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Flag Canada Revenue
Agency		 Agence du revenu
du Canada		 AgriStability
  Statement A AgriInvest
2023
 Harmonized AgriStability and AgriInvest Programs Information  
and Statement of Farming Activities for Individuals
 
Protected B when completed
Participant information  
Participant identification   Contact person information
First name   If you would like someone else to provide more information on your behalf,
    provide all details in this section. This applies only to the AgriStability and
Last name   AgriInvest programs.
    If you have a contact person, tick here:
    First name
Participant identification number (PIN)  
      Note: You must enter your SIN.   Last name
    You must also enter your PIN  
  Social insurance number (SIN)   and BN unless you have not   Business name
    been assigned one.  
  Business number (BN)   Address
     
     
Telephone number Cellphone number   City/Town Prov/Terr Postal code
 
Fax number   Telephone number Cellphone number
 
Email address   Fax number
 
  Do you want a copy of your Calculation of Program
Farming information   Benefits (COB) for the AgriStability program sent to
your contact person?		 Yes No
    Note: If you have a contact person, you must complete this section each time
Province/Territory of main farmstead     you submit this form. The AgriStability and AgriInvest Administrations will
    replace any previous contact person you may have designated with the name
Number of years you have farmed     you provide here.
    By providing a contact person's name, you are authorizing both the
Was 2023 your final year of farming? Yes No   AgriStability and AgriInvest Administrations to receive information from and to
    disclose information to the contact person, and to make changes to your
Industry code     applications as directed by the contact person.
   
Have you completed a production cycle on at
least one of the commodities you produced?		 Yes No   Federal public office holder or employee of AAFC
    Are you, or anyone who participated in the
If you ticked "No" to the above question, were   preparation of this form on your behalf, a current or
you unable to complete a production cycle due Yes No   former federal public office holder or employee of Yes No
to disaster circumstances?   Agriculture and Agri-Food Canada?
     
 
Other farming information  
Location of main farmstead, indicate your district, county, or municipality name and number:
Yukon and British Columbia – district
New Brunswick and Nova Scotia – county
Manitoba – municipality
District/County/Municipality name  
 
District/County/Municipality number  
 
Combined operations
 
Based on the AgriStability combining criteria outlined in Guide RC4408, should this operation be combined with another operation for Yes No
the 2023 program year?
 
Note: If your operations were combined in your last year of participation, they will automatically be combined for 2023, unless you answered "No" to
the previous question.
 
If your operations should be combined in the 2023 program year, or were previously but should no longer be combined, indicate the PIN(s) that should be
added or removed from your whole farm.
 
       
 
  Add Remove Add Remove Add Remove
Are you sending any of the following information directly to your Administration?
  Receipts Other (please specify)  
 
 
T1273 E (23) (Ce formulaire est disponible en français.) Page 1 of 7   Canada Logo