Identity theft and suspicious activity declaration form for individual, business and trust

Personal information, including your Social Insurance Number (SIN), is collected under the authority of the Income Tax Act (s. 220(1) and s. 237) , the Canada Emergency Response Benefit Act (s. 9 and 10), the Canada Emergency Student Benefit Act (s.10 and 11), the Canada Recovery Benefit Act (s. 25 and 26), the Canada Workers Lockdown Benefit Act (s. 12 and 13), the Rental Housing Benefit Act (s. 13 and 14) and/or the Dental Benefit Act (s. 15 and 16) and will be used to verify and confirm identities, to identify fraud and suspicious activity, and to prevent fraudulent transactions. Your information may also be used for any other purpose related to the administration or enforcement of these Acts and may be shared or verified with other federal, provincial, territorial or foreign government institutions to the extent authorized by law. Failure to provide this information may affect consideration for any possible payments and may limit your ability to interact with the Canada Revenue Agency.

Refer to Personal Information Bank CRA PPU 168 at canada.ca/cra-information-about-programs. Under the Privacy Act , individuals have a right of access to, correction and protection of their personal information and to file a complaint to the Privacy Commissioner of Canada regarding our handling of their personal information.

To place immediate protection on your account, you can also call:

Identity Protection Services at 1-833-995-2336 or, if you use a teletypewriter (TTY) please call 1-800-267-7622

Business Enquiries at 1-800-959-5525

Trust Account Enquiries at 1-800-959-8281

You can also report suspected fraud to Service Canada at 1-866-274-6627

Account Type Please check the type of account and provide the account number: (Required)

Business

Individual

Trust

Account Number:

Version:: 2023-05-13