Instruction Sheet

Application for the Guaranteed Income Supplement or Statement of Income

Guaranteed Income Supplement (GIS), Allowance (ALW) Section E
and Allowance for the Survivor (ALWS) payments are
normally based on your previous year's income. Use the information slips issued to you for income tax
Generally, you report your income and use your purposes, together with your federal Income Tax and
deductions in the same way you do on your Canada Benefit Return, in order to declare, accurately, all of the
Revenue Agency (CRA) federal Income Tax and Benefit year's sources of income listed in this section. "Line
Return. Your entitlement for these benefits will be numbers" refer to the federal Income Tax and Benefit
reviewed annually. It is important to file your federal Return.
Income Tax and Benefit Return by the April 30th If you are married or living in a common-law union, your
deadline. We use the information we receive from the spouse or common-law partner must also complete a
CRA to determine your entitlement. If you file an income statement of income in the column provided on your form
tax return after April 30th, the renewal of your benefit or on a separate form. Indicate negative amounts (losses)
could be delayed. by circling them.
Sections A and B Do not include:
Please make sure that your address, telephone number
- Old Age Security Pension (Canadian), Guaranteed
and Social Insurance Number are correct and make any Income Supplement, Allowance or Allowance for the
necessary changes. Survivor
- War Veterans Allowance or Veterans Disability or
Section C Dependents Pension Program
You must confirm your current marital status. If you are - Death Benefits from Canada Pension Plan or Quebec
married, you must submit an original or a certified copy Pension Plan
of your marriage certificate. If you are in a common-law - Canada Child Tax Benefit payments
union, you must submit a Statutory Declaration of - Assistance payments from a municipal, provincial or
Common-law Union (ISP-3004). Canadian federal government
A common-law partner is a person of the opposite sex or - Support or gifts from relatives, registered charities or
same sex who has been living with you in a conjugal other organizations
relationship for at least one year. - Municipal tax rebates
Please let us know whether you are separated or living - Lottery winnings
apart for reasons beyond your control. (For example, - Inheritances
your spouse or common-law partner is in a nursing - GST credits or other such payments issued by the
home.) If you reunite, you must tell us. Canada Revenue Agency (CRA)
How to Certify Photocopies: When you send us - Universal Child Care Benefit
documents, provide readable, certified photocopies - Registered Disability Savings Plan payments
rather than original documents, if possible. Service
Canada Centre staff will photocopy and certify Block 1: Canada Pension Plan or Quebec
documents for free. A member of the following Pension Plan Benefits
professions can certify photocopies: Accountant, Chief
of First Nations Band, Commissioner for Oaths, Report the amount your Canada Pension Plan T4A (P)
Employee of a Service Canada Centre acting in an slip or of your Quebec Pension Plan from line 114 of your
official capacity, Funeral Director, Justice of the Peace, federal Income Tax and Benefit Return. Do not include
Lawyer, Magistrate, Notary, Manager of a Financial Death or Child benefits from Canada Pension Plan or
Institution, Medical and Health Practitioner: Chiropractor, Quebec Pension Plan.
Dentist, Doctor, Naturopathic Doctor, Nurse Practitioner,
Ophthalmologist, Optometrist, Pharmacist, Psychologist, Block 2: Other Pension Income
Registered Nurse, Member of Parliament or their staff,
Member of a Provincial Legislature or their staff, Minister Report the source and gross amount of all other pensions,
of Religion, Municipal Clerk, Official of a federal or pension income splitting, or superannuation (lines 115
provincial government department or one of its agencies, and 116 of your federal Income Tax and Benefit Return).
Official of an Embassy, Consulate or High Commission,
Official of a country with which Canada has a reciprocal - Canadian: Report your income and specify the source
Social Security Agreement, Police Officer, Professional from pensions, Registered Retirement Income Funds
Engineer, Social Worker, Teacher, University Professor. (RRIF's), Life Income Funds (LIF's), superannuation,
People who certify photocopies must compare the retirement plan payments, taxable annuities or other
original document to the photocopy, sign and print the payments as reported to the CRA.
following on the photocopy: their name, official position
or title, telephone number, date they certified the - Foreign: Foreign pension income must be reported
document, and the statement: This photocopy is a true whether it is paid in Canada or abroad. You must
copy of the original document which has not been report total benefits if they are income for Canadian
altered in any way. If there is information on both sides,
both must be photocopied and certified. You cannot income tax purposes, even if the income is exempt
certify photocopies of your own documents and neither from taxation under an income tax treaty. These
can a relative. Ensure to write your Client Identification payments would include all employment pensions,
Number or Social Insurance Number on your social security benefits and war service pensions.
documentation. Please include all back payments, and report the
amounts in Canadian dollars. If the amount is given in
Section D foreign currency please specify.
If you, your spouse or common-law partner were absent
from Canada for more than six consecutive months Block 3: Employment Insurance and
within the last 18 months, you may not be eligible to Workers' Compensation Benefits
receive GIS, ALW or ALWS benefits. Employment Insurance
Payment outside Canada: Your GIS, ALW or ALWS - Report the amount of Employment Insurance and other
benefit can be paid outside Canada for six months only. benefits from line 119 of your federal Income Tax and
You must tell us if you or your spouse or common-law Benefit Return.
partner will be outside of Canada for more than six
months.
Service Canada delivers Employment and Social Development Canada
programs and services for the Government of Canada

SC ISP-3025A (2018-02-23) E / Disponible en français

Workers' Compensation Benefits B) Other deductions
- Report the amount of Workers' Compensation benefits Registered Pension Plan (RPP) deduction (line 207),
from line 144 of your federal Income Tax and Benefit Registered Retirement Savings Plan (RRSP) deduction
Return. (line 208), Saskatchewan Pension Plan deduction (line
If you received income from both sources, please add 209), Pension Income Splitting (line 210), annual union,
them together and report the total in Block 3 of section E. professional or like dues (line 212), child care expenses
(line 214), Disability Supports deduction (line 215),
Block 4: Interest and Other Investment allowable business investment loss (line 217), moving
Income expenses (line 219), support payments made (line 220),
carrying charges and interest expenses (line 221),
Report the total interest received from a bank, trust deduction for Provincial Parental Insurance Plan (line
company, credit union, bonds, mortgage(s), any foreign 223), exploration and development expenses (line 224),
dividends and other investments or other interest received other employment expenses (line 229), Clergy residence
(line 121 of your federal Income Tax and Benefit Return). deduction (line 231) and other deductions (line 232).
All interest amounts should be reported as you do for
income tax purposes. The amount in Line 232 should not include any
Registered Disability Savings Plan (RDSP)
Block 5: Taxable Canadian Dividends and repayment deductions.
Capital Gains
Subtract the total of your deductions (B) from the
Eligible and Other than Eligible Dividends total other income (A). Report this amount in Block 9
Report the amount of your Eligible and Other than Eligible of section E. If negative, circle this amount.
Dividends from Line 120 of your Federal Income Tax and Block 10: Total Income For The Year
Benefit Return.
Add the amounts in Blocks 1 to 9 and enter the total in
Capital Gains Block 10 (if negative, circle this amount). If you have no
Report the amount of your Capital Gains from Line 127 of income, enter "0".
your Federal Income Tax and Benefit Return. Section F
Block 6: Net Rental Income If you complete this section, you will receive a special
Report the amount from line 126 of your Federal Income form on which you may estimate the income you expect
Tax and Benefit Return. If you had a net loss, circle that to receive. The amount of your benefits may be
amount. calculated based on your estimated total income for the
current calendar year, if this is to your advantage.
Block 7: Net Employment Income
Section G
Deduct $3,500.00 of the total of your employment income
(line 101) and other employment income (line 104). If the The application is not complete until it is signed by the
result is negative, report $0.00 in Block 7 of section E. If applicant (and spouse or common-law partner if
the value is positive, deduct your CPP or QPP applicable) or the person receiving the pension as a
contributions through employment (line 308) and Trustee and/or a Power of Attorney. Relatives or friends
Employment Insurance Premiums (line 312) of your may help you complete your application. If this applies
Federal Income Tax and Benefit Return. Report the to you, make sure that you, not the person assisting
balance in Block 7 of section E. If the result is negative, you, sign the application. If the applicant (or the spouse
report $0.00 in Block 7 of section E. or common-law partner) is unable to sign the form, a
mark such as an "X" is acceptable.
Use the following grid to calculate your allowable
deduction. NOTE: If you make a false or misleading statement, you
may be subject to an administrative monetary penalty
Total Net Income from Employment Value and interest, if any, under the Old Age Security Act, or
Deduct $3,500.00 from the value of Line 101 and may be charged with an offence. Any benefits you
Line 104 of the tax return. If the result is negative, A received or obtained to which there was no entitlement
report $0.00 in Block 7 of section E. would have to be repaid.
Report the value from Line 308 + Line 312 of the tax NOTE: If applicable, please attach Trustee or Power of
return. B
Attorney papers if not previously submitted.
Subtract A minus B C
Report the “C” value in Block 7 of section E. (if Section H
negative, report $0.00 in Block 7 of section E) D
If you signed your application or statement of income
Refer to Block 9 for other deductions. with a mark, please provide us with the information
requested.
Block 8: Net Self-Employment Income
If you have any questions, visit our Internet site at:
Total of lines 135 to 143 minus line 222, line 310 and line www.servicecanada.gc.ca
317 of your Federal Income Tax and Benefit Return. If OR you can call us free of charge from Canada and the
you had a net loss last year, circle that amount. Refer to United States
Block 9 for other deductions.
Block 9: Other Income English: 1-800-277-9914
French: 1-800-277-9915
You may have received other income or you may be TTY: 1-800-255-4786
entitled to other deductions that have not been reported in
other blocks of this form. To determine the amount to Please provide your Social Insurance Number when
report in Block 9, calculate your total other income from contacting us.
the sources noted under (A) below, and subtract from that Protection of Personal Information
amount the total of your other deductions noted under (B)
below. Report the result of this calculation in Block 9 of The information requested is required under the Old Age
section E. If negative, circle the amount. Security (OAS) Act.

A) Other income Under the OAS Act and the Privacy Act you have the
right to look at the personal information about you in your
Net partnership income - limited or non-active partners file. We will keep this information in the Personal
only (line 122), taxable support payments received (line Information Bank ESDC PPU 116. You can ask to see
128), Registered Retirement Savings Plan (RRSP) your file by contacting a Service Canada Centre.
income (line 129), and Other income (line 130).

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