Canada Revenue Agency

Agence du revenu du Canada

Protected B when completed

For departmental use.

Foreign Income Verification Statement

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This form must be used for the 2015 and later taxation years.

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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).

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If an election has been made to use a functional currency (see attached instructions), state the elected functional currency code. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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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

Part A is not displayed since Part B checkbox is selected.

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.)

Protected B when completed
Part B: Detailed reporting method
Part B is not displayed since Part A checkbox is selected.
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.