*** Transcriber's Note: Please set your voice synthesizer to read most punctuation. When you encounter the caret sign, please enter the applicable information, if necessary. *** T4 (11) (Front) Canada Revenue Agency STATEMENT OF REMUNERATION PAID Employer's name ^ Year ^ Box 54: Payroll Account Number (15 characters) ^ Box 10: Province of employment ^ Box 12: Social insurance number ^ Box 28: Exempt CPP/QPP ^ EI ^ PPIP ^ Box 29: Employment code ^ Box 14: Employment income - line 101 ^ Box 22: Income tax deducted - line 437 ^ Box 16: Employee's CPP contributions - line 308 ^ Box 17: Employee's QPP contributions - line 308 ^ Box 18: Employee's EI premiums - line 312 ^ Box 20: RPP contributions - line 207 ^ Box 24: EI insurable earnings ^ Box 26: CPP/QPP pensionable earnings ^ Box 44: Union dues - line 212 ^ Box 46: Charitable donations - See over ^ Box 50: RPP or DPSP registration number ^ Box 52: Pension adjustment - line 206 ^ Box 55: Employee's PPIP premiums - see over ^ Box 56: PPIP Insurable earnings ^ Employee's name and address Last name (in capital letter): ^ First name: ^ Initials: ^ Other Information (see over) Box: ^ Amount: ^ Box: ^ Amount: ^ Box: ^ Amount: ^ Privacy Act, Personal Information Bank number CRA PPU 005, 150 and 125 T4 (11) (Back) Report these amounts on your tax return Box 14: Employment income - Enter on line 101. Box 16: Employee's CPP contributions - See line 308 in your tax guide. Box 17: Employee's QPP contributions - See line 308 in your tax guide. Box 18: Employee's EI premiums - See line 312 in your tax guide. Box 20: RPP contributions - Includes past service contributions. See line 207 in your tax guide. Box 22: Income tax deducted - Enter on line 437. Box 37: Employee home-relocation loan deduction - Enter on line 248. Box 39: Security options deduction 110(1)(d) - Enter on line 249. Box 41: Security options deduction 110(1)(d.1) - Enter on line 249. Box 42: Employment commissions - Enter on line 102. This amount is already included in box 14. Box 43: Canadian Forces personnel & police deduction - Enter on line 244.This amount is already included in box 14. Box 44: Union dues - Enter on line 212. Box 46: Charitable donations - See line 349 in your tax guide. Box 52: Pension adjustment - Enter on line 206. Box 53: Deferred security option benefits - See Form T1212. Box 55: Provincial Parental Insurance Plan (PPIP) - Residents of Quebec, see line 375 in your tax guide. Residents of provinces or territories other than Quebec, see line 312 in your tax guide. Box 66: Eligible retiring allowances - See line 130 in your tax guide. Box 67: Non-eligible retiring allowances - See line 130 in your tax guide. Box 72: Section 122.3 income - Employment outside Canada - See Form T626. Box 73: Number of days outside Canada - See Form T626. Box 74: Past service contributions for 1989 or earlier years while a contributor Box 75: Past service contributions for 1989 or earlier years while not a contributor - See line 207 in your tax guide. Box 77: Workers' compensation benefits repaid to the employer -Enter on line 229. See Form T2121.Do not enter on line 101. Box 78: Fishers - Gross income Box 79: Fishers - Net partnership amount Box 80: Fishers - Shareperson amount Gross income. See Form T2125. Do not enter on line 101. Box 81: Placement or employment agency workers Box 82: Taxi drivers and drivers of other passenger-carrying vehicles Box 83: Barbers or hairdressers Box 84: Public transit pass - See line 364 in your tax guide. Box 85: Employee-paid premiums for private health services plans -See line 330 in your tax guide. Box 87: Volunteer firefighter exempt amount - Report this amount only if you are claiming an amount on line 362. See lines 101 and 362 in your tax guide. Do not report these amounts on your tax return - Canada Revenue Agency use only (Amounts in boxes 30, 32, 34, 36, 38, 40, and 86 are already included in box 14.) Box 30: Board and lodging Box 31: Special work site Box 32: Travel in a prescribed zone Box 33: Medical travel assistance Box 34: Personal use of employer's automobile or motor vehicle Box 36: Interest-free and low-interest loans Box 38: Security options benefits Box 40: Other taxable allowances and benefits Box 68: Status Indian (exempt income) - Eligible retiring allowances Box 69: Status Indian (exempt income) - Non-eligible retiring allowances Box 70: Municipal officer's expense allowance Box 71: Status Indian employee Box 86: Security options election Privacy Act, Personal Information Bank numbers CRA PPU 005 and 150