Name Estate Number Date of Insolvency Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20152016201720182019 SIN E-Mail * Home Cell Phone Date of Birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20152016201720182019 Marital Status (as of Dec. 31 of 2014) Address Rent or Property Tax paid $ # of months Landlord Spouse's Name Spouse's SIN Spouse's DOB Spouse's Net Income (found on Line 236 of tax return) Are you claiming Physical Activity Amounts for your child/children? Yes, please complete below No Name of DependentDate of BirthPhysical Activity Amount (Attach Receipt(s)) Name of Dependent Date of Birth Physical Activity Amount (Attach Receipt(s)) Name of Dependent Date of Birth Physical Activity Amount (Attach Receipt(s)) Name of Dependent Date of Birth Physical Activity Amount (Attach Receipt(s)) Name of Dependent Date of Birth Physical Activity Amount (Attach Receipt(s)) Add a row List ALL sources of income and attach tax slip(s); if you had no income from any source in 2013, check this box Yes Name of Employer or Source of IncomePeriod during 2014 for with you received income from this source - FROMPeriod during 2014 for with you received income from this source - TO Name of Employer or Source of Income Period during 2014 for with you received income from this source - FROM Period during 2014 for with you received income from this source - TO Name of Employer or Source of Income Period during 2014 for with you received income from this source - FROM Period during 2014 for with you received income from this source - TO Name of Employer or Source of Income Period during 2014 for with you received income from this source - FROM Period during 2014 for with you received income from this source - TO Name of Employer or Source of Income Period during 2014 for with you received income from this source - FROM Period during 2014 for with you received income from this source - TO Name of Employer or Source of Income Period during 2014 for with you received income from this source - FROM Period during 2014 for with you received income from this source - TO Add a row Did you cash out RRSPs in 2014? Yes No Are you applying for the Disability Benefit? Yes No Are you applying for the Guaranteed Income Supplement? Yes No Upload Tax Form Upload Upload Tax Form Upload Upload Tax Form Upload Upload Tax Form Upload Upload Tax Form Upload IMPORTANT IF YOU DO NOT SUBMIT YOUR TAX INFORMATION TO US BY MARCH 31, 2015, YOU MAY RISK OPPOSITION TO YOUR DISCHARGE, ANNULMENT OF YOUR DISCHARGE, AND POSSIBLE DELAY OF CHILD TAX BENEFITS AND OTHER GOVERNMENT PAYMENTS. PLEASE CALL US IF YOU ARE HAVING DIFFICULTIES. Submit
