du créancier garanti / créancier privilégié ET nom et signature de l'agent du créancier garanti / créancier privilégié.

Initial / Initiale
Initial / Initiale Date of Birth / Date de naissance D /J M /M YYYY / AAAA

$ .00

10552( 09/ 98) This form must not be reproduced for registration purposes. Cette formule ne doit pas être reproduite aux fins d'enregistrement. Central Office Copy / Exemplaire du bureau central
Authorized

Signature
Signature
autorisée

788 MAPLE BLVD OSHAWA ONT N70 1A1
SUPPLIES PLUS INC.
788 MAPLE BLVD OSHAWA ONT N70 1A1

000011097
SAM J PARKER
D

J. B. JONES
SUPPLIES PLUS INC. 66
66 Page 67
61
Part III RSLA Registration
Form 3C and Verification Statement
The form 3C is a change statement that can be used to register the renewal or complete
discharge of a claim for lien. Attached to every form 3C is a verification statement. A
discussion of the use of the form 3C and verification statement under the RSLA has been
combined with a discussion of its use under the PPSA which can be found on page 34 of
this Guide. Following the discussion, two sample fact situations and two completed form
3C's have been set out – one depicting a scenario under the PPSA and the other a
scenario under the RSLA.

Motor Vehicle Schedule – Form 4C
Instructions for the completion of this form under the RSLA have also been combined
with a discussion for its completion under the PPSA which can be found on page 40 of
this Guide. 67

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