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T1198 E (11) (Front) 
 
Canada Revenue Agency 
 
Statement of Qualifying Retroactive Lump-Sum Payment 
 
To the payer: 
 
Complete this form if you paid a qualifying retroactive lump-sum payment 
(QRLSP) to an individual (other than a trust) in 1995 or later years. Enter 
the amount of the QRLSP and its breakdown in the appropriate boxes below. 
Give the completed and signed form to the recipient of the QRLSP. If you paid 
more than one QRLSP to an individual, complete one form for each QRLSP paid. 
See the back of this form for details. 
 
Note: The QRLSP income indicated on this form has to be reported on the 
recipient's information slip (such as a T4, T4A, T4E). 
 
To the recipient: 
 
We will not reassess your returns for prior years to include this income. 
However, you can ask us to tax the parts for the prior years as if you 
received them in those years. You have to include the whole payment on the 
appropriate line of your return for the year. See the back of this form for 
details. 
 
Name of recipient ^
Social insurance number (enter 9-digit number) ^
Year of payment ^
Description of QRLSP and reasons for payment ^
 
Line 6850: Total amount (principal and interest) ^
 
Line 6851: Total principal (current and prior years) ^
 
Total interest (current and prior years) ^
 
Total principal (prior years only) ^
 
Breakdown of principal (box 6851) 
 
In the boxes below, enter the amount of principal that relates to each 
applicable year. Do not include interest amount. 
 
Line 6852: 1978 ^
Line 6853: 1979 ^
Line 6854: 1980 ^
Line 6855: 1981 ^
Line 6856: 1982 ^
Line 6857: 1983 ^
Line 6858: 1984 ^
Line 6859: 1985 ^
Line 6860: 1986 ^
Line 6861: 1987 ^
Line 6862: 1988 ^
Line 6863: 1989 ^
Line 6864: 1990 ^
Line 6865: 1991 ^
Line 6866: 1992 ^
Line 6867: 1993 ^
Line 6868: 1994 ^
Line 6869: 1995 ^
Line 6870: 1996 ^
Line 6871: 1997 ^
Line 6872: 1998 ^
Line 6873: 1999 ^
Line 6874: 2000 ^
Line 6875: 2001 ^
Line 6876: 2002 ^
Line 6877: 2003 ^
Line 6878: 2004 ^
Line 6879: 2005 ^
Line 6893: 2006 ^
Line 6894: 2007 ^
Line 6895: 2008 ^
Line 6896: 2009 ^
Line 6897: 2010 ^
Line 6898: 2011 ^
Line 6899: 2012 ^
Line 6900: 2013 ^
 
Certification 
 
I, First and last name (please print), ^
certify that the information given on this form is, to the best of my 
knowledge, correct and complete. 
 
Signature of payer ^
Position or office ^
Date (Year/Month/Day) ^
 
 
T1198 E (11) (Back) 
 
Statement of Qualifying Retroactive Lump-Sum Payment 
 
Information for payers and recipients 
 
What is a qualifying retroactive lump-sum payment (QRLSP)? 
 
A QRLSP is a lump-sum payment paid to an individual (other than a trust) in a 
year that relates to one or more prior eligible taxation years throughout 
which the individual was a resident of Canada. To be a qualifying amount, the 
payment must have been paid after 1994 from one of the following sources: 
 
- income from an office or employment received under: 
-- a judgment from a court or other competent tribunal; 
-- an arbitration award; or 
-- a lawsuit settlement agreement (including damages for loss of office or 
employment); 
 
- benefits from Unemployment Insurance or Employment Insurance; 
- benefits from a superannuation or pension plan (other than non-periodic 
benefits such as lump-sum withdrawals); 
- spousal, common-law partner, or taxable child support payments; or 
- benefits from a wage-loss replacement plan. 
 
Note: a year in which an individual became bankrupt is not an eligible 
taxation year. 
 
Amounts not qualifying 
 
An amount received under any part of a retroactive lump-sum payment that is 
eligible for any of the following deductions, is not a qualifying amount: 
 
- legal expenses; 
- salary reimbursements; 
- reimbursement of top-up disability payments; 
- repayment of pension or benefits; 
- deduction of social assistance payments, workers' compensation, etc. 
 
An amount under normal collective bargaining, such as negotiated back pay is 
not a qualifying amount, (although, an amount from an arbitration award does 
qualify). 
 
Why provide the breakdown of a QRLSP? 
 
Generally, a lump-sum payment is included in income in the year when the 
recipient receives it. This may result in a greater tax liability than if the 
payment had been received in the year or years to which it related. 
 
A special tax calculation is available to individuals who receive QRLSPs that 
relate to any year after 1977. The calculation applies if the total of all 
principal amounts that relate to prior years (after 1977) from all QRLSPs is 
$3,000 or more. 
 
If you are the payer of a QRLSP, complete this form to help us determine if 
the special tax calculation is beneficial to the recipient. 
 
If you are the recipient of a QRLSP and if the amount shown under "Total 
principal (prior years only)" is $3,000 or more, attach Form T1198, Statement 
of Qualifying Retroactive Lump-Sum Payment to your return for the year of 
payment to ask for a special tax calculation. If you have more than one QRLSP 
form, add the amounts shown under "Total principal (prior years only)" on all 
your forms. If the result is $3,000 or more, attach to your return the QRLSP 
forms that payers have given you. 
 
Privacy Act, Personal Information Bank number CRA PPU 005