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Canada Child Benefits Application

includes federal, provincial, and territorial programs

Find out if this form is for you

Fill out this form to apply for the Canada child benefit and register your children for the goods and services tax/harmonized sales tax (GST/HST) credit, the
climate action incentive payment (CAIP) and related federal, provincial, or territorial programs the Canada Revenue Agency (CRA) administers. You can also use
this form if you started a shared-custody situation for one or more children.
Do not fill out this form if you already applied using My Account on the CRA website or when you registered the birth of your newborn with your province or
territory (except Yukon and Nunavut).

Who should fill out this form

The person who is primarily responsible for the care and upbringing of the child should apply (see "Primarily responsible for the care and upbringing of the
child" on page 3).
When a child resides with a female parent in the home, the female parent is usually considered to be primarily responsible for the child and should apply.
However, if the child’s other parent is primarily responsible, they should apply and attach a signed letter from the female parent stating that the other parent with
whom she resides is primarily responsible for all the children in the home. If the child lives with same-sex parents, only one parent should apply for all the
children in the home.

For more information

For more information on the Canada child benefit, including eligibility requirements, go to canada.ca/cra-benefits, see Booklet T4114, Canada Child Benefit, or
call 1-800-387-1193. From outside Canada or the United States, call 1-613-940-8495. We accept collect calls by automated response.

Step 1 – Your information

Social insurance number (SIN): 9 5 2 7 6 5 1 1 3
If you do not have a SIN, see Booklet T4114, Canada Child Benefit, under "How to apply."

First name: Hoda

Last name: Abdalla

Date of birth: 1 9 8 1 1 2 0 7
Year Month Day

Your language of correspondence: ✔ English Français

Phone numbers: Home: Work: Ext: Cell: (438)270-7274

Step 2 – Your address

Mailing address
Apt. No. – Street No., Street name, PO Box, RR: 7676, 14e Avenue

City: Montreal

Province or territory (or country if outside Canada): Quebec

Postal or ZIP code: H2A2W3

Have you moved from a different province or

territory within the last 12 months? Yes ✔ No

If yes, enter the previous province or territory Date:

and the date you moved:
Year Month Day

Home address ✔ Same as mailing address

Apt. No. – Street No., Street name, RR:

City:

Province or territory (or country if outside Canada):

Postal or ZIP code:

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Step 3 – Your marital status

Select the box that applies to your current Married – you are legally married to someone.
status (select only one box):
Living common-law – you are living in a conjugal relationship with someone to whom you are not
married and to whom at least one of the following situations applies. They:
• have been living with you for at least 12 continuous months. This includes any period you were
separated for less than 90 days because of a breakdown in your relationship
• are the parent of your child by birth or adoption
• have custody and control of your child (or had custody and control immediately before the child
turned 19 years of age) and your child is wholly dependent on that person for support

Separated – you have been living 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.
Once you have been separated for 90 days, the effective day of your separation is the date you started
living apart.

Divorced – you were married and are now legally divorced.

Widowed – your spouse or common-law partner is deceased.

Single – you are single and none of the above apply.

Enter the date the selected status began

(leave it blank if you have always been single):
Year Month Day

If you selected married or living common-law, enter your spouse or common-law partner's information:

Social insurance number (SIN):

If your spouse or common-law partner does not have a SIN, see Booklet T4114, Canada Child Benefit, under "How to apply".

First name:

Last name:

Date of birth:
Year Month Day
If your spouse or common-law partner's address is
different from yours, enter it here; otherwise,
their address will be updated to match the address
indicated in Step 2.

Step 4 – Your citizenship status

You become a Canadian citizen when you are born in Canada or are granted Canadian citizenship by Immigration, Refugees and Citizenship Canada.

Have you been a Canadian citizen for the last

12 months? Yes No

Has your spouse or common-law partner (if you

have one) been a Canadian citizen for the
last 12 months? Yes No

If you answered no to either of these questions, you have to fill out Form RC66SCH, Status in Canada and Income Information.

Step 5 – Newcomer or returning resident of Canada

Within the last two years, did you become a
newcomer to Canada or return after an absence Yes No
of at least six months?
Within the last two years, did your spouse or
common-law partner (if you have one) become a
newcomer to Canada or return after an absence Yes No
of at least six months?
If you answered yes to either of these questions, you have to fill out Form RC66SCH, Status in Canada and Income Information.

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Step 6 – Information about the child(ren)

If the child started living with you more than 11 months ago, you need to provide supporting documents. See "What to attach to this form" on page 5.

Primarily responsible for the care and upbringing of the child

Being primarily responsible for the care and upbringing of the child means that you are responsible for such things as supervising the child's daily activities and
needs, making sure the child's medical needs are met, and arranging for child care, when necessary, when the child lives with you.

Shared custody
This normally happens after a separation or a divorce. We consider you to be in a shared-custody situation if the child lives 40% to 60% of the time with you and
the rest of the time with another individual at a different address.
For more information on shared custody, see Booklet T4114, Canada Child Benefit, under "If you share custody of a child."

Do not give information about a child for whom you have already applied, unless the child left your care and has now returned, or the percentage of time the
child is in your care has changed.

Child 1 – Information
First name:

Last name:

Gender: Female Male

Date of birth:
Year Month Day
City of birth:

Province or territory of birth

(or country if outside Canada):
You must be primarily responsible for the care and upbringing of this child when the child lives with you.

Does the child live with you most or all of the time? Yes No

If yes, enter the date the child started living

with you most or all of the time. If the child has
lived with you since birth, tick the box: or Since birth
Year Month Day

If no, select the box that represents the percentage of time the child lives with you (select only one box):

More than 60% of the time (for example, the child lives with you during the week and with the other
individual every second weekend)
If you select this box, we consider you to be the only eligible individual for this child. Enter the date the
child started living with you more than 60% of the time:

Year Month Day

Between 40% and 60% of the time, and the child lives the rest of the time with another individual at
a different address (for example, the child lives with you one week and with the other individual one
week, or with you 4 days a week and with the other individual 3 days a week)
If you select this box, we consider you to be in a shared custody situation for this child. Enter the date
the child started living with you between 40% and 60% of the time:

Year Month Day

Less than 40% of the time (for example, the child lives with you every second weekend)
If you select this box, you should not apply since we do not consider you to be eligible for the child and
family benefits for this child.

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Step 6 – Information about the child(ren) (continued)

Child 2 – Information
First name:

Last name:

Gender: Female Male

Date of birth:
Year Month Day

City of birth:

Province or territory of birth

(or country if outside Canada):
You must be primarily responsible for the care and upbringing of this child when the child lives with you.

Does the child live with you most or all of the time? Yes No

If yes, enter the date the child started living

with you most or all of the time. If the child has
lived with you since birth, tick the box: or Since birth
Year Month Day

If no, select the box that represents the percentage of time the child lives with you (select only one box):

More than 60% of the time (for example, the child lives with you during the week and with the other
individual every second weekend)
If you select this box, we consider you to be the only eligible individual for this child. Enter the date the
child started living with you more than 60% of the time:

Year Month Day

Between 40% and 60% of the time, and the child lives the rest of the time with another individual at
a different address (for example, the child lives with you one week and with the other individual one
week, or with you 4 days a week and with the other individual 3 days a week)
If you select this box, we consider you to be in a shared custody situation for this child. Enter the date
the child started living with you between 40% and 60% of the time:

Year Month Day

Less than 40% of the time (for example, the child lives with you every second weekend)
If you select this box, you should not apply since we do not consider you to be eligible for the child and
family benefits for this child.
If you are applying for more than two children, you can use Form RC66-1, Additional Children. You can also attach a separate sheet of paper with the information
asked above.

Step 7 – Signature
I certify that the information given on this form and in any attached document is correct and complete. I understand that it is a serious offence to make a false
statement.

Your signature Date:

Year Month Day

If your marital status is married or living common-law, your spouse or common-law partner also needs to sign below.

Spouse or common-law
partner's signature Date:
Year Month Day
Personal information (including the SIN) is collected to administer or enforce the Income Tax Act and related programs and activities including administering tax, benefits, audit,
compliance, and collection. The information collected may be used or disclosed for purposes of other federal acts that provide for the imposition and collection of a tax or duty. It may
also be disclosed to other federal, provincial, territorial, or foreign government institutions to the extent authorized by law. Failure to provide this information may result in paying interest
or penalties, or in other actions. Under the Privacy Act, individuals have a right of protection, access to and correction of their personal information, or to file a complaint with the Privacy
Commissioner of Canada regarding the handling of their personal information. Refer to Personal Information Bank CRA PPU 063 on Information about Programs and Information
Holdings at canada.ca/cra-information-about-programs.

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What to attach to this form

You only have to attach documents to your application if you are in any of the situations mentioned below. However, we may ask you for photocopies of certain
documents at a later date. If the documents are not in English or French, you must provide a translation.
To get our forms and publications, go to canada.ca/cra-forms-publications or call 1-800-387-1193.

If you are in the following situation: You need to attach the following document(s) to your application:
You answered "no" to either of these questions in Step 4: Form RC66SCH, Status in Canada and Income Information
• Have you been a Canadian citizen for the last 12 months?
• Has your spouse or common-law partner (if you have one) been a
Canadian citizen for the last 12 months?
You answered "yes" to either of these questions in Step 5: Form RC66SCH, Status in Canada and Income Information
• Within the last two years, did you become a newcomer to Canada or return
after an absence of at least six months?
• Within the last two years, did your spouse or common-law partner (if you
have one) become a newcomer to Canada or return after an absence of at
least six months?

We have not paid benefits to anyone for this child and the child is in any of A proof of birth for the child (see the examples of acceptable documents
the following situations: below)
• one year of age or older
• was born outside of Canada

The child started living with you more than 11 months ago Clear photocopies (including both sides of all pages) of all of the following
documents for the entire period:
• proof of birth for each child. See the examples of acceptable
documents below
• proof that you resided in Canada (at least three documents). See the
examples of acceptable documents below
• proof that you were the person who is primarily responsible for the care
and upbringing of the child (at least three documents). See the
examples of acceptable documents on the next page
• proof of citizenship or immigration status in Canada for you and your
spouse or common-law partner (if you have one)
Form RC66-1, Additional Children, or attach a separate sheet of paper with
You are applying for more than two children
the information requested in Step 6

Examples of acceptable documents

As proof of birth, you have to provide a photocopy of one document with the child's first name, last name, and date of birth, such as:
• birth certificate or birth registration
• hospital record of birth or record of the physician, nurse, or midwife who attended the birth
• passport
• record of landing or confirmation of permanent residence issued by Immigration, Refugees and Citizenship Canada
• citizenship certificate
• notice of decision or a temporary resident's permit issued under the Immigration and Refugee Protection Act
• certificate of Indian status card
• provincial identity card

As proof that you resided in Canada, you have to provide a photocopy of at least three documents, such as:
• lease agreement
• rent receipt
• household bill (gas, electricity, cable television, telephone)
• driver's license, vehicle registration, or car insurance
• membership in social or professional organizations

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Examples of acceptable documents (continued)

As proof that you were the person who is primarily responsible for the care and upbringing of the child, you have to provide a photocopy of at least
three documents, such as:
• a letter from the daycare or school authorities indicating the child’s home address and contact information on file
• a letter from a social worker, a band council, or a resettlement officer stating that they have personal knowledge that the child lived with you for the period
you indicated
• a registration form or a receipt from an activity or club the child was enrolled in for the period you indicated
• a court order, decree, or separation agreement that explains the type of custody arrangement you have (for example, shared custody) and clearly shows
the living arrangements for the child
• any other document showing that the child lived with you for the period you indicated

For a complete list of all supporting documents, go to canada.ca/child-benefits-supporting-documents.

Getting benefits and credits when in an abusive or violent relationship

At the CRA, we know that some situations can affect access to benefits and credits. We're committed to helping you get your payments, whatever your
circumstances.
If you have not applied for the Canada child benefit for a child under 18 years of age in your care, please apply. In an abusive or violent situation, your spouse or
common-law partner’s signature is not required on Form RC66, Canada Child Benefits Application, or any other benefit-related form. For additional information,
go to canada.ca/child-family-benefits and select "Leaving an abusive or violent situation."

What to do now
• Make sure all steps of this form are filled out.
• If applicable, attach the documents mentioned under "What to attach to this form."
• Make a photocopy of your form and related documents (if applicable) for your records.
• Send your application to the tax centre that serves your area. Use the chart below to find out the address:

If your province or territory of residence is: Send your application to the following address:
Alberta, British Columbia, Manitoba, Northwest Territories, Winnipeg Tax Centre
Nunavut, Saskatchewan, or Yukon Post Office Box 14005, Station Main
Winnipeg MB R3C 0E3
New Brunswick, Newfoundland and Labrador, Nova Scotia, Sudbury Tax Centre
Ontario, or Prince Edward Island Post Office Box 20000, Station A
Sudbury ON P3A 5C1
Québec Jonquière Tax Centre
2251 René-Lévesque Boulevard
Jonquière QC G7S 5J2

After you apply

Unless you tell us otherwise, the information you give on this form will be used for all programs, including federal, provincial, and territorial programs.
Once we have processed your application, we will send you a Canada child benefit notice. The notice will show if you are eligible, how much you will get (if
applicable), and what information was used to calculate the amount. Our goal is to issue your notice or payment, if applicable, within 11 weeks of receiving your
filled out paper application.
We may also review your situation at a later date to confirm that the information you gave us has not changed.

Getting your payments

Direct deposit is a fast, convenient, and secure way to get your CRA payments directly into your account at a financial institution in Canada. For more information
and ways to enrol, go to canada.ca/cra-direct-deposit or contact your financial institution.
You need to do your taxes on time every year so that we can calculate your payments, even if you had no income in the year. If you have a spouse or common
law partner, they also need to do their taxes every year.
Make sure your personal information is up to date with us, as this could affect your payments.
Note
The female presumption is a legislative requirement and only one payment per household can be issued under the Income Tax Act. No matter which parent
receives the CCB, the amount will be the same.

If your spouse or common-law partner is a non-resident

If your spouse or common-law partner is a non-resident of Canada, the CRA needs their income information for each year (or part of the year) they were
a non-resident of Canada to determine your child and family benefits and credits. You can provide this information by filling out Form CTB9, Income of
Non-Resident Spouse or Common-Law Partner. Mail it to the tax centre that serves your area or submit it electronically using My account
at canada.ca/my-cra-account. You can also call 1-800-387-1193 to provide the information.

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