Information

Identification:

First name
Surname
Birthdate

Office Telephone
Home Telephone
Fax
Email

Social security number:

On december 31 1997, you were:

Single
Married
Divorced
Separated
Widow

Impairment (Disability amount claim)

Oui Non

Documents included in your tax return:

T3-T4-T5 (employment, pensions, interest, uic...)
Dividends
RRSP
Programme RAP
Municipal & school taxes
Relevé 4
Alimony or separation allowance income or deduction
Tuition fees
Child care expenses
Capital gains/loss

Spouse's tax return ... ?

Oui Non

Spouse Information :

First name
Surname

Social security number :

Birthdate

Impairment (Disability amount claim)

Oui Non

If spouse's tax return is filed separately, please indicate net income :

Children (names & birthdates)

Other dependants (ex.: parents) (names, birthdates, impairment)