Application Form For Hardship Payments Page 2
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ONTARIO
SUPERIOR COURT OF JUSTICE
(COMMERCIAL LIST)
IN THE MATTER OF THE COMPANIES’ CREDITORS ARRANGEMENT ACT, R.S.C. 1985, c. C-36, AS
AMENDED
AND IN THE MATTER OF A PLAN OF COMPROMISE OR ARRANGEMENT OF SEARS CANADA INC.,
CORBEIL ÉLECTRIQUE INC., S.L.H. TRANSPORT INC., THE CUT INC., SEARS CONTACT
SERVICES INC., INITIUM LOGISTICS SERVICES INC., INITIUM COMMERCE LABS INC., INITIUM
TRADING AND SOURCING CORP., SEARS FLOOR COVERING CENTRES INC., 173470 CANADA
INC., 2497089 ONTARIO INC., 6988741 CANADA INC., 10011711 CANADA INC., 1592580 ONTARIO
LIMITED, 955041 ALBERTA LTD., 4201531 CANADA INC., 168886 CANADA INC., AND 3339611
CANADA INC.
APPLICATION FORM FOR HARDSHIP PAYMENTS
APPLICANT INFORMATION
1. Name:
_______________________________________________________________________
2. Address:
_______________________________________________________________________
_______________________________________________________________________
3. Telephone Number(s):
__________________________________________________________
4. Email Address: ____________________________________________________________________
5. Social Insurance Number:
__________________________________________________________
6. Sears Canada Employee Number: ____________________________________________________
SEARS CANADA EMPLOYMENT INFORMATION
1. Date Employment with Sears Canada Began: ___________________________________________
2. Date Employment with Sears Canada Terminated:
______________________________________
3. Province or Region employed in: _____________________________________________________
4. Store or Head Office: _____________________ Store No.: _______________________________
5. Position: ________________________________________________________________________
6. Gross Monthly Income: $ ___________________________________________________________
7. If any, amount of severance received: _________________________________________________
8. If eligible, date of eligibility to receive Sears Canada pension: _______________________________
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