GENERAL APPLICATION FOR REGISTRATION
Gouvernement du Québec
Ministère de la Justice
Register of personal and movable real rights
GENERAL APPLICATION FOR REGISTRATION
Form RG - Page 1
NATURE
Indicate one nature of right
1- Nature
D.R.C.E
2- DATE AFTER WHICH REGISTRATION CEASES TO BE EFFECTIVE
Year Month Day
Note: Registration may be cancelled on the day following this date without presentation of an application to that effect
PARTIES
1 3- Notice of address no.
4- Check one
a Holder
b Grantor
c Other (specify)
5- Surname
6- Given name
7- Date of birth (Year Month Day)
8- Name of organization or government agency
9- Address (no., street, municipality, province)
10- Postal code
Where applicable, check c certified statement of rights, also sent by c fax c e-mail
2 See instructions
11 Notice of address no
12 Check one
a Holder
b Grantor
c Other (specify)
13- Surname
14- Given name
15- Date of birth (Year Month Day)
16- Name of organization or government agency
17- Address (no., street, municipality, province)
18- Postal code
If necessary, use Annex AP or AD
Where applicable, check c certified statement of rights, also sent by c fax c e-mail
PROPERTY
ROAD VEHICLE See instructions
19- Class
20- Identification number
21- Year
22- Description
1
If necessary, use Annex AV
Where applicable, check c certified statement of rights, also sent by c fax c e-mail
PROPERTY
23- OTHER PROPERTY
If necessary, use Annex AG
PARTICULARS
24- Amount
REFERENCE TO REGISTRATION IN THE REGISTER F PERSONAL AND MOVALBE REAL RIGHTS
25- Entry number 1 2 If necessary, use annex A1
REFERENCE TO CONSTITUTING ACT
26- Form of act Check one
a Private writing
b Notarial act en minute
c Notarial act en brevet
d Judgment
e Other (specify)
27- Date (Year Month Day)
28- Place or judicial district
29- No. of minute or record
30- Full name of notary, name of court or full names of witnesses
31- OTHER PARTICULARS
If necessary, use Annex AG
SIGNATURE
The undersigned hereby requests that this notice be registered.
32- Name of person signing
33- X
Signature
Form no.