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Flag Canada Revenue
Agence du revenu
du Canada
Protected B when completed
Statement A  
AgriStability and AgriInvest Programs Information  
and Statement of Farming Activities for Individuals
Participant identification   Contact person information
First name   If you would like someone else to provide more information on your behalf,
    provide all details in this section. This applies to the AgriInvest program only.
Last name   For AgriStability, please contact your AgriStability Administration.
    If you have a contact person tick here:
    First name
Participant identification number (PIN)  
      Note: You must enter your SIN.   Last name
    You must also enter your PIN  
  Social insurance number (SIN)   and BN unless you have not   Business name
    been assigned one.  
  Business number (BN)   Address
Telephone number Cellphone number   City/Town Prov/Terr Postal code
Fax number   Telephone number Cellphone number
Email address   Fax number
  Note: If you have a contact person, you must complete this section each time
Farming information   you submit this form. The AgriInvest Administration will replace any previous
    contact person you may have designated with the name you provide here.
Province/Territory of main farmstead     By providing a contact person's name, you are authorizing both the
    AgriStability and AgriInvest Administrations to receive information from and to
Number of years you have farmed     disclose information to the contact person, and to make changes to your
    applications as directed by the contact person.
Was 2023 your final year of farming? Yes No   Federal public office holder or employee of AAFC
    Are you, or anyone who participated in the
Industry code     preparation of this form on your behalf, a current or
Have you completed a production cycle on at
least one of the commodities you produced?
Yes No   former federal public office holder or employee of
Agriculture and Agri-Food Canada?
Yes No
If you ticked "No" to the above question, were  
you unable to complete a production cycle due Yes No  
to disaster circumstances?  
T1163 E (23) (Ce formulaire est disponible en français.) Page 1 of 5 Canada Logo