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Canada Revenu Agency 
 
T4RIF SUMMARY (11) (Front) 
 
For the year ending December 31, 20XX 
 
Complete this information return using the instructions in Guide T4079, T4RSP 
and T4RIF Guide for the year indicated. 
 
Important 
 
Payer's name and Account Number have to be the same as on your PD7A 
remittance form. 
 
Name and address of payer (carrier) of fund ^
 
Account Number ^
Tax centre 
TSO code 
 
Box 88: Total number of T4RIF slips filed ^
 
Box 16: Taxable amounts ^
 
Box 18: Deceased (amounts deemed received) ^
 
Box 20: Deregistration ^
 
Box 22: Other income or deductions ^
 
Box 24: Excess amount ^
 
Box 35: Transfers on breakdown of marriage or common–law partnership ^
 
Do not use this area 
 
Box 28: Total income tax deducted (per T4RIF slips) ^
Box 82: Minus remittances ^
Difference ^
 
We do not charge or refund a difference of $2 or less. 
 
Box 84: Overpayment ^
Box 86: Balance due ^
 
Amount enclosed ^
 
Person to contact about this information return 
Box 76: First and last name (print letters) ^
Box 78: Telephone number (including area code) ^
 
Certification 
 
I certify that the information given on this T4RIF return (T4RIF Summary form 
and related T4RIF slips) is, to the best of my knowledge, correct and 
complete. 
 
Date (Year\Month\Day) ^
First and last name (print letters) ^
Signature of authorized person ^
 
Do not use this area
 
Box 90: Transfer 
Box 1: Last to current 
Box 2: No action 
Box 3: Other 
 
Box 91: Proforma 
Box 1: Yes 
Box 2: No 
 
Box 93: Date 
 
Memo 
 
Late-filing penalty 
 
Prepared by 
Date 
 
Privacy Act Personal Information Bank number CRA PPU 005 
 
 
T4RIF Summary (11) (back) 
 
Mandatory electronic filing 
 
If you file more than 50 T4RIF slips for a calendar year, you must file the 
T4RIF return over the Internet. 
 
You may choose one of the following electronic filing formats: 
 
1) Internet File Transfer (XML) 
2) Web Forms 
 
For more information about filing electronically, go to www.cra.gc.ca/iref. 
 
You can also file information returns online using the "File a return" 
service and selecting the "Internet file transfer (XML)" option at: 
 
- www.cra.gc.ca/representatives, if you are an authorized employee or 
representative; or 
 
- www.cra.gc.ca/mybusinessaccount, if you are the business owner. 
 
Filing on paper 
 
Complete this form using the instructions in Guide T4079, T4RSP and T4RIF 
Guide. 
 
The employer's name and Account number have to be the same as shown on your 
PD7A remittance form. 
 
To get our forms or publications, go to www.cra.gc.ca/forms or call 1-800-
959-2221. 
 
Send this summary and the related T4RIF slips to: 
 
Ottawa Technology Centre 
Canada Revenue Agency 
Post Office Box 9633, Station T 
Ottawa ON K1G 6H3 
 
Do you have a balance owing? 
 
If you have a balance owing enclose a cheque or money order payable to the 
Receiver General. You may also be able to pay electronically through your 
financial institution's telephone and Internet banking services. If you remit 
your payment late, any balance due may be subject to penalties and interest 
at the prescribed rate. For more information, go to 
www.cra.gc.ca/electronicpayments.