Protected B when completed
For departmental use.

Foreign Income Verification Statement• This form must be used for the 2015 and later taxation years.
• Complete and file this form if at any time in the year the total cost amount to the reporting taxpayerof all specified foreign property was more than $100,000 (Canadian).

• If an election has been made to use a functional currency (see attached instructions), state theelected functional currency code. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• See attached instructions for more information about completing this form.
If this is an amended return, tick this box.

Identification
Tick a box to indicate who you are reporting for, and complete the areas that apply.
First nameLast name

InitialSocial insurance number

Individual code

Individual1
Corporation's name2

Business number

Corporation

R C
Trust's nameAccount number

Trust

T
Partnership code

Partnership's namePartnership

1

2

–

–

Partnership's account number

3

R

Z

Reporting entity's address

No.

StreetCity

Province or territory

Postal codeYear

For what taxation year are you filing this form?

Month

Day

Year

Country code
Month

Day

to

From

Tick the appropriate box that applies for the taxation year:
If the total cost of all specified foreign property held at any time during the year exceeds $100,000 but was less than $250,000, you are required tocomplete either Part A or Part B;
If the total cost of all specified foreign property held at any time during the year was $250,000 or more, you are required to complete Part B.

Part A: Simplified reporting method
For each type of property that applies to you, tick the appropriate box.
Type of property:
Funds held outside Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Shares of non-resident corporations (other than foreign affiliates) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Indebtedness owed by non-resident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Interests in non-resident trusts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Real property outside Canada (other than personal use and real estate used in an active business) . . . . . . . . .
Other property outside Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Property held in an account with a Canadian registered securities dealer or a Canadian trust company . . . . . . .
Country code:
Select the top three countries based on the maximum cost amount of specified foreign property held during the year. Enter the country codes in the boxes below:

Gross income from all specified foreign property$Gain(loss) from the disposition from all specified foreign property $Privacy Act, personal information bank number CRA PPU 035

T1135 E (19)

(Ce formulaire est disponible en français.)

Protected B when completed

Part B: Detailed reporting method
Categories of specified foreign property
In each of the tables below, provide the required details of each specified foreign property held at any time during the particular tax year. If you need additional
space, please attach a separate sheet of paper using the same format as the tables.
A taxpayer who held specified foreign property with a Canadian registered securities dealer or a Canadian trust company is permitted to report the aggregate
amount, on a country-by-country basis, of all such property in Category 7, Property held in an account with a Canadian registered securities dealer or a Canadiantrust company. See attached instructions for Category 7 for details as to how to report under this method.
1. Funds held outside Canada
Countrycode

Name of bank/other entity holding the funds

Maximum funds held
during the year

Funds heldat year end

Gross income

Cost amountat year end

Gross Income

Gain (loss) on
disposition

Cost amountat year end

Gross Income

Gain (loss) on
disposition

Income received

Capital received

Gain (loss) on
disposition

Cost amountat year end

Gross income

Gain (loss) on
disposition

Cost amountat year end

Gross income

Gain (loss) on
disposition

Gross income

Gain (loss) on
disposition

Total
2. Shares of non-resident corporations (other than foreign affiliates)
Countrycode

Name of corporation

Maximum cost
amount during
the yearTotal
3. Indebtedness owed by non-resident
Countrycode

Description of indebtedness

Maximum cost
amount during
the yearTotal
4. Interests in non-resident trusts
Name of Trust

Countrycode

Maximum cost
amount during
the year

Cost amountat year end

Total
5. Real property outside Canada (other than personal use and real estate used in an active business)
Description of property

Countrycode

Maximum cost
amount during
the yearTotal
6. Other property outside Canada
Description of property

Countrycode

Maximum cost
amount during
the year

Total
7. Property held in an account with a Canadian registered securities dealer or a Canadian trust company
Name of registered security dealer/Canadian trust company

Countrycode

Maximum fair market
value during the year

Fair market value
at year-end

Total
Privacy Act, personal information bank number CRA PPU 035

Protected B when completed

Certification
I certify that the information given on this form is, to my knowledge, correctand complete, and fully discloses the reporting taxpayer's foreign property andrelated information.

If someone other than the taxpayer or the partnership preparedthis form, provide their:

Print name

Name

Sign here (It is a serious offence to file a false statement.)

Address

Position/title
Telephone number

Date (YYYYMMDD)

Postal or ZIP code

Telephone number

Privacy Act, personal information bank number CRA PPU 035

Instructions
All legislative references on this form refer to the Income Tax Act (the Act).

How to complete this form

If the reporting taxpayer is a partnership, references to year or taxation year
should be read as fiscal period and references to taxpayer should be readas partnership.

If the total cost of all specified foreign property held at any time during the year
exceeds $100,000 but was less than $250,000, the form has been designed toprovide you with the option of completing either Part A or Part B.

Do you have to file this form?
All Canadian resident taxpayers (including non-resident trusts deemed
resident in Canada by section 94 of the Act) are required to file theForm T1135, Foreign Income Verification Statement if at any time in theyear the total cost amount of all specified foreign property to the taxpayer
was more than $100,000 (Canadian).
An individual (other than a trust) does not have to file Form T1135 for theyear in which the individual first becomes a resident of Canada (section 233.7of the Act).
The following entities do not have to file this form:• a mutual fund corporation or mutual fund trust;• a non-resident-owned investment corporation;• a person all of whose taxable income is exempt from Part I tax;
• a registered investment under section 204.4 of the Act;• a trust described in any of paragraphs (a) to (e.1) of the definition oftrust in subsection 108(1) of the Act;• a trust in which all of the persons beneficially interested are persons
described above;a partnership in which all the members are persons described above; and•• a partnership where the share of the partnership's income or loss

attributable to non-resident members is 90% or more of the income
or loss of the partnership.

What property do you have to report?
You are required to report all specified foreign property in accordance withsubsection 233.3(1) of the Act which includes:• funds or intangible property (patents, copyrights, etc.) situated, depositedor held outside Canada;• tangible property situated outside of Canada;• a share of the capital stock of a non-resident corporation held by the
taxpayer or by an agent on behalf of the taxpayer;• an interest in a non-resident trust that was acquired for consideration,••other than an interest in a non-resident trust that is a foreign affiliate forthe purposes of section 233.4 of the Act;
shares of corporations resident in Canada held by you or for you
outside Canada;
an interest in a partnership that holds a specified foreign property
unless the partnership is required to file Form T1135;
an interest in, or right with respect to, an entity that is a non-resident;•• a property that is convertible into, exchangeable for, or confers a right toacquire a property that is specified foreign property;• a debt owed by a non-resident, including government and corporate
bonds, debentures, mortgages, and notes receivable;• an interest in a foreign insurance policy; and• precious metals, gold certificates, and futures contracts held
outside Canada.
Specified foreign property does not include:• a property used or held exclusively in carrying on an active business;• a share of the capital stock or indebtedness of a foreign affiliate;• an interest in a trust described in paragraph (a) or (b) of the definition of

Where a particular specified foreign property has been reported all of the otherfields associated with that particular property must also be completed. All nil
amounts should be reported by indicating "0" in the corresponding field rather
than leaving it blank. Amounts should be rounded to the nearest dollar.

Functional currency
If an election has been made under paragraph 261(3)(b) of the Act to report ina functional currency, state all monetary amounts in that functional currency,
otherwise state all monetary amounts in Canadian dollars. The codes for thefunctional currencies are as follows:
AUD – for Australian dollar
USD – for U.S. dollar
GBP – for U.K. pound
EUR – for Euro

Identification
Tick the appropriate box to identify the category of taxpayer filing this form.
Provide the taxpayer's name, address, and identification number. Provide thetaxation year for which this form is being filed.

Reporting individual/partnership identification
For individual code, tick:
1. If the individual or the individual's spouse (common-law partner) is
self-employed.
2. If the individual and the individual's spouse (common-law partner) areboth not self-employed.
For partnership code, tick:
1. If end partners are individuals or trusts.
2. If end partners are corporations.
3. If end partners are a combination of 1 and 2 mentioned above.
An end partner is the final recipient (corporation, trust or individual) thatreceives an allocation of income from the partnership after the income has
flowed through the various levels of a tiered partnership.

Categories of specified foreign property
This form contains seven tables corresponding to different categories of
specified foreign property. Report the detail of each particular property thatwas held at any time during the year in the appropriate category.

Country codes
For the list of country codes, see List of country codes or the CRA
publication T4061 entitled NR4 – Non-Resident Tax Withholding,
Remitting and Reporting Guide, Appendix A .
The country code for each category should identify:• Category 1 – the country where the funds are located;• Category 2 – the country of residence of the non-resident corporation;• Category 3 – the country of residence of the non-resident issuer;• Category 4 – the country of residence of the trust;• Category 5 – the country where property is located;• Category 6 – the country where property is located;• Category 7 – depending on the type of property, use the instructions
above from categories 1 to 6.

"exempt trust" in subsection 233.2(1) of the Act;• a personal-use property as defined in section 54 of the Act; and• an interest in, or a right to acquire, any of the above-noted excluded
foreign property.
For frequently asked questions or examples, see Questions and answers about
Form T1135 on the CRA website at canada.ca/en/revenue-agency/services/
forms-publications/forms/t1135.html.

If you are uncertain of the appropriate country code for a particular specified
foreign property, select "OTH" for "Other."

Cost amount/Maximum cost amount
Cost amount is defined in subsection 248(1) of the Act and generally would
be the acquisition cost of the property. If you immigrate to Canada, the cost
amount is the fair market value of the property at the time of immigration.
Similarly, if you received specified foreign property as a gift, or inheritance,
the cost amount is its fair market value at the time of the gift or inheritance.
The maximum cost amount during the year can be based on the maximum
month-end cost amount during the year.

Foreign currency conversion
The amounts to be reported on Form T1135 should be determined in theforeign currency then translated into Canadian dollars. Generally, whenconverting amounts from a foreign currency into Canadian dollars, use theexchange rate in effect at the time of the transaction (i.e. the time the income
was received or the property was purchased). If you received income
throughout the year, an average rate for the year is acceptable.
The following summarizes how other amounts of the form should be translated:• Maximum funds held during the year – the average exchange rate forthe year.

• Funds held at year end – the exchange rate at the end of the year.
• Maximum fair market value during the year – the average exchange rate
for the year.

• Fair market value at year end – the exchange rate at the end of the year.
TablesSpecified foreign property has been divided into seven (7) categories andshould be reported in one of the following tables:
1. Funds held outside Canada
Funds held outside Canada include money on deposit in foreign bankaccounts, money held with a foreign depository for safekeeping and money
held by any other foreign institution at any time during the year. Prepaid debit
or credit cards and negotiable instruments, such as cheques and drafts, arealso included in this category. Marketable securities should be reported in
category 3.
2. Shares of non-resident corporations (other than foreign affiliates)
Report all shares of non-resident corporations whether or not they arephysically held in Canada.
Do not report shares of a foreign affiliate corporation. Generally, a foreign
affiliate is a non-resident corporation (or certain non-resident trusts) of which
you hold at least 1% of the shares individually, and, either alone or withrelated persons, hold 10% or more of the shares. If you have a foreign affiliate,
you may have to file Form T1134, Information Return Relating to Controlled
and Not Controlled Foreign Affiliates.
3. Indebtedness owed by non-residents
Report all amounts owed to you by a non-resident person (other than aforeign affiliate corporation) whether the indebtedness is held inside oroutside Canada. Include all promissory notes, bills, bonds, commercial paper,
debentures, loans, mortgages, and other indebtedness owed to you by anon-resident person. Marketable securities, such as guaranteed investment
certificates, government treasury bills and term deposits issued by anon-resident, should be reported under this category.
4. Interests in non-resident trusts
Report all interests in non-resident trusts acquired for consideration, other thana non-resident trust that is a foreign affiliate for the purposes of section 233.4of the Act.
If you contributed to, or received a distribution or loan from, a non-resident
trust you may be required to file Form T1141, Information Return in Respectof Contributions to Non-Resident Trusts, Arrangements or Entities orForm T1142, Information Return in Respect of Distributions from andIndebtedness to a Non-Resident Trust.
5. Real property outside Canada
Report all real property located outside of Canada other than real property
used in an active business or used primarily for personal use (such as avacation property used primarily as a personal residence). Rental property
outside Canada should be included in this category.

6. Other property outside CanadaThis category should include any property that does not correspond to any of
the other categories.
Other property includes:• shares of corporations resident in Canada held by you or for you
outside Canada;• an interest in a partnership that holds specified foreign property where
the partnership is not required to file the Form T1135;• foreign insurance policies;• precious metals or bullion (e.g., gold and silver) situated outside Canada;• commodity or future contracts, options or derivatives that constitute aright to, a right to acquire, or an interest in, specified foreign property; and• any other rights to, rights to acquire, or interests in, specified
foreign property.
7. Property held in an account with a Canadian registered securities
dealer or a Canadian trust company
A taxpayer who held specified foreign property with a Canadian registeredsecurities dealer (as defined in subsection 248(1) of the Act) or with a
Canadian trust company (as determined under paragraph (b) of the definitionof restricted financial institution in subsection 248(1) of the Act) is permitted toreport the aggregate amount of all such property in this category.
The table for this category should be completed as follows:• all of the property held with a particular securities dealer or trust company
should be aggregated on a country-by-country basis;• it is also acceptable to provide aggregate totals for each particular
account on a country-by-country basis;• refer to the "country code" instructions above to determine theappropriate country for each property; and• the maximum fair market value during the year may be based on the
maximum month-end fair market value.

Certification
This area should be completed and signed by:• the person filing this form in the case of an individual;• an authorized officer in the case of a corporation;• the trustee, executor or administrator in the case of a trust; or• an authorized partner in the case of a partnership.
Due dates for filing this form
Form T1135 must be filed on or before the due date of your income tax returnor, in the case of a partnership, the due date of the partnership information
return, even if the income tax return (or partnership information return) is not
required to be filed.

Filing by internet (EFILE or NETFILE)
Individuals, corporations, and partnerships can file Form T1135 electronically.

• Individuals can file Form T1135 electronically (EFILE or NETFILE) for
the 2015 and subsequent taxation years.

• Corporations can EFILE Form T1135 electronically for the 2014 andsubsequent taxation years.

• Partnerships can file Form T1135 electronically (EFILE or NETFILE) for
the 2017 and subsequent taxation years.
Trusts are required to file a paper copy of this form.

• EFILE – Your EFILE service provider, including a discounter, cancomplete and file your Form T1135 for you if prepared with tax
preparation software certified by the CRA for the internet filing ofForm T1135. For more information, go to EFILE for individuals andEFILE for corporations.

• NETFILE – You can file your Form T1135 by Internet if prepared withtax preparation software certified by the CRA for the internet filing ofForm T1135. Most individuals are eligible to NETFILE. For more
information or to file your Form T1135, go to NETFILE
at canada.ca/netfile.

Filing a paper return

More information

Form T1135 can be attached to your income tax return, or partnership
information return, and mailed to your tax centre. Alternately, Form T1135
can be mailed separately to the following address:

If you need more information visit our website at canada.ca/taxes.
Alternatively you can call general enquires at:

Winnipeg Taxation Centre
Data Assessment & Evaluation Programs
Validation & Verification Section
Foreign Reporting Returns
66 Stapon Road
Winnipeg MB R3C 3M2• 1-800-959-5525 for businesses, self-employed individuals andpartnerships; or• 1-800-959-8281 for individuals (other than self-employed individuals)
and trusts.
You may also contact your local tax services office. Our addresses and fax
numbers are listed on our website and in the government section of yourtelephone book.

Penalties for non-compliance

Privacy notice

There are substantial penalties for failing to complete and file Form T1135
accurately and by the due date. For additional information regarding penalties,
see the Table of penalties CRA website at canada.ca/en/revenue-agency/
services/forms-publications/forms/t1135.html.

Personal information is collected under the authority of section 233.3 of the
Act and is used to monitor compliance with the foreign reporting requirements
related to offshore investments. Information may also be used for theadministration and enforcement of the Act, including audit, enforcement action,collections, and appeals, and may be disclosed under information-sharing
agreements in accordance with the Act. Incomplete or inaccurate information
may result in various compliance actions, including the assessment ofmonetary penalties.

Voluntary disclosures
To promote compliance with Canada's tax laws, we encourage you tocorrect your tax affairs through the Voluntary Disclosures Program. For
more information, see Information Circular IC00-1R6, Voluntary Disclosures
Program (VDP) or visit the CRA website.

Your Social Insurance Number is the authorized number for income
tax purposes under section 237 of the Act and is used under certain
federal programs.
Information is described in personal information bank CRA PPU 035
in the Canada Revenue Agency (CRA) chapter of the Info Source
publication at canada.ca/cra-info-source. Personal information isprotected under the Privacy Act and individuals have a right of protection,access to, and correction of their personal information. Further details
regarding requests for personal information at the CRA can be foundat canada.ca/cra-access-information-privacy.