Farm Debt Mediation Service: Notice of Intent by Secured Creditor

You can use either the Web version below or the PDF (64 KB).

Please complete, print and send the form by mail or fax to your region or closest region.

Locations

Regional Office responsible for Alberta, British Columbia, Manitoba, Northwest Territories, Nunavut, Saskatchewan and Yukon

Agriculture and Agri-Food Canada
Farm Debt Mediation Service
301-2010 12th Avenue
Regina SK S4P 0M3

Toll free number: 1-866-452-5556
Fax: 1-833-902-8388

Email: aafc.fdms-smmea.aac@agr.gc.ca

Regional Office responsible for New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Prince Edward Island, and Quebec

Agriculture and Agri-Food Canada
Farm Debt Mediation Service
2560 Hochelaga Boulevard
Quebec QC G1V 2J3

Toll free number: 1-866-452-5556
Fax: 1-833-902-8388

Email: aafc.fdms-smmea.aac@agr.gc.ca

Protected B

As required under Section 21 of the Farm Debt Mediation Act, you are hereby notified that it is the intent of:

Name of creditor

To enforce a remedy against the property of; or commence a proceeding, action, execution or other proceeding, judicial or extra-judicial, for the recovery of a debt, the realization of the security or the taking of the property of:

Full name of farmer or business name

Farmer's address

Unit/Suite/Apartment

Street number

Number suffix

Street name

Street type

Street direction

PO Box or Route Number

Municipality (City, Town, etc.)

Province

Postal code

The security being (type(s) of security):	On (asset(s)):
1.	1.
2.	2.
3.	3.
4.	4.
5.	5.

Dated this day of , at

Name of secured creditor or authorized representative

Signature of secured creditor or authorized representative (by hand only)

Creditor's phone number and extension

Email address of secured creditor or authorized representative

Creditor’s fax number

You are hereby notified of your right to make application under Section 5 of the Farm Debt Mediation Act for a review of your financial affairs, mediation with your creditors, and to obtain a stay of proceedings against this action. Provided you are:

currently engaged in farming for commercial purposes; and
insolvent, meaning that you are:
- unable to meet your obligations as they generally become due; or
- have ceased paying your current obligations in the ordinary course of business as they generally become due; or
- the aggregate of your property is not, at fair valuation, sufficient, or if disposed of at a fairly conducted sale under legal process would not be sufficient, to enable payment of all your obligations, due and accruing due.

Please note: A secured creditor must wait 15 business days after this notice has been deemed served before beginning action to realize on their security. You may apply for mediation and a stay of proceedings at any time, before, during, or after the 15 business day period, by making an application to the Farm Debt Mediation Service.

The Farm Debt Mediation Service provides qualified farm financial counselors to conduct a financial review and to prepare a recovery plan for your mediation meeting. Qualified mediators are provided to help you and your creditors reach a mutually satisfactory arrangement.

Contact the service to get application forms and more information about the service.

Eastern Canada Office

Toll free number: 1-866-452-5556
Email: aafc.fdms-smmea.aac@agr.gc.ca
Fax: 1-833-902-8388

Western Canada Office

Toll free number: 1-866-452-5556
Email: aafc.fdms-smmea.aac@agr.gc.ca
Fax: 1-833-902-8388

The information you provide on this document is collected by Agriculture and Agri-Food Canada under the authority of the Farm Debt Mediation Act for the purpose of facilitating financial arrangements between farmers and their creditors. Personal information will be protected under the provisions of the Privacy Act and will be stored in Personal Information Bank AAFC-PPU-227. Information may be accessible or protected as required under the provisions of the Access to Information Act.