| 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: |
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| 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 | ||||||||