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punctuation. When you encounter the caret sign at the end of a line, please 
enter the applicable information, if necessary. *** 
 
Canada Revenue Agency 
 
CTB9 (11) 
 
CANADA CHILD TAX BENEFIT - STATEMENT OF INCOME 
 
PROTECTED B (when completed) 
Tax year 20^
 
Use this form if you are receiving the Canada Child Tax Benefit (CCTB) and 
your spouse or common-law partner was a non-resident of Canada for any part 
of the tax year you indicated above. Complete this form even if your spouse 
or common-law partner had no income so that we can calculate your CCTB 
payments. To continue receiving the CCTB, you have to fill out this form and 
send it to us after each year (or part of a year) that your spouse or common-
law partner was a non-resident of Canada. 
 
Enter the year your spouse or common-law partner was a non-resident in the 
"Tax year" box above. 
 
For more information, call 1-800-267-5177 from Canada or the United States. 
From outside Canada and the United States, call 613-952-3741. We accept 
collect calls. 
 
Section 1 - Information about the CCTB applicant 
 
First name and initial ^
Last name ^
Social insurance number ^
 
Mailing address (Apartment Number - Street Number Street name, Post Office 
Box, Rural Route) ^
City ^
Province or territory ^
Postal code ^
 
Home address (if different from mailing address) (Apartment Number - Street 
Number Street name, Rural Route) ^
City ^
Province or territory ^
Postal code ^
 
Telephone number 
Home (including area code) ^
Work (including area code) ^
 
Section 2 - Information about your spouse or common-law partner 
 
First name and initial ^
Last name ^
Social insurance number ^
 
Date of birth: (Year/Month/Day) ^
 
Tick this box (enter an "X") if your spouse or common-law partner does not 
have a social insurance number. ^
 
Mailing address (Apartment Number - Street Number Street name, Post Office 
Box, Rural Route) ^
City ^
Province or territory ^
Postal code ^
 
Section 3 - Statement of income 
 
Complete Part A, B or C, whichever applies. Enter your spouse or common-law 
partner's income in Canadian dollars from all sources inside and outside of 
Canada. Do not include income that was reported on a Canadian tax return. 
Enter "0" if he or she had no income. 
 
Part A - Non-resident of Canada for the whole year 
 
If your spouse or common-law partner was a non-resident of Canada for the 
whole tax year, enter his or her income for the whole tax year: $^
 
Part B - Became a non-resident of Canada in the year 
 
If your spouse or common-law partner became a non-resident of Canada in the 
tax year, enter the date he or she became a non-resident: (Year/Month/Day) 
20^
 
Enter his or her income for the part of the tax year that he or she was a 
non-resident of Canada: $^
 
Part C - Became a resident of Canada in the year 
 
If your spouse or common-law partner became a resident of Canada in the tax 
year, enter the date he or she became a resident: (Year/Month/Day) 20^
 
Enter his or her income for the part of the tax year that he or she was a 
non-resident of Canada: $^
 
Section 4 - Certification 
 
I certify that the information given on this form and in any documents 
attached is, to the best of my knowledge, correct. 
 
Applicant's signature (It is a serious offence to make a false statement.) ^
 
Date (Year/Month/Day) ^ 
 
Privacy Act, Personal Information Bank number CRA PPU 063