Client Data Sheet
Please fill in all capital letters
Your Information:
First Name: ___________________________ __________ Last Name: ___________________________
SIN No.: ___________________________ Date of Birth: ___________________________
Marital Status:
n
Married
n
Common Law
n
Widowed
n
Divorced
n
Separated
n
Single
Phone Number: ____________________ Alternate Phone Number: ___________________
eMail: ________________________________________________________________________________
Home Address: Apt # _________ Street # and Name _________________________________________
City: _____________________________ Province: _______ Postal Code: ______ ______
Spouse/Common Law Information:
First Name: ___________________________ __________ Last Name: ___________________________
SIN No.: ___________________________ Date of Birth: ___________________________
Date of marriage or common law: _____________________ Phone Number: ______________________
eMail: ________________________________________________________________________________
Children Information:
1
2
3
Dependent living with you in Canada (mother, father, grandmother, grandfather, in-laws?):
1
2
Receipts and slips: 1. Proof of payments & receipts are mandatory for claims 2. You must retain them for CRA verification.
Rent paid $ ___________________ Property Tax paid $ ___________________
Medical (dental, drugs, optical)
n
Yes
n
No Premium paid for Medical Insurance
n
Yes
n
No
Public Transit Pass (TTC, Go)
n
Yes
n
No RRSP (contribution or cash withdrawal)
n
Yes
n
No
Dontations
n
Yes
n
No RRSP withdrawals under HBP or LLP
n
Yes
n
No
Union / Professional Fee
n
Yes
n
No RRSP repayment under HBP or LLP
n
Yes
n
No
Tuition Fee (full time or part time)
n
Yes
n
No First Time Home Buyer for the tax year
n
Yes
n
No
Interest Paid on student loan
n
Yes
n
No Investments (capital gain/loss)
n
Yes
n
No
Safety Deposit Box Rental Fee
n
Yes
n
No Moving expenses
n
Yes
n
No
Installment tax payments
n
Yes
n
No
Disabilty tax credits (yours or spouse’s)
n
Yes
n
No
Are you a newcomer to Canada? If yes, your entry date to Canada: ___________________________
Are you a new client? If yes, Referal Name: _____________________________ Phone Number: __________________
Comments: _____________________________________________________________________________________________
_______________________________________________________________________________________________________
To maximize your refund, please ask us for a Tax Cheklist
First Name Last Name Son/ Date of Birth Day Gym Private Disability Camps RESP
Daughter (YYYY/MM/DD) Care School
(YYYY/MM/DD)
(YYYY/MM/DD)
(YYYY/MM/DD)
First Name Last Name Date of Birth Medical Disability Low/Zero
(YYYY/MM/DD) Reason Income
(YYYY/MM/DD)
