Tax Preparation Client Intake Form
Filing Status
Single
Married Filing Separate
Married Filing Joint
Widowed
Seperated
Divorced
Common-law Filing Joint
Common-law Filing Seperate
If marital status changed during the year, provide date of change
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Month
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Day
Year
Date
Taxpayer Information
Name
First and Middle Name as per Notice of Assessment
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
SIN
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Is this individual dependent of another?
Yes
No
Spouse Information
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
SIN
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Is this individual dependent of another?
Yes
No
Dependents
Enter your dependents here
Name
SIN
Date of Birth (Month/Day/Year)
Relationship
1
2
3
4
5
6
Do any of the dependents require their own tax returns, which ones?
Tax Related Questions of the individual
Employment Status
Employed
Unemployed
Self-employed
Retired
Province or territory of residence on December 31?
ON
Other
Did you immigrate to Canada or emigrate from Canada during the year?
Yes
No
If yes, date entered Canada
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Month
-
Day
Year
Date
Or if departed, date of departure
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Month
-
Day
Year
Date
Canadian Sourced non-resident income?
Are you a Canadian citizen?
Yes
No
If yes do you authorize the CRA to provide your name, address and date of birth to Elections Canada?
Yes
No
Did you own or hold foreign property with a total cost betweenCDN$100,000 and CDN$250,000 at any time during the year?
Yes
No
If yes, please provide us with a list and all relevant details?
Did you own or hold foreign property with a total cost of more than CDN$250,000 at any time during the year?
Yes
No
If yes, please provide us with a list and all relevant details?
Do your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
Did you rent a property during the year?
Yes
No
What was the total rental amount for the tax year?
What is the name of the landlord/company you paid rent to?
How long have you been renting this property?
# of months
Do you have your own home?
Yes
No
Do you have documents that shows you paid for property taxes?
Yes
No
What was the total amount of Property tax paid during the tax year and the municipality it was paid to?
Did you sell any stock?
Yes
No
General income/ Deductions
Please fill-up the information within the current year only.
General Income checklist
documents provided
T4 slips - Employment income
T4A – Commission and self-employment
T4E – Employment insurance
T5007 – Social assistance
Eployment income or taxable benefits not shown on the T4 slip? Tips?
Investment Interest
Self-employed income
Rental income
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of
General Expenses
Amount
Medical Expenses
Dental Expenses
Health Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Union and professional dues as well as the names of the organizations
List of childcare expenses, with receipts, for each child?
List of moving expenses paid in the year. (relocate for work or study)
List of spousal support payments made or received?
List of deductible employment expenses? Attach a signed T2200
Home accessibility tax credit?
Total Expenses
Pension income
General Income checklist
documents provided
T4A – Pension, retirement and annuity income?
T4AP – Canada pension plan benefits?
T4A(OAS) Old age security pension slip/foreign pensions?
T4A(RCA) – Retirement compensation arrangements?
T4RSP – Registered retirement savings plan income?
T4RIF – Registered Retirement income fund income?
Foreign pensions
Does the taxpayer elect to split eligible pension income with his/her spouse or common-law partner?
Yes
No
Investment income/ deductions
documents provided
T3 – Income from trust allocations?
T5 – Investment income?
T4PS – Income from profit sharing plans?
T5013 – Partnership income?
T5008 – Income from securities transactions? Book Value of disposed stock.
Investment fees
RRSP/pool registered pension plan Contributions and withdrawals
documents provided
T-slip for contributions made attached? – for you
T-slip for contributions made attached? – for spouse by you
Were any amounts repaid during the year to a home buyers’ plan or a lifelong learning plan?
Were any withdrawals made?
Other credits
documents provided
T2202 – Tuition/education amount for taxpayer? – total paid
T2202 – Tuition/education amount claimed/ transferred?
Student loan interest?
First-time making charitable donations?
Charitable donations
Political contributions
Statement for new home to claim the first-time home buyer’s amount.
documents provided
T2202 – Tuition/education amount for taxpayer? – total paid
T2202 – Tuition/education amount claimed/ transferred?
Student loan interest?
First-time making charitable donations?
Charitable donations
Political contributions
Statement for new home to claim the first-time home buyer’s amount.
Tax Return Information/ Correspondence
Would you like to sign up for email notification from the CRA?
Yes
No
Do you authorize Anca Rotaru to access your information with the CRA?
Yes
No
Attach a void check for direct deposit
Principal residence designation
Did you dispose a property (or properties) the tax year for which you claim a principal residence exemption?
Yes
No
If yes: Did you use it all years owned as principal resident?
For partial years please complete form T2091 (IND) Designation of a property as a principal residence by an individual.
Please provide the address, Year of acquisition, proceeds of disposition
Additional comments
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true. I allow ABC Financial to capture my sensitive data like personal id, government id, social security number (SSN), and other information. I have read the terms and conditions and privacy policy of ABC Financial. By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed
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Month
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Day
Year
Date
Taxpayer Signature
Date Signed
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Month
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Day
Year
Date
Spouse Signature
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