Application Under Part I of the Garnishment, Attachment and Pension Diversion Act and Section 3 of the Garnishment and Attachment Regulations

A copy of the order against the debtor and a garnishee summons must be served with this application at the place specified in the Garnishment and Attachment Regulations.

Part 1 - Debtor's Information - Please provide the following information concerning the debtor.

Check one of the items from items 5 to 16

18. Telephone No. (if known)

19. The money payable to the debtor is payable as

Part 2 - Summons Information - Please provide the following information concerning the amount due.
23. Address of issuer

Check item 24 or 25, as applicable, and fill in

    • Periodic support payment due:
Part 3 - Declaration

Correspondence requested in:

I declare that the information given in this application is true and is provided for the purpose of applying for garnishment of federal monies in accordance with Part I of the Garnishment, Attachment and Pension Diversion Act.

Privacy Act Notice Statement

The personal information you provide on this form is collected for the purpose of garnishment under Part I of the Garnishment, Attachment and Pension Diversion Act.  This information will be used, disclosed and retained by each entity in accordance with applicable federal privacy legislation, information management practices and policies. Information protected by an entity subject to the Privacy Act is stored in Personal Information Bank Garnishment Registry JUS PPU 150.

(2020/12)

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