Protected B
when completed
Marital Status Change
Is this form for you?
Use this form to tell us of a change in your marital status. You can also change your marital status using MyCRA or MyBenefits CRA mobile app
at canada.ca/cra-mobile-apps, My Account at canada.ca/my-cra-account, or by calling 1-800-387-1193. In some situations, you may be eligible for
additional child and family benefits. For more information, see page 3 of this form.
You must tell us by the end of the month following the month in which your status changed. However, do not tell us of your separation until you have been
separated for more than 90 consecutive days.
Step 1 – Your information
Social insurance number:
First name:
Last name:
Gender:
Female Male
Date of birth:
Year Month Day
Your language of correspondence:
English Français
Phone numbers:
Home:
Work: Ext:
Cell:
Step 2 – Your address
Mailing address
Apt. No. – Street No., Street name, PO Box, RR:
City:
Province or territory:
Postal code:
Have you moved from a different province or
territory within the last 12 months?
Yes No
If yes, enter the previous province or territory:
Enter the date you moved:
Year Month Day
Home address
Same as mailing address
Apt. No. – Street No., Street name, RR:
City:
Province or territory:
Postal code:
RC65 E (19) (Ce formulaire est disponible en français.)
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Protected B when completed
Step 3 – Your new marital status
Select the box that applies to your new status
(select only one box):
Married
– you are legally married to someone.
Living common-law
– you are living in a conjugal relationship with someone to whom you are not
married and to whom at least one of the following situations applies. They:
have been living with you for at least 12 continuous months. This includes any period you were
separated for less than 90 days because of a breakdown in your relationship
are the parent of your child by birth or adoption
have custody and control of your child (or had custody and control immediately before the child
turned 19 years of age) and your child is wholly dependent on that person for support
Separated
– you have been living apart from your spouse or common-law partner because of a
breakdown in the relationship for a period of at least 90 days and you have not reconciled.
Once you have been separated for 90 days, the effective day of your separated status is the date you
started living apart.
Divorced
– you were married and are now legally divorced.
Widowed
– your spouse or common-law partner is deceased.
Single
– you are single and none of the above apply.
Enter the date this status began:
Year Month Day
If you selected married or living common-law, enter your spouse's or common-law partner's information:
Social insurance number:
First name:
Last name:
Gender:
Female Male
Date of birth:
Year Month Day
If your spouse or common-law partner's address is
different than yours, enter it here; otherwise, their
address will be updated to match the address
indicated in Step 2.
Step 4 – Signature
I certify that the information given on this form and in any attached documents is correct and complete. I understand that it is a serious offence to make a false
statement.
Signature
Date:
Year Month Day
If your new marital status is married or living common-law, your spouse or common-law partner also needs to sign below.
Spouse's or common-law
partner's signature
Date:
Year Month Day
Personal information (including the SIN) is collected for the purposes of the administration or enforcement of the Income Tax Act and related programs and activities including
administering tax, benefits, audit, compliance, and collection. The information collected may be used or disclosed for purposes of other federal acts that provide for the imposition
and collection of a tax or duty. It may also be disclosed to other federal, provincial, territorial or foreign government institutions to the extent authorized by law. Failure to provide this
information may result in interest payable, penalties or other actions. Under the Privacy Act, individuals have the right to access their personal information, request correction, or file
a complaint to the Privacy Commissioner of Canada regarding the handling of the individual's personal information. Refer to Personal Information Bank CRA PPU 005, CRA PPU
063, and CRA PPU 140 on Info Source at canada.ca/cra-info-source
.
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What happens after you send this form?
When we get notification of your change in marital status, we will recalculate your child and family benefits and credits taking into consideration all of
the following:
your new marital status
your new adjusted family net income
your province or territory of residence
Note
You cannot use this form to make a correction to a previously reported marital status change. Corrections must be sent in writing to your tax centre.
Your new marital status may change the number of children in your care (for example, a new child in your care or a new shared custody arrangement). You will
need to let us know, as this may affect your child and family benefits and credits. For more information, go to canada.ca/canada-child-benefit
or see
Booklet T4114, Canada Child Benefit.
We may validate your marital status at a later date.
When will your payments be adjusted?
Your Canada child benefit (CCB) and/or goods and services tax/harmonized sales tax (GST/HST) credit payments will be adjusted the month following the
month that your marital status changed.
For more information about the CCB, go to canada.ca/canada-child-benefit or see Booklet T4114, Canada Child Benefit.
For more information about the GST/HST credit, go to canada.ca/gst-hst-credit or see Guide RC4210, GST/HST Credit.
Direct deposit
Direct deposit is a fast, convenient, reliable, and secure way to get your CRA payments directly into your account at a financial institution in Canada. To sign up
for direct deposit or to update your banking information, go to canada.ca/cra-direct-deposit
.
Where do you send this form?
Send this form and any document to the tax centre that serves your area. Use the chart below to find out the address.
If your tax services office is located in:
Send your correspondence to the following
address:
Alberta, British Columbia, Manitoba, Northwest
Territories, Nunavut, Saskatchewan, or Yukon
Winnipeg Tax Centre
66 Stapon Road
Winnipeg MB R3C 3M2
New Brunswick, Newfoundland and Labrador,
Nova Scotia, Ontario, or Prince Edward Island
Sudbury Tax Centre
Post Office Box 20000, Station A
Sudbury ON P3A 5C1
Québec Jonquière Tax Centre
2251 René-Lévesque Boulevard
Jonquière QC G7S 5J2
For more information
For more information, go to canada.ca/cra-benefits or call 1-800-387-1193.
To get our forms and publications, go to canada.ca/cra-forms
or call 1-800-387-1193.
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