Claim Of Lien. Province Of British Columbia. Form 5
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1FORM_CBL_V19
BUILDERS LIEN ACT
FORM 5 (S ections 15, 16, 18)
1
1
CLAIM OF LIEN Province of British Columbia
LOCK
PAGE
OF
PAGES
Your electronic signature is a representation that you are a subscriber as
defined by the Land T itle Act, RSBC 1996 c.250, and that you have applied
your electronic signature in accordance with Section 168.3, and a true copy, or
a copy of that true copy, is in your possession.
APPLICATION: (Name, address, phone number of applicant, applicant’s solicitor or agent)
Import Profile
I,
of
,
agent of the lien claimant
state that:
1.
of
claims a lien against the following land:
[PID]
[legal description]
No PID NMBR
STC?
YES
Use 30 Parcel Schedule
Use 3 Parcel Schedule
Pick up STC
2.
A general description of the work done or material supplied, or to be done or supplied, or both, is as follows:
3.
The person who engaged the lien claimant, or to whom the lien claimant supplied material, and who is or will become indebted to the lien claimant
is:
4.
The sum of $
is or will become due and owing to
on
.
5.
The lien claimant's address for service is:
Signed: ___________________________
Date:
Add Schedule
Note: Section 45 of the Builders Lien Act provides as follows:
45 (1) A person who knowingly files or causes an agent to file claim of lien containing a false statement commits an offence.
(2) A person who commits an offence under subsection (1) is liable to a fine not exceeding the greater of $2,000 and the amount
by which the stated claim exceeds the actual claim.
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