Gouvernement du Québec
Ministère de la Justice
Register of personal and movable real rights
ANNEX: NAME
Form AD
Enter the form number of the first page of the application
Number the annex in the order in which it appears on the application form.
3- NAME (ASSUMED NAME)
1- Check one
a Holder
b Grantor
c Other (specify)
2- Name
3- Address (no., street, municipality, province)
4- Postal code
Where applicable, check c certified statement of rights, also sent by c fax c e-mail
NAMES OF PERSONS ACTING UNDER ABOVE NAME (ASSUMED NAME)
4- See instructions
5- Notice of address number
6- Surname
7- Given name
8- Date of birth (Year Month Day)
9- Name of organization or government agency
10- Address (no., street, municipality, province)
11- Postal code
Where applicable, check c certified statement of rights, also sent by c fax c e-mail
5- See instructions
5- Notice of address number
6- Surname
7- Given name
8- Date of birth (Year Month Day)
9- Name of organization or government agency
10- Address (no., street, municipality, province)
11- Postal code
Where applicable, check c certified statement of rights, also sent by c fax c e-mail
6- See instructions
5- Notice of address number
6- Surname
7- Given name
8- Date of birth (Year Month Day)
9- Name of organization or government agency
10- Address (no., street, municipality, province)
11- Postal code
Where applicable, check c certified statement of rights, also sent by c fax c e-mail
7- See instructions
5- Notice of address number
6- Surname
7- Given name
8- Date of birth (Year Month Day)
9- Name of organization or government agency
10- Address (no., street, municipality, province)
11- Postal code
Where applicable, check c certified statement of rights, also sent by c fax c e-mail
8- See instructions
5- Notice of address number
6- Surname
7- Given name
8- Date of birth (Year Month Day)
9- Name of organization or government agency
10- Address (no., street, municipality, province)
11- Postal code
Where applicable, check c certified statement of rights, also sent by c fax c e-mail
Form no.