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Flag Canada Revenue
Agency		 Agence du revenu
du Canada		 Protected B when completed
  13
Retirement Compensation Arrangement (RCA) Part XI.3 Tax Return
 
RCA trust's tax year   Tax Centre TSO code
  WINNIPEG 21
Is this the first T3-RCA tax return filed? Yes 
1
 No 
2
 Do not use this area.
If yes, send us a copy of the trust agreement if it was not already submitted.  
Is this the final return of the RCA trust? Yes 
1
 No 
2
  
If yes, send us the complete details for closure.  
Language of correspondence English  French  
For instructions on how to fill out this return, go to canada.ca/retirement-compensation-arrangements.  
Identification and other information  
RCA trust's name (maximum 60 characters) Trust account number
T
 
Custodian information (Choose only one of the two following options and fill in the required information about the custodian)
Option 1 – The custodian is an Individual (For example, a trustee, a filer, a custodian, an executor, a liquidator, or an administrator)  
 First name of custodian  Last name of custodian  Telephone number
 
 Address City Province/Territory or State Country  Postal or ZIP code
 
Option 2 – The custodian is a Non-individual (For example, a corporation, a partnership, or a trust company)  
 Name of non-individual custodian
 
 First name of contact person  Last name of contact person  Telephone number
 
 Address City Province/Territory or State Country  Postal or ZIP code
 
 
If the mailing address of the custodian is different from the address above, fill in this section.  
 Care of (C/O)  Telephone number
 
 Address City Province/Territory or State Country  Postal or ZIP code
 
 
Step 1 – Supporting documents
1. Were any changes made to the terms of the arrangement during the year? Yes
1
 No 
2
  If yes, send us the documents to support the original or amended arrangement, as applicable.
2. Were any transfers of beneficial interests in the arrangement reported to you? Yes
1
 No 
2
  If yes, provide the following:  
   Name of person who disposed of an interest Address Social insurance number or business number
   
   Name of person who bought an interest Address Social insurance number or business number
   
3. Were any amounts returned to an employer or contributor, or distributed as benefits during the year? Yes 
1
 No 
2
  If yes, send us the copies of T4A-RCA Summary or the copies of the NR4 Summary.
  Payroll account number Non-resident remittance account number   
 
4. How many members of the RCA did the RCA trust receive contributions for?  
5. Was any property other than cash distributed during the year? Yes 
1
 No 
2
  If yes, send us the complete details
6. Has the RCA trust acquired or disposed of property during the year at other than fair market value? Yes 
1
 No 
2
  If yes, send us the complete details
 
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