Child Tax Benefit Application Form - Canada

Part 1 – Information about the applicant
CANADA CHILD TAX BENEFIT APPLICATION
Use this form to apply for the Canada Child Tax Benefit (CCTB), to register your children under the
age of 19 for the goods and services tax/harmonized sales tax (GST/HST) credit, or both.
RC66 E (06)
Do not use this area
If you moved from a different province or territory, name the previous province or territory
If you moved to this address within the last 12 months, enter the date you moved
MonthYear Day
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . .
Social insurance number
First name and initial
()
Last name
Enter the date your current status began. (If you checked 2 or 5, see the definitions for living
common law and separated in Part 2 of this form)
Month
Year
Day
We define married, living common law, and separated in Part 2.
Check the box that shows your current marital status.
20
Married
1
2
Living common law
5
Separated Divorced Single
3
Widowed
4 6
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Complete schedule RC66SCH, Status in Canada/Statement of Income, if you or your spouse or common-law partner:
Yes
No
()
Last name at birth (if different from last name above)
Female Male
Province or territory (or country, if outside Canada)
Date of birth
Month
Year Day
Apt. no. – Street no. Street name P.O. Box, R.R.
City
Postal code
Language of correspondence
English
Français
Work telephone number
Home telephone number
Postal code
Home address (if different from above):
Province or territory (or country, if outside Canada)
Apt. no. – Street no. Street name
Have you been a Canadian citizen for at least 12 months?
Mailing address:
If you are the person who is primarily responsible for a child under the age of 18, you can apply for
the CCTB for that child. For CCTB purposes, when both a male and a female parent live in the same
home as the child, we presume that the female parent is primarily responsible for the child and should
apply, unless a note from the female parent is attached to this application that states that the male parent is
primarily responsible for the child. Complete this form as soon as possible after the child is born or begins to live with you, or when
you become a resident of Canada. This form is also used to determine if you can get benefits or credits from provincial or territorial
programs we administer. See pamphlet T4114, Your Canada Child Tax Benefit, for more details about the CCTB.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
City
If yes, and any of the three conditions above apply to that period, complete schedule RC66SCH, Status in Canada/Statement of
Income. If yes, and none of the three conditions above apply to that period, you must attach to this application a legible photocopy of
proof of your and your spouse or common-law partner's citizenship (e.g., Canadian birth certificate) for that period.
(Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca ou au 1 800 959-3376.)
Yes No
. . . . . . . . .
Does your application for CCTB include a period that started more than 11 months ago?
If no, you must complete the schedule RC66SCH, Status in Canada/Statement of Income.
are a permanent resident, protected person (refugee), or temporary resident (who has lived in Canada for the previous 18 months),
as defined in the Immigration and Refugee Protection Act; or
became a Canadian citizen in the last 12 months;
became a new resident or returned as a resident of Canada in the last 2 years.
z
z
z
Note: The information you give on this form will be used for both programs, unless you indicate
otherwise on an attached note.
When both a male and female parent reside in the same home, we usually consider the female parent to be the applicant.
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