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Notice of Intent by Secured Creditor

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


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
Telephone: 306-780-5544
TTY: 613-773-2600
Fax: 306-780-7353

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
Jules-Dallaire Complexe
2828 Laurier Blvd - Room 640
Quebec QC G1V 0B9

Toll Free Number: 1-866-452-5556
Telephone (Atlantic and Quebec): 418-649-8142
Telephone (Ontario): 613-773-0878
TTY: 613-773-2600
Fax (Atlantic and Ontario): 506-452-4975
Fax (Quebec): 418-648-2439

Protected B

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

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:

Farmer's address

The security being (type(s) of security): On (asset(s)):

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

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:

  1. currently engaged in farming for commercial purposes; and
  2. 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.

Application forms and more information about the service can be obtained from:
Farm Debt Mediation Service

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.

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