5013-SC 
 
T1-2011 
 
Schedule C 
 
Electing Under Section 217 of the Income Tax Act 
 
Complete this schedule and attach it to your return if you were a non-
resident of Canada for all of 2011 and you are electing under section 217 of 
the Income Tax Act. 
 
Part 1 - Eligible section 217 income 
 
Line 1: Old Age Security pension 
Amount * ^
multiplied by Rate (%)** ^
Non-resident tax = ^
 
Line 2: Canada Pension Plan and Quebec Pension Plan benefits 
Amount * ^
multiplied by Rate (%)** ^
Non-resident tax = ^
 
Line 3: Other pensions or superannuation 
Amount * ^
multiplied by Rate (%)** ^
Non-resident tax = ^
 
Line 4: Registered Retirement Savings Plan (RRSP) payments 
Amount * ^
multiplied by Rate (%)** ^
Non-resident tax = ^
 
Line 5: Registered Retirement Income Fund (RRIF) payments 
Amount * ^
multiplied by Rate (%)** ^
Non-resident tax = ^
 
Line 6: Death benefits 
Amount * ^
multiplied by Rate (%)** ^
Non-resident tax = ^
 
Line 7: Employment Insurance benefits 
Amount * ^
multiplied by Rate (%)** ^
Non-resident tax = ^
 
Line 8: Retiring allowances 
Amount * ^
multiplied by Rate (%)** ^
Non-resident tax = ^
 
Line 9: Registered supplementary unemployment benefit plan payments 
Amount * ^
multiplied by Rate (%)** ^
 
Non-resident tax = ^
 
Line 10: Deferred profit-sharing plan payments 
Amount * ^
multiplied by Rate (%)** ^
Non-resident tax = ^
 
Line 11: Amounts received from, or the purchase price of, a retirement 
compensation arrangement 
Amount * ^
multiplied by Rate (%)** ^
Non-resident tax = ^
 
Line 12: Prescribed benefits under a government assistance program 
Amount * ^
multiplied by Rate (%)** ^
Non-resident tax = ^
 
Line 13: Auto Pact benefits 
Amount * ^
multiplied by Rate (%)** ^
Non-resident tax = ^
 
Line 14 and line 133: Add lines 1 to 13. Amount* = ^
Line 14 and line 443: Add lines 1 to 13 Non-resident tax = ^
 
Line 15: Enter the total of the amounts from lines 207, 208, 209, 232, 250, 
and 256, of your return, that apply only to the eligible section 217 income. 
^
Line 16 and line 148: The amount at box 133, minus line 15 (if negative, 
enter "0"). = ^
 
The amount at box 133 is your total section 217 eligible income. The amount 
at box 443 is your non-resident tax required to be withheld on the eligible 
section 217 income. The amount at box 148 is your total section 217 eligible 
income after adjustments. 
 
* Do not include the following amounts: 
 
- any supplement received under the Old Age Security Act; 
 
- an amount transferred to acquire an annuity contract, registered pension 
plan, RRSP, or RRIF following an authorization from the CRA; 
 
- an amount exempt under the Income War Tax Act; and; 
 
- any amount that can reasonably be regarded as attributable to services 
rendered while you were not resident in Canada, and while you were not 
employed or were only occasionally employed, in Canada. 
 
** If you were a resident of a country that Canada has a tax treaty with, 
enter the appropriate rate of withholding from the applicable tax treaty. If 
you are unsure of the tax treaty rate, refer to our Web site at www.cra-
arc.gc.ca/ treaties or contact the International Tax Services Office. If you 
were a resident of a country with which Canada does not have a tax treaty 
enter 25%. 
 
Note 
The amount you calculate may be different from the non-resident tax withheld 
on your eligible section 217 income. This would be the case if the payer did 
not withhold the correct amount of tax, or if you submitted Form NR5, 
Application by a Non-Resident of Canada for a Reduction in the Amount of Non-
Resident Tax Required to be Withheld, and we approved a reduction in the 
amount of tax to be withheld. 
 
Part 2 - Section 217 tax adjustment 
 
Do the calculation below only if the amount entered on line 35 of your 
Schedule 1 is the same as your "net world income after adjustments" entered 
on line 16 of your Schedule A. 
 
Line 17: Net world income after adjustments (line 16 of Schedule A) ^
Line 18: Taxable income (line 260 of your return) ^
Line 19: Line 17 minus line 18 (if negative, enter "0") = ^
Line 20: Amount from line 58 of Schedule 1 ^
Line 21: Multiply the amount on line 19 by the amount on line 20. = ^
Line 22: Enter the amount from line 17. ^
Line 23: Divide the amount on line 21 by the amount on line 22 and enter the 
result on line 445 of Schedule 1. Section 217 tax adjustment = ^
 
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