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Flag Canada Revenue
Agence du revenu
du Canada
Protected B when completed
Use this form to request an adjustment (a reassessment) to an individual income tax return.
See the back of this form for information on how to complete it.
Send the completed form to the Individual Client Services and Benefits Division of your tax centre as indicated on your notice of assessment. You can find the
address on the back of this form.
A   Identification  For filing DO NOT USE THIS AREA  
 Social insurance number  Adjustment request for the  
    2023   tax year  
 (complete a separate form for each year)  
 Full name: (please print your surname first) Space reserved for administrative purposes
 Address: (please print)  
  same as the return  
  Or:   Acknowledgement Stall code
   CRA User ID  Date  Rev.  Date
B   Authorization – Complete this area if you are authorizing a person or firm to make this request on your behalf.  
 Name and address of authorized person or firm preparing this request:
(please print)
 Letter of authorization (or Form T1013, Authorizing or Cancelling a
) for the year under review (must indicate level 2—see
was submitted previously
  is attached
C   Adjustment details  
  List the details of your requested change below. If you have received an assessment or reassessment notice with an amount that is different from the amount
on the return you submitted, show the amount stated on the notice as the previous amount. You must provide supporting documentation for the entire revised
amount. This may include receipts, schedules, or other relevant documents. Your request may be delayed if you do not provide all required information
with this form
. See the back of this form for information about required documentation and for examples of how to complete this area.
Line number from
return or schedule
Name of line from return or schedule Previous amount +
Amount of change Revised amount
  Other details or explanations (attach an extra sheet if required)
D   Certification  
 I certify that the information given on this form and any documents attached is, to the best of my knowledge, correct and complete.
  Date Taxpayer signature Representative signature Telephone  
T1-ADJ E (23) (Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca ou au 1-800-959-3376.)