Protected A when completed
Office of the Taxpayers' Ombudsman
Permission to Disclose
***Please do not include your Social Insurance Number, Business Number, or any personal information
other than what is requested below***
File Number (as provided by the Office of the Taxpayers' Ombudsman):
Title (optional)
Mr. Ms. Other
First name
Last name
Section 1 – Identification
I understand that, in reviewing my complaint, the Office of the Taxpayers' Ombudsman (OTO) may need to share my information with the CRA. This
includes my complaint form, any supporting documentation, and any additional information provided to the OTO, and I consent to such disclosure. I
give consent to the OTO to refer my complaint and the aforesaid information and documentation to the CRA Service Complaints program for a first
level review if my complaint has not already been addressed through the CRA Service Complaints program. I further understand the CRA may also
need to share information with the OTO for the purpose of the OTO reviewing my complaint, and I consent to such disclosure.
Signature of complainant (or, if a corporation or organization, signature of authorized representative)
Year Month Day
Section 2 – Consent to disclose information
Section 3 – Submitting this form
You can submit the completed form to us by:
Fax: 1-866-586-3855
Email: (please put your file number in the subject line)
Mail: Office of the Taxpayers' Ombudsman
171 Slater Street, Suite 1000
Ottawa ON K1P 5H7
Privacy Notice – 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 the Taxpayers’ Ombudsman’s Personal Information Bank
CRA PPU 222 on Info Source at
OMB116 E (18)
Clear Data