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Protected B when completed
Supplementary Unemployment Benefit Plan Income Tax Return
Unless otherwise stated, each legislative reference in this return is to the Income Tax Act.
Do not use this area.
As trustee for a trust governed by a supplementary unemployment benefit plan, you have to send one completed T3S
return, along with any payment owing, no later than 90 days after the end of the tax year. The tax year of the trust is the
calendar year. If you do not file this return on time, we will charge penalties and interest on any amount owing.
When a trustee responsible for filing this return does not act as administrator of the supplementary unemployment
benefit plan, the trustee is still responsible for obtaining and reporting the required information.
If the plan is not registered under the Income Tax Act throughout its period of operation or existence during the tax year,
the income of the trust may be taxable. To report taxable income or claim a Part XII.2 tax credit, complete Form T3RET,
Trust Income Tax and Information Return.

You can get a copy of Guide T4013, T3 Trust Guide, and the T3 Trust Forms at canada.ca/cra-forms-publications
or by calling 1-800-959-8281
Identification and other information
 Is this an amended return? Yes
Is this return a first year filing? Yes
Tax year of return   
 Name of plan Account number (if one has been assigned)
 Province or territory of residence of the plan Plan registration number Your language of correspondence:
English  French 
Trustee information (Choose only one of the two following options and fill in the required information about the trustee.)
Enter only the information of the trustee that is the CRA's primary contact. Do not enter information for any other trustees.
Option 1 – The trustee is an Individual (For example, a trustee, a filer, a custodian, an executor, a liquidator, or an administrator)
 First name of trustee  Last name of trustee  Telephone number
 Address City Province/Territory or State Country  Postal or ZIP code
Option 2 – The trustee is a Non-individual (For example, a corporation, a partnership, or a trust company)
 Name of non-individual trustee
 First name of contact person  Last name of contact person  Telephone number
 Address City Province/Territory or State Country  Postal or ZIP code
Information about the trust
 Address where the trust keeps its books and records (if different from trustee's address)
 City Province/Territory or State Country  Postal or ZIP code
 Date the trust: came into existence ceased to exist  
  (effective date of registration) Date (YYYYMMDD)   Date (YYYYMMDD)  
 Did the trust also file a related T3RET, T3 Trust If yes, provide the related
 Income Tax and Information Return? Yes
trust account number. T  
T3S E (23) (Ce formulaire est disponible en français.) Page 1 of 2 Canada Logo

Protected B when completed
Tax under subsection 207.1(5) on agreements to acquire shares
  Complete Form T2000, Calculation of Tax on Agreements to Acquire Shares, if the trust entered into an agreement (other than for the acquisition, or the
writing by it, of an option listed on a designated stock exchange) to acquire a share of the capital stock of a corporation (other than from the corporation)
at a price different from the fair market value at the time the share was acquired.
  Send us the completed Form T2000 with this return and enter the calculated amount on line 1.
Tax on agreements to acquire shares  241    1
Enter this amount on line 2.     
Summary of tax or refund
  Tax under subsection 207.1(5) on agreements to acquire shares (from line 1) Total tax payable   190   •2
  Minus: Payments on account   010   •3
  Balance owing or refund (line 2 minus line 3)   090   = •4
If the result is positive, you have a balance owing. If the result is negative, you have a refund.  
Generally, we do not charge or refund $2 or less.  
Amount enclosed   095   •5
  Balance owing: Pay a balance owing online using CRA’s My Payment service at canada.ca/cra-my-payment. You can also
send us a cheque or money order payable to the Receiver General. Do not mail cash.
Refund code    102    6
(see the guide for details)  
  Refund: To receive a refund by direct deposit, complete Form T3-DD, Direct Deposit Request for T3.
I,  , certify that the information given on this return and in any attached documents is correct, complete and
(Print name)   fully discloses all of my income.
  Signature of trustee or trust company official Position or office if trustee is a corporation Telephone number Date (YYYY MM DD)
How to file this return
  By internet By mail
You have the option to file this return through EFILE.
For more information about this filing method, go to canada.ca/efile.
Sudbury Tax Centre
T3 Trust Returns Program
Canada Revenue Agency
1050 Notre Dame Avenue
Sudbury ON P3A 6C2
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.
T3S E (23) Page 2 of 2