Clear Data
Protected B
when completed
Election by a Credit Union to Allocate Taxable Dividends
and Net Non-taxable Capital Gains to Member Credit Unions
• For use by a credit union to elect, under subsection 137(5.1) of the Income Tax Act, to allocate to member credit
Do not use this area
unions the part of the following amounts that can reasonably be attributed to them:
– the total of taxable dividends received from taxable Canadian corporations in the year;
– the excess of the total of the non-taxable parts of capital gains from dispositions of property in the year
over the total of the non-allowable parts of capital losses from dispositions of property in the year (the net
non-taxable capital gains);
– the amounts allocated for the year to the credit union under subsection 137(5.1) from another credit union that
it is a member of.
• Mail one complete copy of the election, separately from any tax return, to your tax centre. Find your tax centre's
address at canada.ca/tax-centres. This election is valid if it is filed within 120 days after the credit union's tax
year-end.
Name of credit union
Address
Business number
Tax services office
Tax year-end
Year
Month Day
Amounts that can reasonably be attributed to and are allocated to member credit unions under this election:
A
Total taxable dividends received from a taxable Canadian corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B
Net non-taxable capital gains from dispositions of property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C
Amounts allocated to the credit union under subsection 137(5.1) from another credit union . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The above amounts have been allocated to the following (if you need more space, attach a separate schedule).
Name and address of member credit unions
Amount A
Amount B
Amount C
1.
2.
3.
4.
Election and certification
The credit union named above elects under subsection 137(5.1) of the Act to allocate to member credit unions the amounts specified in the schedule
above.
I certify that the information given in this election, and in all attached documents, is correct and complete.
Name of authorized officer
Position or office
Signature of authorized officer
Date yyyy-mm-dd
Privacy statement
Personal information is collected under the Income Tax Act to administer tax, benefits, and related programs. It may also be used for any purpose
related to the enforcement of the Act such as audit, compliance and collection activities. It may be shared or verified with other federal, provincial,
territorial or foreign government institutions to the extent authorized by law. Failure to provide this information may result in interest payable, penalties or
other actions. Under the Privacy Act, individuals have the right to access their personal information, request correction, or file a complaint to the Privacy
Commissioner of Canada regarding the handling of the individual's personal information. Refer to Personal Information Bank CRA PPU 047 on Info
Source at canada.ca/cra-info-source.
T2004 E (18)
(Ce formulaire est disponible en français.)
Clear Data
Protected B
when completed
Election by a Credit Union to Allocate Taxable Dividends
and Net Non-taxable Capital Gains to Member Credit Unions
• For use by a credit union to elect, under subsection 137(5.1) of the Income Tax Act, to allocate to member credit
Do not use this area
unions the part of the following amounts that can reasonably be attributed to them:
– the total of taxable dividends received from taxable Canadian corporations in the year;
– the excess of the total of the non-taxable parts of capital gains from dispositions of property in the year
over the total of the non-allowable parts of capital losses from dispositions of property in the year (the net
non-taxable capital gains);
– the amounts allocated for the year to the credit union under subsection 137(5.1) from another credit union that
it is a member of.
• Mail one complete copy of the election, separately from any tax return, to your tax centre. Find your tax centre's
address at canada.ca/tax-centres. This election is valid if it is filed within 120 days after the credit union's tax
year-end.
Name of credit union
Address
Business number
Tax services office
Tax year-end
Year
Month Day
Amounts that can reasonably be attributed to and are allocated to member credit unions under this election:
A
Total taxable dividends received from a taxable Canadian corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B
Net non-taxable capital gains from dispositions of property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C
Amounts allocated to the credit union under subsection 137(5.1) from another credit union . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The above amounts have been allocated to the following (if you need more space, attach a separate schedule).
Name and address of member credit unions
Amount A
Amount B
Amount C
1.
2.
3.
4.
Election and certification
The credit union named above elects under subsection 137(5.1) of the Act to allocate to member credit unions the amounts specified in the schedule
above.
I certify that the information given in this election, and in all attached documents, is correct and complete.
Name of authorized officer
Position or office
Signature of authorized officer
Date yyyy-mm-dd
Privacy statement
Personal information is collected under the Income Tax Act to administer tax, benefits, and related programs. It may also be used for any purpose
related to the enforcement of the Act such as audit, compliance and collection activities. It may be shared or verified with other federal, provincial,
territorial or foreign government institutions to the extent authorized by law. Failure to provide this information may result in interest payable, penalties or
other actions. Under the Privacy Act, individuals have the right to access their personal information, request correction, or file a complaint to the Privacy
Commissioner of Canada regarding the handling of the individual's personal information. Refer to Personal Information Bank CRA PPU 047 on Info
Source at canada.ca/cra-info-source.
T2004 E (18)
(Ce formulaire est disponible en français.)
ADVERTISEMENT