Client Data - LSP Canada

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Client Information Form

I am looking for my :
Personal ReturnSelf-EmployedHST/GST ReturnRentalUS Return

Office Locations :

Client Information :

First Name :

Last name :

Email :

Gender:

S.I.N :

Date of Birth (yyyy/mm/dd):

Phone :

Address :

City :

Province :

Postal Code :

Disabled :

Disability certificate with CRA :

For US Return :

Address :

S.S.N :

City :

State :

Zip Code :

Marital Status :SingleMarriedCommon-LawWidowedDivorcedSeparated

Has your marital status changed in the tax year? :

Date of Change :

Previous Status :

Spouse Information :

First Name :

Last name :

Email :

S.I.N :

Date of Birth :

Phone :

Net Income $ :

Disabled (if not filing together) :

Valid disablity certificate with CRA :

Dependent Information :

Do have any dependents living with you *

Please Select the option :Sole CustodyShared CustodyJoint CustodyChild SupportSpousal SupportN/A

Please Select the option :Child SupportSpousal SupportN/A

Add dependent information here :

Name:

S.I.N :

Date of Birth :

Relation :

Disabled :

Name:

S.I.N :

Date of Birth :

Relation :

Disabled :

Name:

S.I.N :

Date of Birth :

Relation :

Disabled :

Are you a Canadian Citizen? :

Would you like to provide your information to Elections Canada? :

Did you immigrate to Canada during tax year? :

Immigration Date :

Did you Buy or Sell a home or any property during the tax year? :

Have you claimed bankruptcy in the past two years? :

Have u been discharged ? :

Have you been confined to a prison or similar institution? :

What is the date from & to :

Did you own foreign Property of more than $100,000? :

Do you have any of the following receipts: (receipts must be given with dropped off materials) :
DaycareMedical expensesDonationsRent/Property tax

Are you a Self-Employed ? :

Business Number :

IS your Business name and address different from Personal :

Business Name :

Address :

Additional Services Available (Check if you are interested in getting more details on) :
US TaxesIndividual / Group InsuranceHome & Auto InsuranceReal Estate / Mortgage ServicesFinancial Consultations & PlanningInvestments

Are you required to file Underused Housing Tax (UHT) return? :

Are you considered to be a Bare Trustee? :

Do you hold legal title with another person or on behalf of group of people, have a joint account or co-signed with someone for an investment over $50,000 :

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