5000-S5 
 
T1 - 2011 
 
Schedule 5 
 
Details of Dependant 
 
See the guide to find out if you can claim an amount on line 305, 306, 315, 
or 331 of Schedule 1. For each dependant claimed, provide the details 
requested below. Attach a copy of this schedule to your return. 
 
Line 305 - Amount for an eligible dependant 
 
If your marital status changed in 2011, enter the date of the change. 
(Month/Day) ^
 
Do not forget to tick the box on page 1 of your return to state your marital 
status on December 31, 2011. 
 
Last name ^
First name ^
Address ^
Date of birth (Month/Day/Year) ^
Relationship to you ^
Net income in 2011 ^
Nature of the impairment (if it applies) ^
Amount of claim ^
 
Line 306, 315, or 331 - Attach a separate sheet of paper if you need more 
space. 
 
Line 1 
Last name ^ 
First name ^
Address ^
Year of birth ^
Relationship to you ^
Net income in 2011 ^
Nature of the impairment (if it applies) ^
Line claimed ^
Amount of claim ^
 
Line 2 
Last name ^
First name ^
Address ^
Year of birth ^
Relationship to you ^
Net income in 2011 ^
Nature of the impairment (if it applies) ^
Line claimed ^
Amount of claim ^
 
Privacy Act, Personal Information Bank number CRA PPU 005