NR4 Statement of Amounts Paid or Credited to Non-Residents of Canada

NR4 Slip

Year

Code box 10
 

Recipient code

Code box 11
 

Country code

Code box 12
 

Payer or agent identification number

 

Foreign or Canadian tax identification number

Code box 13
 

Financial Information

Line 1

Income code

Code box 14
 

Currency code

Code box 15
 

Gross income

Code box 16
 

Non-resident tax withheld

Code box 17
 

Exemption code

Code box 18
 

Line 2

Income code

Code box 24
 

Currency code

Code box 25
 

Gross income

Code box 26
 

Non-resident tax withheld

Code box 27
 

Exemption code

Code box 28
 

Non-resident recipient's name and address

Individual’s surname

 

First Name

 

Initial

 

Corporation,organization,association, trust or institution name

 

Second individual’s surname

 

Second individual’s first name

 

Second individual’s initial

 

Street Address

 

Street Address

 

City, Province/territory or US state/territory/possession, Postal Code/ZIP code

 

Country

 

Country code

 

Name and address of payer or agent

Last Name

 

First Name

 

Initial

 

Street Address

 

Street Address

 

City

 

Province

 

Country

 

Postal Code (A1A1A1)

 

Non-resident account number

Area code
 
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