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Flag Canada Revenue
Agence du revenu
du Canada
Calculation of tax on agreements to acquire shares
(section 207.1(5) of the Income Tax Act)
Protected B when completed
Complete this return for 2002 and later tax years for a taxpayer who agreed to acquire shares of the capital stock of a corporation from someone other than the corporation, at a price different from the fair market value of the shares when
they were acquired. The date the agreement to acquire the shares was entered into determines which columns to complete in Area 2 below.
For each month, attach a description of the shares that were subject to an agreement at any time in the month (other than an option listed on a designated stock exchange). State how many shares were subject to such an agreement.
Tax year refers to the tax year of the person required to file this return.
Area 1 – Identification
   Name  Telephone number
Year Month Day  Address  City Province/Territory or State Country Postal or ZIP code  Account number
   Name of Plan/Fund/Amateur Athlete for the associated T3ATH-IND, T3D, T3GR, T3P, T3PRP or T3S income tax return  Trust account number
Area 2 – Calculating the amounts subject to tax
  Complete columns B to H based on the date the agreement was entered into.            
  A   B C For agreements after 1992 but before April 26, 1995 For agreements after April 25, 1995 I J K L M N
Month For agreements
July 14, 1990,
enter the maximum
amount required to
pay for the shares.
For agreements
after July 13, 1990,
but before 1993,
enter the fair
market value of the
shares at the time
of the agreement.


Enter the fair
market value of the
shares at the time
of the agreement.


Enter the total
amount of
dividends paid on
the shares.


Enter the total
amount of
received from
the shares.


Enter the total
amount of
dividends paid on
the shares.


Enter the total
amount of
received from
the shares.
Enter 1%
of column B.
Enter 1%
of column C.
Enter 1%
of column D.
Column E
column F
Enter the
amount from
column K or
column L,
whichever is
Column G
column H
  Total       Total    
Area 3 – Calculating tax payable Area 4 – Certification
 Send the completed return, along with any payment owing, to the  
 tax centre or tax services office for the area in which the books and Total of all amounts from columns I, J, M, and N   2411     I,   , certify that the information given on this return and in
 records are maintained for the person required to file this return. Minus payments on account       any attached documents is correct and complete.
 Send it no later than 90 days after the end of the tax year. Attach a Balance owing or refund   =                
 cheque or money order payable to the Receiver General. Do not mail   Date   Authorized person's signature   Position or title  
 cash. Refund: Complete Form T3-DD, Direct deposit request for T3. We neither charge nor refund a difference of $2 or less.  
T2000 E (23) (Ce formulaire est disponible en français.) Page 1 of 2 Canada Logo

Protected B when completed
How to file this return
    By internet
You have the option to file this return through EFILE.
For more information about this filing method, go to
By mail
Sudbury Tax Centre

T3 Trust Returns Program
Canada Revenue Agency
1050 Notre Dame Avenue
Sudbury ON P3A 6C2
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territorial, aboriginal or foreign government institutions to the extent authorized by law. Failure to provide this information may result in paying interest or penalties, or in other actions. Under the Privacy Act, individuals have a right of protection, access to and correction of their personal
information, or to file a complaint with the Privacy Commissioner of Canada regarding the handling of their personal information. Refer to Personal Information Bank CRA PPU 015 on Information about Programs and Information Holdings at canada.ca/cra-information-about-programs.
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