Canadian Agricultural Loans Act program: Report of Claim for Loss (Schedule 4)

You can use either the Web version or the PDF(580 KB). Please complete, print and send the form by mail or fax.

Please send to:

Canadian Agricultural Loans Act (CALA)
Financial Guarantee Programs Division
Agriculture and Agri-Food Canada (AAFC)
1341 Baseline Road, Tower 7, 7th Floor
Ottawa, Ontario K1A 0C5
Fax: 613-773-2020

Protected "B" once completed

The information you provide on this document is collected under the authority of the Canadian Agricultural Loans Act for the purpose of obtaining a loan. Personal information will be stored in Personal Information Bank AAFC PPU 165, and will be protected under the provisions of the Privacy Act. The Collection Registration Number is AGR/POL-465-02960.

Loan Registration Number (AAFC)

The following documents are attached:

   Application form and financial statements at time loan granted and most recent (Cash Flow Analysis and Plan of Operation)
   Statement of loan account
   Bill(s) of sale, Purchase agreements, Appraisals and supporting receipts/paid cheques evidencing that the loan proceeds were used from the stated purpose
   Copy of Promissory Note
   Invoice(s) or receipt(s) to support payment of legal, seizure and sales costs
   Approved requests for revision of terms (Schedule 2)
   Copy of legal documents: Statement of Claim, Judgment and Writ of Execution
   Statement of unrealized security with current market values and any other documentation
   Registration Certificate and copy of Schedule 1

Claim Items

1. Unpaid principal
$ (1)

2. Interest
$ (2)

Interest paid up to (yyyy-mm-dd)

Date of first defaulted payment (yyyy-mm-dd)

3. Uncollected taxed costs for or incidental to legal proceedings
$ (3)

4. Legal fees, legal cost and legal disbursements, whether taxable or not, actually incurred by the lender whether with or without litigation
$ (4)

5. Other disbursements actually incurred by the lender in collecting
$ (5)

6. Amount of claim (sum 1 through 5)
$ (1+2+3+4+5)

7. Minister's liability (95% of claim)
$ (Amount of Claim (6) * 0.95)

Date submitted (yyyy-mm-dd)

Signature on behalf of Lender:

Instructions

A Schedule 4 must be completed whenever a Claim for Loss is to be made under the CALA guarantee.
A Claim for Loss must be submitted within 18 months from the date of default. CALA defines the date of default as the day after the day on which a payment under a loan was scheduled to be made, but was not made.
Documents listed on the Claim for Loss form must accompany the Schedule 4 unless previously submitted with the Schedule 3.
The lender should take care to provide the loan registration number (Agriculture and Agri-Food Canada No.) when submitting a Claim for Loss.
Any cost claimed for Legal Services will be forwarded to Justice Canada by CALA for approval and taxing prior to payment.
It is the lender's responsibility to inform itself of the non-refundable nature of taxes (HST, GST, PST) or custom duties that apply to assets financed.

For additional information please refer to Section C of the Lender's Guidelines or Section 20 of the CALA Regulations.