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 box14

Currency code

Code box15

Gross income

Code box16

Non-resident tax withheld

Code box17

Exemption code

Code box18

Line 2

Income code

Code box24

Currency code

Code box25

Gross income

Code box26

Non-resident tax withheld

Code box27

Exemption code

Code box28

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

Code box