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Disability Tax Credit Form
We help Canadians with disabilities receive a tax deduction (within 30 seconds).
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1
Name
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First Name
Last Name
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2
Are you or someone in your family physically or mentally unwell?
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This can include trouble walking, speaking, hearing, or functioning in daily life, etc.
Yes
No
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3
Is the unwell person:
*
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Yourself or your spouse
Your Child
Someone I financially support or regularly assist
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4
Child's name
*
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First Name
Last Name
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5
Child's date of birth
*
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-
Date
Year
Month
Day
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6
Email
*
This field is required.
example@example.com
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7
Phone Number
*
This field is required.
Please enter a valid phone number.
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8
Form submission
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DTC Q1-Jotform
DTC Q1-Jotform
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DTC Q1-Jotform
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9
DTC Lead Source
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In House
In House
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In House
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10
Marketing Source
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DTC Facebook - G
DTC Facebook - G
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DTC Facebook - G
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11
DTC Create Deal
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Yes
Yes
Please Select
Yes
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12
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