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Flag Canada Revenue
Agency
Agence du revenu
du Canada
Protected B when completed
  For departmental use.
Foreign Income Verification Statement  
   
This form must be used for the 2015 and later taxation years.  
Complete and file this form if at any time in the year the total cost amount to the reporting taxpayer
of all specified foreign property was more than $100,000 (Canadian).
 
If an election has been made to use a functional currency (see attached instructions), state the
elected functional currency code. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
   
See attached instructions for more information about completing this form.  
 
If this is an amended return, tick this box.
 
Identification
 
Tick a box to indicate who you are reporting for, and complete the areas that apply.
   First name  Last name  Initial  Social insurance number  Individual code
 
Individual
 
1
2
   Corporation's name  Business number
 
Corporation
 
   Trust's name  Account number
 
Trust
  T
     Partnership's name  Partnership code  Partnership's account number
  Partnership  
1
2
3
 Reporting entity's address
 
     
  No.   Street  
 
         
  City   Province or territory Postal code Country code
 
  Year Month Day   Year Month Day  
 For what taxation year are you filing this form? From to  
 
 
 Tick the appropriate box that applies for the taxation year:
If the total cost of all specified foreign property held at any time during the year exceeds $100,000 but was less than $250,000, you are required to
complete either Part A or Part B;
If the total cost of all specified foreign property held at any time during the year was $250,000 or more, you are required to complete Part B.
 
  Tick the appropriate box to select the method of filing; Part A – Simplified reporting method or Part B – Detailed reporting method 
 
Part A: Simplified reporting method
 For each type of property that applies to you, tick the appropriate box.
 Type of property:
 
  Funds held outside Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
 
  Shares of non-resident corporations (other than foreign affiliates) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
 
  Indebtedness owed by non-resident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
 
  Interests in non-resident trusts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
 
  Real property outside Canada (other than personal use and real estate used in an active business) . . . . . . .
 
  Other property outside Canada. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
 
  Property held in an account with a Canadian registered securities dealer or a Canadian trust company. . . . .
 
 Country code:
 Select the top three countries based on the maximum cost amount of specified foreign property held during the year. Enter the country codes in the boxes below:
 
       
 
 Gross income from all specified foreign property $  
 Gain(loss) from the disposition from all specified foreign property $  
 
 Privacy Act, personal information bank number CRA PPU 035
 
T1135 E (23) (Ce formulaire est disponible en français.) Canada Logo
       

Protected B when completed
Part B: Detailed reporting method
 
Categories of specified foreign property
In each of the tables below, provide the required details of each specified foreign property held at any time during the particular tax year. If you need additional
space, please attach a separate sheet of paper using the same format as the tables.
 
A taxpayer who held specified foreign property with a Canadian registered securities dealer or a Canadian trust company is permitted to report the aggregate
amount, on a country-by-country basis, of all such property in Category 7, Property held in an account with a Canadian registered securities dealer or a Canadian
trust company
. See attached instructions for Category 7 for details as to how to report under this method.
 
1. Funds held outside Canada  
Name of bank/other entity holding the funds
Country
code
Maximum funds held
during the year
Funds held at
year end
Gross income
 
 
Total 
 
2. Shares of non-resident corporations (other than foreign affiliates)  
Name of corporation
Country
code
Maximum cost
amount during
the year
Cost amount
at year end
Gross income
Gain (loss) on
disposition
 
 
Total 
 
3. Indebtedness owed by non-resident  
Description of indebtedness
Country
code
Maximum cost
amount during
the year
Cost amount
at year end
Gross income
Gain (loss) on
disposition
 
 
Total 
 
4. Interests in non-resident trusts  
Name of trust
Country
code
Maximum cost
amount during
the year
Cost amount
at year end
Income received
Capital received
Gain (loss) on
disposition
 
 
Total 
 
5. Real property outside Canada (other than personal use and real estate used in an active business)
Description of property
Country
code
Maximum cost
amount during
the year
Cost amount
at year end
Gross income
Gain (loss) on
disposition
 
 
Total 
 
6. Other property outside Canada  
Description of property
Country
code
Maximum cost
amount during
the year
Cost amount
at year end
Gross income
Gain (loss) on
disposition
 
 
Total 
 
7. Property held in an account with a Canadian registered securities dealer or a Canadian trust company
Name of registered security dealer/Canadian trust company
Country
code
Maximum fair market
value during the year
Fair market value
at year end
Gross income
Gain (loss) on
disposition
 
 
Total 
 
  T1135 E (23)      Privacy Act, personal information bank number CRA PPU 035

Protected B when completed
 
Certification  
I certify that the information given on this form is, to my knowledge, correct
and complete, and fully discloses the reporting taxpayer's foreign property and
related information.
If someone other than the taxpayer or the partnership prepared
this form, provide their:
Print name Name
 
Sign here (It is a serious offence to file a false statement.) Address
   
Position/title  
   
Telephone number Date (YYYYMMDD) Postal or ZIP code Telephone number
 
 
     
T1135 E (23)    Privacy Act, personal information bank number CRA PPU 035

Instructions
 
All legislative references on this form refer to the Income Tax Act (the Act).

If the reporting taxpayer is a partnership, references to year or taxation year
should be read as fiscal period and references to taxpayer should be read
as partnership.
Where a particular specified foreign property has been reported all of the other
fields associated with that particular property must also be completed. All nil
amounts should be reported by indicating "0" in the corresponding field rather
than leaving it blank. Amounts should be rounded to the nearest dollar.
 
Do you have to file this form? Functional currency
 
All Canadian resident taxpayers (including non-resident trusts deemed
resident in Canada by section 94 of the Act) are required to file the
Form T1135, Foreign Income Verification Statement if at any time in the
year the total cost amount of all specified foreign property to the taxpayer
was more than $100,000 (Canadian).

An individual (other than a trust) does not have to file Form T1135 for the
year in which the individual first becomes a resident of Canada (section 233.7
of the Act).
If an election has been made under paragraph 261(3)(b) of the Act to report in
a functional currency, state all monetary amounts in that functional currency,
otherwise state all monetary amounts in Canadian dollars. The codes for the
functional currencies are as follows:
AUD – for Australian dollar
USD – for U.S. dollar
GBP – for U.K. pound
EUR – for Euro
  Identification
The following entities do not have to file this form: Check the appropriate box to identify the category of taxpayer filing this form.
a mutual fund corporation or mutual fund trust; Provide the taxpayer's name, address, and identification number. Provide the
a non-resident-owned investment corporation; taxation year for which this form is being filed.
a person all of whose taxable income is exempt from Part I tax;  
a registered investment under section 204.4 of the Act; Reporting individual/partnership identification
a trust described in any of paragraphs (a) to (e.1) of the definition of For individual code, check ( ✔ ) :
  trust in subsection 108(1) of the Act; 1. If the individual or the individual's spouse (common-law partner) is
a trust in which all of the persons beneficially interested are persons   self-employed.
  described above; 2. If the individual and the individual's spouse (common-law partner) are
a partnership in which all the members are persons described above; and   both not self-employed.
a partnership where the share of the partnership's income or loss For partnership code, check ( ✔ ) :
  attributable to non-resident members is 90% or more of the income 1. If end partners are individuals or trusts.
  or loss of the partnership. 2. If end partners are corporations.
  3. If end partners are a combination of 1 and 2 mentioned above.
What property do you have to report?
You are required to report all specified foreign property in accordance with
subsection 233.3(1) of the Act which includes:
An end partner is the final recipient (corporation, trust or individual) that
receives an allocation of income from the partnership after the income has
funds or intangible property (patents, copyrights, etc.) situated, deposited
or held outside Canada;
flowed through the various levels of a tiered partnership.
tangible property situated outside of Canada; Categories of specified foreign property
a share of the capital stock of a non-resident corporation held by the
taxpayer or by an agent on behalf of the taxpayer;
This form contains seven tables corresponding to different categories of
specified foreign property. Report the detail of each particular property that
an interest in a non-resident trust that was acquired for consideration,
other than an interest in a non-resident trust that is a foreign affiliate for
was held at any time during the year in the appropriate category.
  the purposes of section 233.4 of the Act; Country codes
shares of corporations resident in Canada held by you or for you
outside Canada;
For the list of country codes, see the CRA website at
www.cra-arc.gc.ca/E/pub/tg/t4061/t4061-e.html#P482_43418.
an interest in a partnership that holds a specified foreign property The country code for each category should identify:
  unless the partnership is required to file Form T1135; Category 1 – the country where the funds are located;
an interest in, or right with respect to, an entity that is a non-resident; Category 2 – the country of residence of the non-resident corporation;
a property that is convertible into, exchangeable for, or confers a right to Category 3 – the country of residence of the non-resident issuer;
  acquire a property that is specified foreign property; Category 4 – the country of residence of the trust;
a debt owed by a non-resident, including government and corporate Category 5 – the country where property is located;
  bonds, debentures, mortgages, and notes receivable; Category 6 – the country where property is located;
an interest in a foreign insurance policy; and Category 7 – depending on the type of property, use the instructions
precious metals, gold certificates, and futures contracts held
outside Canada.
  above from categories 1 to 6.

Specified foreign property does not include:
If you are uncertain of the appropriate country code for a particular specified
foreign property, select "Other".
a property used or held exclusively in carrying on an active business;
a share of the capital stock or indebtedness of a foreign affiliate; Cost amount/Maximum cost amount
an interest in a trust described in paragraph (a) or (b) of the definition of
"exempt trust" in subsection 233.2(1) of the Act;
Cost amount is defined in subsection 248(1) of the Act and generally would
be the acquisition cost of the property. If you immigrate to Canada, the cost
a personal-use property as defined in section 54 of the Act; and amount is the fair market value of the property at the time of immigration.
an interest in, or a right to acquire, any of the above-noted excluded
foreign property.
Similarly, if you received specified foreign property as a gift, or inheritance,
the cost amount is its fair market value at the time of the gift or inheritance.

For frequently asked questions or examples, check our web site at
www.cra-arc.gc.ca/tx/nnrsdnts/cmmn/frgn/1135_fq-eng.html.
The maximum cost amount during the year can be based on the maximum
month-end cost amount during the year.
How to complete this form
If the total cost of all specified foreign property held at any time during the year
exceeds $100,000 but was less than $250,000, the form has been designed to
provide you with the option of completing either Part A or Part B.
Foreign currency conversion
The amounts to be reported on Form T1135 should be determined in the
foreign currency then translated into Canadian dollars. Generally, when
converting amounts from a foreign currency into Canadian dollars, use the
exchange rate in effect at the time of the transaction (i.e. the time the income
was received or the property was purchased). If you received income
throughout the year, an average rate for the year is acceptable.

The following summarizes how other amounts of the form should be translated: 7. Property held in an account with a Canadian registered
Maximum funds held during the year – the average exchange rate for securities dealer or a Canadian trust company
  the year. A taxpayer who held specified foreign property with a Canadian registered
securities dealer (as defined in subsection 248(1) of the Act) or with a
Funds held at year end – the exchange rate at the end of the year. Canadian trust company (as determined under paragraph (b) of the definition
of restricted financial institution in subsection 248(1) of the Act) is permitted to
Maximum fair market value during the year – the average exchange rate
for the year.
report the aggregate amount of all such property in this category.
Fair market value at year end – the exchange rate at the end of the year. The table for this category should be completed as follows:

Tables
all of the property held with a particular securities dealer or trust company
should be aggregated on a country-by-country basis;
Specified foreign property has been divided into seven (7) categories and
should be reported in one of the following tables:
it is also acceptable to provide aggregate totals for each particular
account on a country-by-country basis;
1. Funds held outside Canada refer to the "country code" instructions above to determine the
appropriate country for each property; and
Funds held outside Canada include money on deposit in foreign bank
accounts, money held with a foreign depository for safekeeping and money
held by any other foreign institution at any time during the year. Prepaid debit
the maximum fair market value during the year may be based on the
maximum month-end fair market value.
or credit cards and negotiable instruments, such as cheques and drafts, are
also included in this category. Marketable securities should be reported in
Certification
category 3. This area should be completed and signed by:
  the person filing this form in the case of an individual;
2. Shares of non-resident corporations (other than foreign an authorized officer in the case of a corporation;
affiliates) the trustee, executor or administrator in the case of a trust; or
Report all shares of non-resident corporations whether or not they are
physically held in Canada.
an authorized partner in the case of a partnership.
Do not report shares of a foreign affiliate corporation. Generally, a foreign Due dates for filing this form
affiliate is a non-resident corporation (or certain non-resident trusts) of which
you hold at least 1% of the shares individually, and, either alone or with
related persons, hold 10% or more of the shares. If you have a foreign affiliate,
you may have to file Form T1134, Information Return Relating to Controlled
and Not Controlled Foreign Affiliates
.
Form T1135 must be filed on or before the due date of your income tax return
or, in the case of a partnership, the due date of the partnership information
return, even if the income tax return (or partnership information return) is not
required to be filed.
  Filing by internet (EFILE or NETFILE)
3. Indebtedness owed by non-residents
Report all amounts owed to you by a non-resident person (other than a
foreign affiliate corporation) whether the indebtedness is held inside or
outside Canada. Include all promissory notes, bills, bonds, commercial paper,
Individuals can file Form T1135 electronically for the 2014 and subsequent
taxation years. Corporations, trusts and partnerships are required to file a
paper copy of this form.
debentures, loans, mortgages, and other indebtedness owed to you by a EFILE – Your EFILE service provider, including a discounter, can
non-resident person. Marketable securities, such as guaranteed investment
certificates, government treasury bills and term deposits issued by a
non-resident, should be reported under this category.
  complete and file your Form T1135 for you if prepared with tax
preparation software certified by the CRA for the internet filing of
Form T1135. For more information or to file your Form T1135, go
to EFILE at www.cra.gc.ca/efile.
4. Interests in non-resident trusts
Report all interests in non-resident trusts acquired for consideration, other than
a non-resident trust that is a foreign affiliate for the purposes of section 233.4
of the Act.

If you contributed to, or received a distribution or loan from, a non-resident
NETFILE – You can file your Form T1135 by Internet if prepared with
tax preparation software certified by the CRA for the internet filing of
Form T1135. Most individuals are eligible to NETFILE. For more
information or to file your Form T1135, go to NETFILE at
www.cra.gc.ca/netfile.
trust you may be required to file Form T1141, Information Return in Respect
of Contributions to Non-Resident Trusts, Arrangements or Entities
or
Form T1142, Information Return in Respect of Distributions from and
Indebtedness to a Non-Resident Trust
.

Filing a paper return
Form T1135 can be attached to your income tax return, or partnership
information return, and mailed to your tax centre. Alternately, Form T1135
can be mailed separately to the following address:
5. Real property outside Canada
Report all real property located outside of Canada other than real property
used in an active business or used primarily for personal use (such as a
vacation property used primarily as a personal residence). Rental property
outside Canada should be included in this category.

6. Other property outside Canada
Winnipeg Taxation Centre
Data Assessment & Evaluation Programs
Validation & Verification Section
Foreign Reporting Returns
66 Stapon Road
Winnipeg MB R3C 3M2
This category should include any property that does not correspond to any of
the other categories.

Penalties for non-reporting

Other property includes:
There are substantial penalties for failing to complete and file Form T1135
accurately and by the due date. For additional information regarding
shares of corporations resident in Canada held by you or for you
outside Canada;
penalties, see the CRA website at
www.cra-arc.gc.ca/tx/nnrsdnts/cmmn/frgn/pnlts_grd-eng.html.
an interest in a partnership that holds specified foreign property where
the partnership is not required to file the Form T1135;
Voluntary disclosures
foreign insurance policies; To promote compliance with Canada's tax laws, we encourage you to
correct your tax affairs through the Voluntary Disclosures Program. For
precious metals or bullion (e.g., gold and silver) situated outside Canada; more information, see Information Circular IC00-1R3, Voluntary Disclosures
commodity or future contracts, options or derivatives that constitute a  Program (VDP) or visit the CRA website.
  right to, a right to acquire, or an interest in, specified foreign property; and
any other rights to, rights to acquire, or interests in, specified
  foreign property.
 

More information Privacy notice
If you need more information visit our website at www.cra-arc.gc.ca.
Alternatively you can call general enquires at:
Personal information is collected under the authority of section 233.3 of the
Act and is used to monitor compliance with the foreign reporting requirements
1-800-959-5525 for businesses, self-employed individuals and
partnerships; or
related to offshore investments. Information may also be used for the
administration and enforcement of the Act, including audit, enforcement action,
1-800-959-8281 for individuals (other than self-employed individuals)
and trusts.
collections, and appeals, and may be disclosed under information-sharing
agreements in accordance with the Act. Incomplete or inaccurate information
may result in various compliance actions, including the assessment of
You may also contact your local tax services office. Our addresses and fax monetary penalties.
numbers are listed on our website and in the government section of your Your Social Insurance Number is the authorized number for income
telephone book. tax purposes under section 237 of the Act and is used under certain
  federal programs.
 
Information is described in personal information bank CRA PPU 035 in
the Canada Revenue Agency (CRA) chapter of the Info Source publication
at www.infosource.gc.ca. Personal information is protected under the
Privacy Act and individuals have a right of protection, access to, and correction
of their personal information. Further details regarding requests for personal
information at the CRA can be found at www.cra-arc.gc.ca/atip.