*** Transcriber's Note: Please set your voice synthesizer to read most punctuation. When you encounter the caret sign at the end of a line, please enter the applicable information, if necessary. In print, the T4A slip is repeated for the possibility of up to three recipients. *** T4A (11) (Front) Canada Revenu Agency STATEMENT OF PENSION, RETIREMENT,ANNUITY, AND OTHER INCOME Payer's name ^ Year ^ Income tax deducted Box 061: Payer's Account Number (15 characters) ^ Box 012: Social insurance number ^ Box 013: Recipient's Account Number ^ Box 016: Pension or superannuation - line 115 ^ Box 018: Lump-sum payments line 130 ^ Box 022: Income tax deducted - line 437 ^ Box 020: Self-employed commissions ^ Box 024: Annuities ^ Box 048: Fees for services ^ Recipient's name and address Last name (in capital letters) ^ First name ^ Initials ^ Other information (see over) *** Transcriber’s note: The following are 12 empty boxes to be filled as per instructions on the back. Box ^ Amount^ Box ^ Amount^ Box ^ Amount^ Box ^ Amount^ Box ^ Amount^ Box ^ Amount^ Box ^ Amount^ Box ^ Amount^ Box ^ Amount^ Box ^ Amount^ Box ^ Amount^ Box ^ Amount^ Report these amounts on your tax return. T4A (11) Back) Box 016, Pension or superannuation - Enter this amount on line 115. It may qualify for the pension income amount (see line 314 in your tax guide). Box 018, Lump-sum payments - Enter this amount on line 130. The amounts in the following boxes are included in box 018: - Box 102, Lump-sum payments - non-resident services transferred under paragraph 60(j) - Box 108, Lump-sum payments from a registered pension plan (RPP) that you cannot transfer - Box 110, Lump-sum payments accrued to December 31, 1971 - Box 158, Lump-sum payments that you cannot transfer that are not reported elsewhere - Box 180, Lump-sum payments from a deferred profit-sharing plan (DPSP) that you cannot transfer - Box 190, Lump-sum payments from an unregistered plan Box 020, Self-employed commissions - Enter your gross commissions income on line 166 and your net commissions income on line 139. Box 022, Income tax deducted - Enter this amount on line 437. Box 024, Annuities - See line 115 in your tax guide. The amounts in the following boxes are included in box 024: - Box 111, Income averaging annuity contracts (IAAC) - Box 115, Deferred profit-sharing plan (DPSP) annuity or instalment payments Box 026, Eligible retiring allowances - Enter this amount on line 130. You may be able to transfer part or all of this amount into a registered retirement savings plan or registered pension plan. See line 130 in your tax guide. Box 027, Non-eligible retiring allowances - Enter this amount on line 130. Box 028, Other income - Amounts not reported anywhere else on the T4A slip. See line 130 in your tax guide. Box 030, Patronage allocations - Enter this amount on line 130. Do not report the amount if it was for goods or services you consumed and for which you cannot deduct the cost when you calculate your income. This amount does not qualify for the federal dividend tax credit. Box 032, Registered pension plan contributions (past service) - Enter the amount you can deduct on line 207 (see Guide T4040, RRSPs and Other Registered Plans for Retirement). - Box 126, Pre-1990 past service contributions (included in box 032) Box 034, Pension adjustment - Enter this amount on line 206. This amount is not income or a deduction. Box 040, RESP accumulated income payments - Enter this amount on line 130 and complete Form T1172, Additional Tax on Accumulated Income Payments from RESPs. - Box 122, RESP accumulated income payments paid to other (included in box 040) Box 042, RESP educational assistance payments - Enter this amount on line 130. For details, see Information Sheet RC4092, Registered Education Savings Plans. Box 046, Charitable donations - See line 349 in your tax guide. Box 048, Fees for services - Report this amount as business income. Box 133, Variable pension benefits - See line 115 in your tax guide. Box 135, Recipient-paid premiums for private health services plans - See line 330 in your tax guide. Enter on line 104: - Box 104, Research grants - See line 104 in your tax guide. - Box 107, Payments from a wage-loss replacement plan - See line 104 in your tax guide. - Box 118, Medical premium benefits - Box 119, Premiums paid to a group term life insurance plan - Box 127, Veterans' benefits - Box 132, Wage Earner Protection Program - Box 152, SUBP qualified under the Income Tax Act - Box 156, Bankruptcy settlement Enter on line 125: - Box 131, Registered disability savings plan Enter on line 130: - Box 105, Scholarships, bursaries, fellowships, artists' project grants, and prizes - See line 130 in your tax guide. - Box 106, Death benefits - See line 130 in your tax guide. - Box 109, Periodic payments from an unregistered plan - Box 117, Loan benefits - Box 123, Payments from a revoked DPSP - Box 125, Disability benefits paid out of a superannuation or pension plan - Box 129, Tax deferred cooperative share - Box 130, Apprenticeship incentive grant or Apprenticeship completion grant - Box 134, Tax-Free Savings Account (TFSA) taxable amount - Box 150, Labour Adjustment Benefits Act and Appropriation Acts - Box 154, Cash award or prize from payer Do not report on your tax return - Canada Revenue Agency use only - Box 014, Recipient number - Box 036, Plan registration number - Box 116, Medical travel assistance - Box 124, Board and lodging at special work sites - Box 142, Indian (exempt income) - Eligible retiring allowances - Box 143, Indian (exempt income) - Non-eligible retiring allowances - Box 144, Indian (exempt income) - Other income - Box 146, Indian (exempt income) - Pension or superannuation - Box 148, Indian (exempt income) - Lump-sum payments Privacy Act, Personal Information Bank numbers CRA PPU 005 and 150