Claim of Lien

Form 5


Builders Lien Act

(Sections 15, 16, 18)

Claim of Lien

I, _______________ [claimant] of [address] ______________________________ British Columbia [if claim is made by an agent, insert here "agent of the lien claimant"] state that:

1 _______________ [claimant] of [address] ______________________________ British Columbia claims a lien against the following land:

[Insert legal description here or, if a lien is claimed under section 16 against more than one parcel of land, insert the legal description of all parcels of land against which the lien is claimed. If insufficient space is provided, attach a schedule. If a lien is to be filed in the gold commissioner's office, insert the name of the mineral title, its tenure number and the name of the mining division.]

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 _______________ [month, day, year].

5 My address for service is
Signed: _____________________
[Month, day, year] _______________

NOTE: Section 45 of the Builders Lien Act provides as follows:

45 (1) A person who knowingly files or causes an agent to file a claim or 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 $2000 or the amount by which the stated claim exceeds the actual claim.

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