Canadian Tax Refund Application

Tax Back - Income Tax Refund Specialists

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		Canada Tax Refund Application

Please fill out this simple form with as much information as possible - it will take just 4 minutes! Once you complete this form, our representative will contact you within 8 hours!

Use secure connection (SSL)

CONTACT DETAILS
(*- mandatory fields )

Title

First Name *

Middle Name

Surname *

Postal Address *

E-mail Address *

Phone number *

Line Type *

Country Code *

Area Code *

Phone number *

Please send confirmation via SMS to this number

Date of Birth *

DD/MM/YYYY

Which country are you from? *


State *
City *


How did you hear about our service? *
What is the name of that person/organisation? *
Year of Employment *


EMPLOYMENT INFORMATION

Have you applied for this refund before? *
Approximate first date of arrival in Canada *	DD/MM/YYYY
Approximate last date of departure from Canada *	DD/MM/YYYY
Social Insurance Number (if possible)
How many employers did you work for? *


EMPLOYER 1

Company Name
Full Business Address


Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began work	DD/MM/YYYY
Approximate date you finished work	DD/MM/YYYY
Do you have your T4 form (tax card)?
Do you have your final payslip?


EMPLOYER 2

Company Name
Full Business Address


Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began work	DD/MM/YYYY
Approximate date you finished work	DD/MM/YYYY
Do you have your T4 form (tax card)?
Do you have your final payslip?


EMPLOYER 3

Company Name
Full Business Address


Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began work	DD/MM/YYYY
Approximate date you finished work	DD/MM/YYYY
Do you have your T4 form (tax card)?
Do you have your final payslip?


EMPLOYER 4

Company Name
Full Business Address


Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began work	DD/MM/YYYY
Approximate date you finished work	DD/MM/YYYY
Do you have your T4 form (tax card)?
Do you have your final payslip?


EMPLOYER 5

Company Name
Full Business Address


Telephone Number
Fax Number
E-mail Address / Website
Approximate date you began work	DD/MM/YYYY
Approximate date you finished work	DD/MM/YYYY
Do you have your T4 form (tax card)?
Do you have your final payslip?


I want to provide you with my bank details


Currency of the transfer *
Bank name *
Address of the bank branch *
Branch code *
SWIFT /BIC code *
Personal account number /IBAN for all EU countries/ *
Name of account holder *



Have you also worked in any of the following countries? to select multiple options, hold down the control key while selecting
Did you receive a tax refund?

YOUR FEEDBACK AND ADDITIONAL INFORMATION
Please enter any additional comments and information here:

Please read our terms and conditions and indicate that you accept them in order for your registration to proceed
Yes, I accept the Terms and Conditions *

DON'T FORGET-IMPORTANT! Once you hit submit you will need to send us your final pay-slip(s) or T4 form (tax card) from each of your employers (if you have them) - see details on the next page.