Authorizing or Cancelling a Representative
SIN, TTN or ITN
Name
First name
Last name
If you are the taxpayer, you must sign and date this form. If you are the legal representative, you must tick the box below, and sign and date this form.
I am the legal representative for this taxpayer or estate/trust executor/administrator, power of attorney, the legal guardian or the trustee or custodian of this trust account
Print name of taxpayer or each legal representative
Signature (If you are unable to sign from your device, please go to part 2)
Part 2 - Type name here, please clear Signature above.
Year Month Day
Preview PDF
Submit
Should be Empty: