APPLICATION FOR REGISTRATION OF AN ADDRESS
Gouvernement du Québec
Ministère de la Justice
Register of personal and movable real rights
APPLICATION FOR REGISTRATION OF AN ADDRESS
FORM RA - Page 1
NATURE
1- Check one and fill in the corresponding section
a- Registration of address for notification purposes
b Change of name or of address for notification
c Registration of notice of address number following registration of the right in question
d Correction
BENEFICIARY
See instructions
2- Surname
3- Given name
4- Date of birth (Year Month Day)
5- Name of organization or government agency
6- Address (no., street, municipality, province)
7- Postal Code
OBJECT OF REGISTRATION
A- REGISTRATION OF ADDRESS FOR NOTIVICATION POURPOSES
Fill in the References section
ADDRESS FOR NOTIFICATION
8- Address
9- Postal code
10- Fax number
B- CHANGE OF NAME OR OF ADDRESS FOR NOTIFICATION
11- Notice or address number
Change of name Fill in spaces 12, 13, 14, 16, 17, 18 or 15, 19
Former name
12- Surname
13- Given name
14- Date of birth (Year Month Day)
15- Name of organization or government agency
New name
16- Surname
17- Given name
18- Date of birth (Year Month Day)
19- Name of organization or government agency
Change of address for notification Fill in spaces 20 to 25
Previous address
20- Address
21- Postal code
22- Fax number
New address
20- Address
21- Postal code
22- Fax number
C- REGISTRATION OF NOTICE OF ADDRESS NUMBER FOLLOWING REGISTRATION OF THE RIGHT IN QUESTION
26- Notice of address number Fill in the References section
D- CORRECTION Fill in a or b
a- Of a registration number
27- Incorrect registration number
28- Correct registration number
29- Notice of address number in question
b- Of a notice of address number Fill in the References section
30- Incorrect notice of address number
31- Correct notice of address number
REFERENCES
32- REGISTRATION NUMBER OR FORM NUMBER
1
2
3
4
5
6
7
8
SIGNATURE
The undersigned hereby requests that this notice be registered.
33- Name of person signing
34- X
Signature
Form no.