Undertaking To File An Income Tax Return By A Non-Resident Receiving Rent From Real Property Or Receiving A Timber Royalty
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1
2Canada Customs
Agence des douanes
UNDERTAKING TO FILE AN INCOME TAX RETURN BY
and Revenue Agency
et du revenu du Canada
A NON-RESIDENT RECEIVING RENT FROM REAL PROPERTY
OR RECEIVING A TIMBER ROYALTY
for tax year
Before completing this form, please read the instructions on the back.
Section 1 – Non-resident identification
Last name or, if applicable, complete name of the corporation, trust, or estate
Social insurance number or
First name
Canadian tax identification number
Address (street number and name)
Date of birth
Year
Month
Day
City
Country
Postal or zip code
Canadian corporation, trust, or
estate tax account number
Fiscal year end for corporation, trust,
Area code and telephone number
or estate
Year
Month
Day
(
)
Mailing address if different than above
Do not write in this area
C/O
Street number and name
City
Country
Postal or zip code
Section 2 – Rental property information
*
Addresses of all rental properties (list additional properties on a separate sheet)
Gross rents
Total expenses
Net income
Address
City
Province
Postal code
Address
City
Province
Postal code
Address
City
Province
Postal code
*
Provide a breakdown of expenses for each property on a separate sheet (see Section 2 on the back).
Total
Section 3 – Undertaking by non-resident
I, the undersigned, undertake to file an income tax return under subsection 216(4) of the Canadian Income Tax Act for the tax year indicated
above, within six months of the tax year, to include all rents from my real property and timber royalities, and to pay any additional tax owing. If I do
not fulfill these obligations, I will have to pay to the Receiver General for Canada, the full amount of tax that I would otherwise have been required
to remit in the year, as well as applicable interest charges.
Non-resident’s signature
Name of representative* (please print)
Date
* If you sign for the non-resident, print your name on this line and provide a copy of the power of attorney document.
Section 4 – Canadian agent* identification
Name (individual or company)
Non-resident tax account number
J
4 9 0 2 9
7
N R
Landlord Property & Rental Management Inc.
Address (street number and name)
Year
Month
Date the first rental
82 Avenue Rd, 2nd Floor
payment is due
City
Province
Postal code
Area code and telephone number
Toronto
Ontario
M5R 2H2
(
416
)
462 3800
* For purposes of this form, the "agent" must be a resident of Canada to whom the rental payments are paid or credited on behalf of the
non-resident when this form is signed.
I, the undersigned, declare that I am the Canadian agent of the non-resident indicated in Section 1. If the non-resident does not file an income tax
return or pay tax according to the undertaking, I understand that I will have to pay to the Receiver General for Canada the full amount of tax that
would otherwise have been required to be remitted for the year, as well as applicable penalty and interest charges.
Agent’s signature
Name of individual signing on the agent’s* behalf (please print)
Date
* If the agent is a company, print the name of the person signing on the agent’s behalf.
NR6 E (00)
(Ce formulaire existe en français.)
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