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Flag Canada Revenue
Agency		 Agence du revenu
du Canada		 AgriStability
AgriInvest
Protected B when completed
Statement A  
2023
 AgriStability and AgriInvest Programs Information  
and Statement of Farming Activities for Individuals
 
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 to the AgriInvest program only.
Last name   For AgriStability, please contact your AgriStability Administration.
    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
 
  Note: If you have a contact person, you must complete this section each time
Farming information   you submit this form. The AgriInvest Administration will replace any previous
    contact person you may have designated with the name you provide here.
Province/Territory of main farmstead     By providing a contact person's name, you are authorizing both the
    AgriStability and AgriInvest Administrations to receive information from and to
Number of years you have farmed     disclose information to the contact person, and to make changes to your
    applications as directed by the contact person.
   
Was 2023 your final year of farming? Yes No   Federal public office holder or employee of AAFC
    Are you, or anyone who participated in the
Industry code     preparation of this form on your behalf, a current or
Have you completed a production cycle on at
least one of the commodities you produced?		 Yes No   former federal public office holder or employee of
Agriculture and Agri-Food Canada?		 Yes No
     
If you ticked "No" to the above question, were  
you unable to complete a production cycle due Yes No  
to disaster circumstances?  
   
   
T1163 E (23) (Ce formulaire est disponible en français.) Page 1 of 5 Canada Logo

Protected B when completed
  2023 Statement A
  Confidential Information and Participant Consent
 
  Agriculture and Agri-Food Canada (AAFC) and the Canada Revenue Agency (CRA) are committed to protecting the privacy of your
information. The information on this form, including your social insurance number, will be used exclusively for the purposes of
administering your participation in the AgriStability and AgriInvest programs, determining your eligibility for benefits, verifying the
information submitted, administering the premium adjustment linkage between production insurance and the AgriStability program, as
well as for the purposes of administering benefits under other farm income and special assistance programs, and for purposes of audit,
analysis, and evaluation of the AgriStability and AgriInvest and other farm income and special assistance programs.
 
  By completing this form, you authorize the CRA to share information from your Statement A with the Minister of Agriculture and
Agri-Food, and you authorize the Minister of Agriculture and Agri-Food to share the information on the form and any additional
information that is provided as the application is processed, with provincial ministers of agriculture and with the administrators of other
federal/provincial farm programs.
 
  In addition, by submitting this form for benefits under the AgriStability and AgriInvest programs, you:
 
  1) certify that the information provided is complete and correct;
 
  2) declare that the structure of this farming operation has not been altered or created for the purpose of manipulating program benefits or
avoiding prescribed maximum limits on program payments;
 
  3) understand and agree that any Interim or Targeted Advance payment of AgriStability program funds will be deducted in the
calculation of a final AgriStability program payment;
 
  4) agree that you will repay any amounts paid to you by the AgriStability and AgriInvest programs that are in excess of the amount
calculated under the program rules and understand that any amount you owe to the Crown may be subtracted from any payments to
be sent to you by the Crown;
 
  5) understand and agree that the information you submit may be combined with the information of other participants for the purposes of
determining AgriStability and AgriInvest benefits, and consent to the disclosure of information pertaining to you or your financial
affairs to the other participants who are being combined with your information;
 
  6) understand and certify that where you have provided information about other individuals or entities you have been authorized by
those individuals or entities to provide that information;
 
  7) understand and agree that where you have provided information about other individuals or entities, if they request to see the
information you have submitted about them, the Administration will give them access to that information;
 
  8) understand and agree that the person you identified on this form as your contact person may receive information relating to your
application from the Administration and may instruct the Administration to modify information relating to your application;
 
  9) consent to third parties, CRA, and other government programs disclosing to the Administration, upon its request, any information
pertaining to you or your financial affairs which the Administration considers necessary for the purpose of verifying the AgriStability
and AgriInvest benefit or the information provided on this form; and
 
  10) understand that it is a criminal offense to make a false statement in application for program benefits and any declarations made are
subject to audit.
 
 The personal information collected on this form is protected under the Privacy Act and is stored in personal information bank numbers AAFC PPU 183 and CRA PPU 005.
 
Page 2 of 5

 
Protected B when completed
2023 Statement A  
 
Identification – Complete a Form T1164 (Statement B) for each additional farming operation. Operation 1 of    
 
Farm name Address: City: Postal code:  
  Method of accounting  
   
   
Sole proprietorship Partnership   Enter Code 1: If you are using the
accrual method for tax purposes and
Note: If you indicate you are in a partnership, complete the partnership
information section on page 5.		   the AgriStability and AgriInvest
programs.
   
Fiscal period:   Enter Code 2: If you are using the
  From     to         cash method for tax purposes and the
  Year   Month   Day   Year   Month   Day     AgriStability and AgriInvest programs.
   
 
Was your farming operation involved in any of the following? (Tick all applicable boxes for this operation.)
 
a member of a feeder association a crop share (landlord) a crop share (tenant)
 
Income  
Enter the applicable code for each entry on the form. The codes are listed in the Commodity list and in the Program payment lists included in Guide RC4060.
 
Round all income amounts to the nearest dollar.
 
Commodity sales and
program payments		 Code Amount   Other farming income Line Amount
   Other program payments 9540
   Business risk management (BRM) and    
   disaster assistance program payments
9544
   Resales, rebates, GST/HST for    
   allowable expenses
9574
   Resales, rebates, GST/HST for    
   non-allowable expenses, and recapture of
9575
   capital cost allowance (CCA)    
   Agricultural contract work 9601
   Patronage dividends 9605
   Interest 9607
   Gravel 9610
   Trucking (farm-related only) 9611
   Resales of commodities purchased 9612
   Leases (gas, oil well, surface, etc.) 9613
   Machine rentals 9614
   Other (specify): 9600
       
       
       
        Total B: Total of other farming income  $
       
         
       
Summary of Income
        Total A 
        Total B  +
         Gross farming income: Total A plus Total B  
         (enter on line 9959 on page 5 of this form and on  
Total A  9950 $    line 14099 of your income tax return) $
 
 
 
T1163 E (23) Page 3 of 5
   

 
Protected B when completed
2023 Statement A  
 
Expenses Operation 1 of    
 
Enter the applicable code for each entry on the form. The codes are listed in the Commodity list and in the Program payment lists included in RC4060,
Farming Income and the AgriStability and AgriInvest Programs Guide.
 
Round all expense amounts to the nearest dollar.
 
Commodity purchases and repayment
of program benefits		 Code Amount   Non-allowable expenses Line Amount
Point of sale adjustments 575    Machinery (repairs, licences, insurance) 9760
   Machinery lease/rental 9765
   Advertising and promotion costs 9792
   Building and fence repairs 9795
   Land clearing and draining 9796
   Agricultural contract work 9798
   Other insurance premiums 9804
   Interest (real estate, mortgage, other) 9805
   Memberships/subscription fees 9807
   Office expenses 9808
   Legal and accounting fees 9809
   Property taxes 9810
   Rent (land, buildings, pastures) 9811
   Non-arm's length salaries 9816
   Motor vehicle expenses 9819
   Small tools 9820
   Soil testing 9821
   Licences/permits 9823
   Telephone 9824
Total C  9960 $    Quota rental (tobacco, dairy) 9825
   Gravel 9826
         Purchases of commodities resold 9827
Allowable Expenses
Line
Amount
    Motor vehicle interest and leasing costs 9829
Containers and twine 9661    Allowance on eligible capital property 9935
Fertilizers and soil supplements 9662    Capital cost allowancey 9936
Pesticides and chemical treatments 9663    Mandatory inventory adjustments    
Insurance premiums (crop or production) 9665    – prior year
9937
Veterinary fees, medicine, and breeding        Optional inventory adjustments    
fees
9713
    – prior year
9938
Minerals and salts 9714    Other (specify) 9896
Machinery (gasoline, diesel fuel, oil) 9764        
Electricity 9799        
Freight and shipping 9801        
Heating fuel 9802        
Arm's length salaries 9815        
Storage/drying 9822        
Commissions and levies 9836        
Private insurance premiums for allowable       Total E: Total of non-allowable expenses   $
commodities
9953
    
         
       
Summary of Expenses
        Total C 
        Total D: Total of allowable expenses  +
        Total E   +
Total D   $   Total expenses: Add Total C, Total D, and Total E
(enter on line 9968 on page 5) 		  $
 
 
 
Page 4 of 5
 

 
Protected B when completed
2023 Statement A  
 
 Summary of income and expenses Operation 1 of    
 
 
  Gross farming income (enter total from "Summary of income" on page 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9959    
  Total expenses (enter total from "Summary of expenses" on page 4). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9968 –   
  Net income (or loss) before adjustments (line 9959 minus line 9968) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9969 =   
 
  Other deductions (see line 9940 in the Guide RC4060) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9940 –   
  Subtotal: Line 9969 minus line 9940   A
 
  Optional inventory adjustment – current year (if applicable) . . . . . . 9941    
  Mandatory inventory adjustment – current year (if applicable) . . . . 9942 +  
  Subtotal: Line 9941 plus line 9942   ►   B
Subtotal: Amount A plus amount B   C
  Partnership information (if applicable)
  Your share of amount C or the amount from your T5013 slip (enter the dollar amount) . . . . . . . . D
  Return of fuel charge proceeds to farmers tax credit allocated to you in the year (box 237 of
  T5013 slip or amount provided by your partnership in a letter) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9951    
Subtotal: Amount D plus line 9951   E
 
  Net income (loss) after adjustments (enter amount C or E, whichever applies) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9944    
 
  Adjustment to business-use-of-home expenses (from Form T1175, if it applies) . . . . . . . . . . . . . . . 9934 +   
 
  GST/HST rebate for partners received in the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9974 +   
 
  Net farming income (loss). Add lines 9944, 9934, and 9974. See the following note.
  Enter this amount on line 14100 of your income tax return. . . . . . 9946 =   
     
 
Note: If you have multiple operations, or additional expenses that apply to partnerships, add the amounts from line 9946 of the following forms:
  • Form T1163, Statement A – AgriStability and AgriInvest Programs Information and Statement of Farming Activities for Individuals
  • Form T1164, Statement B – AgriStability and AgriInvest Programs Information and Statement of Farming Activities for Additional
Farming Operations
  Enter the total on line 14100 of your income tax return.
 
 
 Partnership information Note: Ensure you provide your PIN and your partner/partners' PIN(s).
 
 Partnership name:  
 
 
Note: Enter a participant identification number (PIN) for each of your partners. Enter the first and last names
for individual partners. Enter the corporation's name for corporate partners. Your partnership's total
shares must equal 100%.
Your % share of the partnership 
%
AgriStability and AgriInvest PIN Only enter the first and last name if the partner is an individual. Only enter the corporation name
if the partner is a corporation.		 %
share
       
  Individual's first name Individual's last name    
    %
         
  Individual's first name Individual's last name    
    %
         
  Individual's first name Individual's last name    
    %
         
  Individual's first name Individual's last name    
    %
         
  Individual's first name Individual's last name    
    %
         
  Individual's first name Individual's last name    
    %
         
  Individual's first name Individual's last name    
    %
         
 
Page 5 of 5