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Welcome to H&R Block! Please ll out the following form. Provide as much detail as possible.
If you have any questions while completing this form, please do not hesitate to ask.
Once your tax return is ready, the Tax Professional will contact you to set up an appointment to nalize your tax return.
Client Information:
First Name: Initial: Last Name:
Social Insurance Number (SIN): Date of birth:
dd
/
mm
/
yyyy
Address:
City: Province: Postal Code:
Preferred contact method: ■ ■ Phone ■ ■ Email Preferred method to review tax return: ■■ In person ■■ By phone
Phone : Alternate phone number:
Best time to call: Email:
Marital Status on December 31 last year:
■■ Single ■■ Married ■■ Common-law ■■ Widowed ■■ Separated ■■ Divorced
Spouse or Common-law partner information: (if applicable)
Last Name First Name Date of Birth Net Income Post-secondary
Student
Disabled
dd/mm/yyyy
YES ■■ NO ■■ YES ■■ NO ■■
Dependents*: (if applicable) Children, parents, grandparents, etc - living at the same address
Last Name First Name Date of Birth Net
Income
Relation-
ship
Post-secondary
Student
Disabled
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
dd/mm/yyyy
*Require Dependant's SIN during Tax Interview See reverse for addtional space
1. a) Are you a U.S. Citizen by birth or bloodline? B) Do you meet the Green Card Test (Lawful Permanent Resident of
U.S.)? c) Were you PHYSICALLY PRESENT in U.S. at least 183 days during current year?
(check Yes if any of the questions above are true) YES ■■ NO ■■
2. Do you have an incorporated business? YES ■■ NO ■■
3. Do you need to complete an Estate Return or le for a deceased person? YES ■■ NO ■■
4. Are you self-employed, did you own your own business or did you work for a placement agency? YES ■■ NO ■■
5. Are you currently in Bankruptcy status? YES ■■ NO ■■
6. Did you work outside Canada or have foreign employment or foreign pension income? YES ■■ NO ■■
7. Excluding RRSPs, do you have any investments, own any rental properties or sell your principal residence last year? YES ■■ NO ■■
8. Are you claiming employment expenses (did your employer reimburse you for ofce or vehicle expenses)? YES ■■ NO ■■
9. Did you move to Canada last year or switch provinces? YES ■■ NO ■■
10. Are we preparing more than one return for you today? YES ■■ NO ■■
Other Information:
Last year, did you receive any government related nancial assistance such as CERB or CRB? YES ■■ NO ■■
Any other information:
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© H&R Block Canada, Inc. 2020 91104-4 11-20
