Fillable Printable Child Tax Benefit Application Form - Canada
Fillable Printable Child Tax Benefit Application Form - Canada
Child Tax Benefit Application Form - Canada
Part 1 – Information about the applicant
CANADA CHILD TAX BENEFIT APPLICATION
Use this form to apply for the Canada Child Tax Benefit (CCTB), to register your children under the
age of 19 for the goods and services tax/harmonized sales tax (GST/HST) credit, or both.
RC66 E (06)
Do not use this area
If you moved from a different province or territory, name the previous province or territory
If you moved to this address within the last 12 months, enter the date you moved
MonthYear Day
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . .
Social insurance number
First name and initial
()
Last name
Enter the date your current status began. (If you checked 2 or 5, see the definitions for living
common law and separated in Part 2 of this form)
Month
Year
Day
We define married, living common law, and separated in Part 2.
Check the box that shows your current marital status.
20
Married
1
2
Living common law
5
Separated Divorced Single
3
Widowed
4 6
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Complete schedule RC66SCH, Status in Canada/Statement of Income, if you or your spouse or common-law partner:
Yes
No
()
Last name at birth (if different from last name above)
Female Male
Province or territory (or country, if outside Canada)
Date of birth
Month
Year Day
Apt. no. – Street no. Street name P.O. Box, R.R.
City
Postal code
Language of correspondence
English
Français
Work telephone number
Home telephone number
Postal code
Home address (if different from above):
Province or territory (or country, if outside Canada)
Apt. no. – Street no. Street name
Have you been a Canadian citizen for at least 12 months?
Mailing address:
If you are the person who is primarily responsible for a child under the age of 18, you can apply for
the CCTB for that child. For CCTB purposes, when both a male and a female parent live in the same
home as the child, we presume that the female parent is primarily responsible for the child and should
apply, unless a note from the female parent is attached to this application that states that the male parent is
primarily responsible for the child. Complete this form as soon as possible after the child is born or begins to live with you, or when
you become a resident of Canada. This form is also used to determine if you can get benefits or credits from provincial or territorial
programs we administer. See pamphlet T4114, Your Canada Child Tax Benefit, for more details about the CCTB.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
City
If yes, and any of the three conditions above apply to that period, complete schedule RC66SCH, Status in Canada/Statement of
Income. If yes, and none of the three conditions above apply to that period, you must attach to this application a legible photocopy of
proof of your and your spouse or common-law partner's citizenship (e.g., Canadian birth certificate) for that period.
(Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca ou au 1 800 959-3376.)
Yes No
. . . . . . . . .
Does your application for CCTB include a period that started more than 11 months ago?
If no, you must complete the schedule RC66SCH, Status in Canada/Statement of Income.
are a permanent resident, protected person (refugee), or temporary resident (who has lived in Canada for the previous 18 months),
as defined in the Immigration and Refugee Protection Act; or
became a Canadian citizen in the last 12 months;
became a new resident or returned as a resident of Canada in the last 2 years.
z
z
z
Note: The information you give on this form will be used for both programs, unless you indicate
otherwise on an attached note.
When both a male and female parent reside in the same home, we usually consider the female parent to be the applicant.
1)
You have a common-law partner and are
living common law if you are living in a
conjugal relationship with a person who is
is the parent of your child by birth or adoption; or
Living common law
You are married and have a spouse when
you are legally married.
Married
Part 2 – Information about your spouse or common-law partner
Social insurance number
Month
Year Day
If your spouse or common-law partner's address is different from your address, please explain:
First name and initial
Last name
You are separated when you start living
separate and apart from your spouse or
common-law partner because of a breakdown in
the relationship for a period of at least 90 days
and you have not reconciled.
Separated
Date of birth
Last name at birth (if different from last name above)
Female Male
has been living with you in a conjugal relationship for at least 12 continuous
months;
2)
Attach legible photocopies of all sides of all pages of one of the following documents for proof of birth:
Proof of birth
a baptismal or cradle roll certificate or other church record;
a birth certificate or birth registration;
the hospital record of birth or the record of the physician,
nurse, or midwife who attended the birth;
z
What is this child's relationship to you?
If no, when did you become primarily responsible for the child?
Place of birth:
City
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
MonthYear Day
Female Male
MonthYear Day
Have you been primarily responsible for this child since birth?
Yes No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Province or territory (or country, if outside Canada)
First name and initial
Last name
First child
Part 3 – Information about your child(ren)
Yes No
Has your spouse or common-law partner been a Canadian citizen for at least 12 months?
. . . . . . . . . . .
Complete this part to provide information about your child(ren).
Do not provide information about a child for whom you have already applied, or for whom you receive, the CCTB.
Date of birth
Note: Separated status begins on the first
day of the period (at least 90 days) in which
you lived apart.
In addition, an individual immediately becomes your common-law partner if you
previously lived together in a conjugal relationship for at least 12 continuous
months and you have resumed living together in such a relationship. Under
proposed changes, this condition will no longer exist. The effect of this
proposed change is that a person (other than a person described in 2) or 3)
above) will be your common-law partner only after your current relationship with
that person has lasted at least 12 continuous months. This proposed change will
apply to 2001 and later years.
a passport;
z
z
a Notice of Decision or a Temporary Resident's Permit
issued under the Immigration and Refugee Protection Act.
a Record of Landing or Confirmation of Permanent Residence
issued by Citizenship and Immigration Canada;
3)
has custody and control of your child (or had custody and control
immediately before your child turned 19 years of age) and your child is wholly
dependent on that person for support.
z
a citizenship certificate; or
z
z
z
Attach proof of birth to this completed form if the Canada Revenue Agency has not previously paid CCTB benefits or
the GST/HST credit for the child, and either of the following applies:
z
z
the child was born outside Canada; or
the child was born in Canada and is one year of age or older.
Reference to "12 continuous months" in this definition includes any period that
you were separated for less than 90 days because of a breakdown in the
relationship.
(Do not include children for whom you have already applied.)
If no, you must complete schedule RC66SCH, Status in Canada/Statement of Income.
. . . . . .
not your spouse, and any of the following applies. He or she:
If you are applying for more than three children, use a separate sheet of paper to give the information requested above for the
additional children. Sign the sheet and attach it to your completed form.
What is this child's relationship to you?
If no, when did you become primarily responsible for the child?
Date of birth
Place of birth:
City
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
MonthYear Day
Female Male
MonthYear Day
Have you been primarily responsible for this child since birth?
Province or territory (or country, if outside Canada)
First name and initial
Last name
Second child
What is this child's relationship to you?
If no, when did you become primarily responsible for the child?
Date of birth
Place of birth:
City
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
MonthYear Day
Female Male
MonthYear Day
Have you been primarily responsible for this child since birth?
Province or territory (or country, if outside Canada)
First name and initial
Last name
Third child
Yes No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Complete this part if someone else has applied for, or is receiving, the CCTB for the child(ren).
If you cannot get the previous caregiver's signature, please explain:
Date the child(ren) left the
previous recipient's care
MonthYear Day
Previous caregiver's signature
Part 4 – Change of recipient
I certify that the information given on this form is, to the best of my knowledge, correct and complete.
If you cannot get your spouse or common-law partner's signature, please explain:
Spouse or common-law partner's signature
Part 5 – Certification
We cannot process this form unless it is signed. If you are married or living common law, your spouse or common-law partner
also needs to sign this form.
It is a serious offence to make a false statement.
Date
Applicant's signature
Date
Use the checklist on the back of this page to be sure you have filled out all the proper sections. You will also find
information on where to send your completed form and a section to apply for direct deposit for your CCTB payments.
Part 3 – continued
Name, address, and telephone number
of previous caregiver or agency
Name of child (or children)
20
It is a serious offence to make a false statement.
(Do not include children for whom you have already applied.)
(Do not include children for whom you have already applied.)
If you do not have direct deposit for your CCTB payments and you want to start, provide the banking information requested below.
If you do not have direct deposit for your income tax refund or GST/HST credit and you want to start, or you have it and want to
change the account information, complete Form T1-DD(1), Direct Deposit Request – Individuals.
Complete all parts of the form that apply to you and to your spouse or common-law partner.
Attach legible photocopies of all required documents (such as immigration documents and proof of birth).
We want to process your completed form as soon as we can. Be sure to do the following:
Checklist
For information about the CCTB or to get pamphlet T4114, Your
Canada Child Tax Benefit, visit our Web site at
www.cra.gc.ca/benefits. You can also get the pamphlet by calling
1-800-959-2221 or get information by calling 1-800-387-1193.
Additional information
We can only calculate your CCTB if you and your spouse or common-law partner have filed a return for the previous year (if you were a
resident of Canada in that year). To continue getting the CCTB, you both have to file a return every year that you are a resident in Canada,
even if you have no income to report. However, if your spouse or common-law partner is a non-resident, he or she must report his or
her income on Form CTB9, Canada Child Tax Benefit Statement of Income.
Complete and attach the schedule Status in Canada/Statement of Income if it applies to you or to your spouse or common-law
partner.
For information about the GST/HST credit or to get
pamphlet RC4210, GST/HST Credit, visit our Web site at
www.cra.gc.ca/benefits. You can also get the pamphlet by
calling 1-800-959-2221 or get information by calling
1-800-959-1953.
Privacy Act Personal Information Bank number CRA/P-PU-140
CCTB
GST/HST credit
This form is used to register your child(ren) under 19 years
of age for the GST/HST credit. If you did not apply for the
GST/HST credit on your last return, you can apply now by
including a letter with this form.
Sign this form. If you are married or living common law, your spouse or common-law partner must also sign this form.
Send us your completed form and any required documents in the
envelope included with your package. If you do not have the
preprinted envelope, send them to one of our tax offices. You can
find the addresses on our Web site at www.cra.gc.ca/benefits or in
pamphlet T4114, Your Canada Child Tax Benefit.
Where to send your completed form
Printed in Canada
If you use direct deposit for your CCTB payments, we will automatically deposit (into the same account) any payments from related
provincial or territorial benefit and credit programs that we administer.
If you are changing any account into which we deposit a payment, do not close the old account before we deposit the payment into
the new account. If your financial institution tells us that you have a new account, we may deposit your payments into the new
account. If we cannot deposit a payment into your account, we will mail a cheque to you at the address we have on file.
Your direct deposit request will stay in effect until you change the information or cancel the service. However, your payments
may stop if you move and do not give us your new address.
Branch number
(5 digits)
Institution number
(3 digits)
Account number
(12 digits maximum)
Name of financial institution
If you have direct deposit for your CCTB payments for other children and your account information has not changed, you do not
need to complete this part. If your account information has changed, provide the banking information requested below.
Attach a blank cheque with the banking information encoded on it and write "VOID – CCTB" or complete the banking information
requested below. To find these numbers, see your passbook, bank statement, encoded deposit slip, or cheque, or contact your
financial institution.
z
Banking information
. . . . . . . . . . . . . . . . . . . . . . . . . . .
z
If you have direct deposit for your tax refund and GST/HST credit payments and you want your CCTB payments
deposited into the same account, check this box. If you want your CCTB payments deposited into a different
account, do not check the box. Provide the banking information requested below
z
Part 6 – Direct deposit
If you checked the box above, do not provide your banking information.
