| Protected B when completed | |||||||||||||||||||||||||||||
Part 4 – Cancel your representative |
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| Complete this section to cancel your representative(s) and remove their access to your information. Tick the appropriate box. | |||||||||||||||||||||||||||||
| Cancel all representatives | |||||||||||||||||||||||||||||
| or | |||||||||||||||||||||||||||||
| Cancel the representative listed below: | |||||||||||||||||||||||||||||
| Rep ID | |||||||||||||||||||||||||||||
| First name: | Last name: | ||||||||||||||||||||||||||||
| Group ID | |||||||||||||||||||||||||||||
| G | |||||||||||||||||||||||||||||
| Business number (BN) | |||||||||||||||||||||||||||||
| Business name: | |||||||||||||||||||||||||||||
Part 5 – Signature and date |
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| If you are the taxpayer, you must sign and date this form. If you are the legal representative, you must tick the box below, sign and date this form. |
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| I am the legal representative for this taxpayer or estate/trust (executor, administrator, power of attorney, legal guardian or | |||||||||||||||||||||||||||||
| parent of a taxpayer under the age of 16, or trustee). | |||||||||||||||||||||||||||||
| Important: | If you haven't already done so, you must send a complete copy of the legal document giving you the authority to act in this capacity. If the taxpayer is under the age of 16, no legal document is required. |
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| Name of taxpayer or legal representative | Signee's telephone number | ||||||||||||||||||||||||||||
| Year | Month | Day | |||||||||||||||||||||||||||
| X | |||||||||||||||||||||||||||||
| Signature of taxpayer or legal representative | Date of signature | ||||||||||||||||||||||||||||
| The CRA must receive this form within 6 months of the date it was signed, or it will not be processed. | |||||||||||||||||||||||||||||
| Personal information is collected under the Income Tax Act to administer tax, benefits, and related programs. It may also be used for any purpose related to the enforcement of the Act such as audit, compliance and collection activities. It may be shared or verified with other federal, provincial, territorial or foreign government institutions to the extent authorized by law. Failure to provide this information may result in interest payable, penalties or other actions. The social insurance number is collected under section 237 of the Act and is used for identification purposes. Under the Privacy Act, individuals have the right to access, or request 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 005, CRA PPU 015, CRA PPU 063, CRA PPU 140, CRA PPU 178 and CRA PPU 218 at canada.ca/cra-info-source. |
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| BARCODE | |||||||||||||||||||||||||||||
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