AP-1
FONDS D’ASSURANCE-PRÊTS AGRICOLES ET FORESTIERS
CLAIM FOR REPAYMENT OF LOSSES UNDER
THE ACT RESPECTING FARM-LOAN INSURANC AND FORESTRY-LOAN INSURANCE
Permanent No. (FADQ)
Identification No. (lender)
Loan No. (FADQ)
Identification of the lender Identification of the borrower
Fonds d’assurance-prêts agricoles et forestiers
Gouvernement du Québec
In accordance with the Act respecting farm-loan insurance and forestry-loan insurance (chapter A-29.1), the undersigned hereby claims the amount of the loss sustained by the above-mentioned lender and resulting from a loan made under the Act
(name of Act under which the loan was granted)
and obtained by the above-mentioned borrower and, where applicable, the payment of which has been assumed by the above-mentioned debtor.
This amount, calculated in accordance with section 4 of the Act respecting farm-loan insurance and forestry-loan insurance and sections 3 and 5 of the Regulation respecting the application of that Act, includes:
The amount of unpaid principal and interest on the date of the claim, on the loan and on the expenses covered in section 5 of the Regulation related to the loan and incurred by the lender
$
THE UNDERSIGNED HEREBY DECLARES that the interest calculations made exactly correspond to the charges made on the borrower, that all the charges have been recorded therein and that he has furnished all vouchers required for the submission of this claim.
In the opinion of the undersigned officer of the lender, the balance of the loan cannot be recovered from the borrower (or the debtor, if payment of the loan has been assumed by third party.)
Date Signature of an officer of the lender
Address to :
La Financière agricole du Québec
Direction du recouvrement
1400, boulevard de la Rive-Sud
Saint-Romuald (Québec) G6W 8K7