Tax year CANADA CHILD TAX BENEFIT STATEMENT OF INCOME Complete

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                                                                                                                                                                                         Tax year
                                             CANADA CHILD TAX BENEFIT - STATEMENT OF INCOME

 Complete this form if you are receiving the Canada Child Tax Benefit                                                Enter the year your spouse or common-law partner was a
 (CCTB) and your spouse or common-law partner was a non-resident of                                                  non-resident in the "Tax year" box above.
 Canada for any part of the year you indicated above. Complete this form                                             If you want more information or you need help to complete
 even if your spouse or common-law partner had no income so that we can                                              this form, call 1-800-267-5177 in Canada and the United
 calculate your CCTB payments. To continue receiving the CCTB, you have                                              States. If you live outside Canada or the United States,
 to fill out this form and send it to us after each year (or part of a year) that                                    call 613-952-3741. We accept collect calls.
 your spouse or common-law partner was a non-resident of Canada.

   Information about the CCTB applicant
    First name and initial                                                      Last name                                                                    Social insurance number

    Mailing address                                                                                       Home address (if different from mailing address)
    Apt. no. – Street no. Street name                                                                     Apt. no. – Street no. Street name

    P.O. Box                                           R.R.                                               City

    City                                                Prov./Terr.            Postal code                Province or territory                                                 Postal code



    Telephone numbers                             Home                                                                                     Work


   Information about your spouse or common-law partner
    First name and initial                                                      Last name                                                                    Social insurance number (SIN)

    Mailing address: Apt. no. – Street no. Street name                                           P.O. Box                    R.R.
                                                                                                                                                             Check this box if he or
                                                                                                                                                             she does not have a SIN
    City
                                                                                                                                                                                 Date of birth
    Province or territory (country, if outside Canada)                                                                  Postal code                                       Year          Month    Day



    Statement of income                            (Complete part A, B, or C, whichever applies.)
    Enter your spouse's or common-law partner's income in Canadian dollars from all sources inside and outside Canada.
    Do not include income that was reported on a Canadian tax return. If he or she had no income, enter "0."

    A.       If your spouse or common-law partner was a non-resident of Canada for the whole year,
             enter his or her income for the whole year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                           Year         Month    Day
    B.       If your spouse or common-law partner became a non-resident of Canada in the year,
             enter the date he or she became a non-resident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                 2 0


             Enter the income for the part of the year that he or she was a non-resident of Canada . . . . . . . . . . . . . . . . . . . .

                                                                                                                                                                           Year         Month    Day
    C.       If your spouse or common-law partner became a resident of Canada in the year,
             enter the date he or she became a resident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .             2 0

             Enter the income for the part of the year that he or she was a non-resident of Canada . . . . . . . . . . . . . . . . . . . .

   Certification
    I certify that the information given on this form and in any documents attached, is correct.


    Sign here                                                                                                                                                     Date
                                                             It is a serious offence to make a false statement.
                                                                                                                                         Privacy Act Personal Information Bank number CRA/P-PU-063
CTB9 (08)
Printed in Canada                                                                    (Français au verso)