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Flag Canada Revenue
Agency		 Agence du revenu
du Canada		 Protected B when completed
  13
Retirement Compensation Arrangement (RCA) Part XI.3 Tax Return
 
RCA trust's tax year   Tax Centre TSO code
  WINNIPEG 21
Is this the first T3-RCA tax return filed? Yes 
1
 No 
2
 Do not use this area.
If yes, send us a copy of the trust agreement if it was not already submitted.  
Is this the final return of the RCA trust? Yes 
1
 No 
2
  
If yes, send us the complete details for closure.  
Language of correspondence English  French  
For instructions on how to fill out this return, go to canada.ca/retirement-compensation-arrangements.  
Identification and other information  
RCA trust's name (maximum 60 characters) Trust account number
T
 
Custodian information (Choose only one of the two following options and fill in the required information about the custodian)
Option 1 – The custodian is an Individual (For example, a trustee, a filer, a custodian, an executor, a liquidator, or an administrator)  
 First name of custodian  Last name of custodian  Telephone number
 
 Address City Province/Territory or State Country  Postal or ZIP code
 
Option 2 – The custodian is a Non-individual (For example, a corporation, a partnership, or a trust company)  
 Name of non-individual custodian
 
 First name of contact person  Last name of contact person  Telephone number
 
 Address City Province/Territory or State Country  Postal or ZIP code
 
 
If the mailing address of the custodian is different from the address above, fill in this section.  
 Care of (C/O)  Telephone number
 
 Address City Province/Territory or State Country  Postal or ZIP code
 
 
Step 1 – Supporting documents
1. Were any changes made to the terms of the arrangement during the year? Yes
1
 No 
2
  If yes, send us the documents to support the original or amended arrangement, as applicable.
2. Were any transfers of beneficial interests in the arrangement reported to you? Yes
1
 No 
2
  If yes, provide the following:  
   Name of person who disposed of an interest Address Social insurance number or business number
   
   Name of person who bought an interest Address Social insurance number or business number
   
3. Were any amounts returned to an employer or contributor, or distributed as benefits during the year? Yes 
1
 No 
2
  If yes, send us the copies of T4A-RCA Summary or the copies of the NR4 Summary.
  Payroll account number Non-resident remittance account number   
 
4. How many members of the RCA did the RCA trust receive contributions for?  
5. Was any property other than cash distributed during the year? Yes 
1
 No 
2
  If yes, send us the complete details
6. Has the RCA trust acquired or disposed of property during the year at other than fair market value? Yes 
1
 No 
2
  If yes, send us the complete details
 
T3-RCA E (23) (Ce formulaire est disponible en français.) Page 1 of 5 Canada Logo
     

Protected B when completed
Step 1 – Supporting documentation (continue)
 
7. Did any member of the RCA or a person related to a member use or lease any property of the RCA? Yes 
1
 No 
2
  If yes, send us the complete details
8. Did the RCA trust loan money out of the RCA? If yes, give us the date it made the loan(s). If you did not Year Month Day  
  submit a loan agreement previously, send us a copy.  
9. Were any amounts transferred to, or received from, another RCA during the year? Custodian trust account number
  If yes, send us a copy of the letter of agreement and tell us the other RCA's custodian trust account number. T
10. If the employer submitted the RCA for registration under the Income Tax Act as a registered pension plan
(RPP) and we refused to register the arrangement as an RPP, send us a copy of the final determination
Year Month Day		  
  letter and indicate the final determination date in the box on the right.  
11. Is the RCA one of the following: Yes 
1
 No 
2
    • a deemed trust under subsection 207.6(1)
    • a trust which is not resident in Canada
    • a trust which meets one of the exceptions listed under paragraphs 150(1.2)(a) or (b)?
  If yes, the trust is not required to complete a T3 Schedule 15, Beneficial Ownership information of a trust.
 
Step 2 – Details of contributions received during the year
 
 
 Part 1 – Amounts received from employer
 (Give details for each contribution received from an employer during the year. Send us a separate list if required.)
 
Date contribution received   Amount received  
  Year     Month   Day  
         
         
         
         
         
         
         
         
         
         
         
         
Subtotal   
   x 2   
Total contributions from employer  6021   = •1
     
The total in box 18 on all the slips has to equal the amount on line 1. Transfer this amount to line 2 of Step 3
Send us a copy 2 of the T737-RCA information slips		    
 
 Part 2 – Amounts received directly from an RCA member (Send us a separate list if required.)
 
Date contribution received Name of member who made the contribution Amount received  
  Year     Month   Day  
         
         
         
         
         
         
         
         
         
         
         
         
Total contributions from members (Add lines 1 to 12 above)  6031   •2
     
Transfer this amount to line 3 of Step 3     
 
 
T3-RCA E (23) Page 2 of 5
   

Protected B when completed
Step 2 – Details of contributions received during the year (continue)
 
 Part 3 – Amounts transferred directly from another RCA trust
 (Send us a separate list if required.)
 For more information about transferring amounts between trusts, go to canada.ca/retirement-compensation-arrangements.
 
  Date contribution received Name of RCA trust making the transfer Amount received  
  Year     Month   Day  
         
         
Transfer this subtotal amount to line 42 - Subtotal   
   x 2   
Transfered amount  6041   = •3
     
Transfer this amount to line 4 of Step 3   
Send us a copy of the letter of agreement.   
 
 
Step 3 – Calculating the refundable tax on hand for the current year
 
 Part 1 – Refundable tax on hand before distributions or election
  Refundable tax on total contributions at the beginning of the year (from line 7 of Step 3 of your prior year's tax return)   601   • 1
  Current year's employer contributions (from line 1 of Step 2)   602   • 2
  Current year's member contributions (from line 2 of Step 2)   603   + • 3
  Current year's amount transferred from another RCA trust (from line 3 of Step 2)   604   + • 4
  Add lines 2 to 4   =  5
  Multiply line 5 by 50%   x 50 %  
  Refundable tax on total contributions   =  ► +  6
  Refundable tax on total contributions at the end of the year (line 1 plus line 6)     606   = •7
 Income and capital gains at the beginning of the year (from line 11 of
  Step 3 of your prior year's tax return)   607   •8
  Current year's income from business and property*   608   + •9
  Current year's capital gains*   609   + •10
  Total income and capital gains (add lines 8 to 10)   610   = •11
 Losses and capital losses at the beginning of the year
  (from line 15 of your prior year's tax return)   611   •12
  Current year's losses from business and property*   612   + •13
  Current year's capital losses*   613   + •14
  Total losses and capital losses (add lines 12 to 14)   614   = •15
 Excess of income and capital gains over losses and capital losses
  (Line 11 minus line 15. If negative, enter 0)        16
  Multiply line 16 by 50%       x 50 %  
  Refundable tax on excess of income and capital gains over losses and capital losses.   616   =  ► + •17
  Refundable tax on hand before distributions or election (line 7 plus line 17).
  Transfer this amount to line 25 of Part 3   617   = •18
     
 * If you enter income or losses from business and property on line 9, line 10 or line 13 or have a current-year capital loss on
line 14, send us the financial statements.
 
 Part 2 – Distributions
  Distributions at the beginning of the year (from line 24 of your prior year's return)   618   •19
 Current year's distributions out of the RCA trust (do not include amounts transferred directly to another RCA or amounts
  returned to the employer). Send us a copy of all T4A-RCA summaries or NR4 summaries   619   + •20
 Current year's amounts returned to employer or employee to be included in employer or employee's
  income. Send us a copy of the T4A-RCA Summary or NR4 Summary   620   + •21
 Current year's amounts transferred directly to another RCA trust.
  Send us a copy of the letter of agreement   621   •x2=  ► + 22
 Taxes on prohibited investments and advantages paid in the current year, to the extent that these taxes have not been
  waived, refunded or cancelled (distribution under section 207.65)   6211   + •23
 
  Total distributions (add lines 19 to 23). Transfer this amount to line 26 of Part 3   622   = •24
     
 
 
T3-RCA E (23) Page 3 of 5
   

Protected B when completed
Step 3 – Calculating the refundable tax on hand for the current year (continue)
 
 Part 3 – Refundable tax on hand (after distributions) at the end of the tax year
  Enter the amount from line 18 of Part 1    25
  Enter the amount from line 24 of Part 2    26
  Multiply line 26 by 50%   x 50 %  
  Refundable tax on hand   =  ► –  27
  Refundable tax on hand (after distributions) at the end of the tax year (line 25 minus line 27)   624   = •28
     
 
 Use Option A, complete Option B, or use Option C, whichever applies.
 A – If you satisfy the conditions specified in Step 4 and you want to make the election under subsection 207.5(2), go to Step 4.
 B – If you have distributed all the property the RCA held and no property remains
in the RCA at the end of the year (other than the right to receive a refund of the refundable tax):
  Enter the refundable tax on hand (from line 28 above)    29
 Enter the amount of the refundable tax on hand that will be distributed when
  received – send us the T4A-RCA or NR4 summaries   627   •30
  Multiply line 30 by 50%   x 50% ► –  31
  Line 29 minus line 31   629   = •32
     
 
 If the amount on line 32 is zero, enter the amount on line 39 of Step 5. If the amount is positive you must use Option A (if
available) or use Option C. For final returns reporting a positive result at line 32, you must use Option A.
 C – If Options A or B are not applicable, enter the amount from line 28 above on line 39 of step 5.
 
 
Step 4 – Election under subsection 207.5(2) to recover refundable tax on hand
 
You can make this election only if all of the property, if any, in the RCA at the end of the tax year (other than a right to claim a refund under subsections 164(1)
or 207.7(2)) consisted of cash, debt obligations, shares listed on a designated stock exchange, or any combination of these. The election is generally not
available if any part of the decline in value of the property is attributable to a prohibited investment or advantage.
 Property of the RCA trust (at the end of the tax year):
  Cash   631   •33
 
  Debt obligations: Principal amounts      34
  Fair market values      35
  Enter Line 34 or 35 for each, whichever is more + +   634   + •36
  Fair market value of shares listed on a designated stock exchange   635   + •37
  Total property of the RCA trust at the end of the tax year (add lines 33, 36, and 37). Transfer this amount to line 39.   636   = •38
     
 
 Election – You have to complete and sign the election before we can refund the tax.
I,   , custodian of the  RCA trust,
  (print name)    
 elect to have the amount on line 38 above deemed to be refundable tax at the end of the tax year. I have sent separate lists giving
 details of amounts entered on lines 34, 35, and 37.
         
Date Custodian's signature
 
Step 5 – Part XI.3 tax payable or refundable  
 
  Refundable tax on hand at the end of the tax year (line 28, 32, or 38, whichever one applies)   641   •39
 
  Refundable tax on hand at the beginning of the year   642   •40
  Refundable tax on hand transferred during the year to another RCA   643   –  41
  Refundable tax on hand transferred during the year from another RCA   644   +  42
  Line 40 minus line 41 plus line 42   =  ► –  43
  Subtotal: Total Part XI.3 tax payable or refundable in the year (line 39 minus line 43). If negative, enclose in brackets   646   = •44
     
 
 
T3-RCA E (23) Page 4 of 5
Protected B when completed
Step 6 – Tax on advantages and prohibited investments
 
  Tax under section 207.61 on prohibited investments x 50 % =   650   •45
  Tax under section 207.62 on advantages x 100 % =   651   + •46
  Minus allowable refund on prohibited investments   652   – •47
  Subtotal: Balance owing or refund (line 45 plus line 46 minus line 47)   653   = •48
     
 
 
Step 7 – Refundable tax remitted
 
  Refundable tax deducted and remitted by employer or contributor during the year   49
  Payments on account remitted by custodian during the year   +  50
  Line 49 plus line 50   662   = ► •51
 
 
Step 8 – Balance owing or refund  
 
  Balance owing or refund (line 44 plus line 48 minus line 51)   663   •52
     
 If the result is positive, you have a balance owing. If the result is negative, you have a refund.  
Amount enclosed    95   •53
  Balance owing: Pay a balance owing online using CRA’s My Payment service. You can also send us a cheque or money
order payable to the Receiver General. Do not mail cash
Refund code    102    54
(see the webpage for details)  
  Refund: To receive a refund by direct deposit, Complete Form T3-DD, Direct Deposit Request for T3.
 
 
Step 9 – Certification
 
I,  , certify that the information given in this return and on any attached documents is correct and complete.
(Print name)  
 
           
  Signature of authorized person   Position or office Telephone number Date YYYYMMDD  
 
 
Personal information (including the SIN) is collected and used to administer or enforce the Income Tax Act and related programs and activities including administering tax, benefits, audit,
compliance, and collection. The information collected may be disclosed to other federal, provincial, 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.
T3-RCA E (23) Page 5 of 5