Authorization request – signature page
1. Have the taxpayer or legal representative sign and date this page.
2. Retain a copy of the signed and dated signature page in your les for six years from the date that this information is transmitted to the
CRA. Do not send us the signature page by mail or fax unless requested to do so.
Taxpayer information
Representative information and authorization
SIN:
Rep ID:
Last name:
Last name:
First name:
First name:
Group ID: Group name:
Business number (BN) Business name:
Level of authorization
(Level 1 or 2)
Telephone:
Signature information
I am the legal representative for this taxpayer
Signee’s telephone number Name of taxpayer or legal representative
Certication
By signing and dating this page, you authorize the Canada Revenue Agency to interact
with the representative(s) mentioned above.
Date of signature
Signature of taxpayer or legal representative
x
Year Month Day
T1013A_EN_1.0© H&R Block Canada, Inc. 2019
Expiry date, if applicable:
