Form CPT100 "Appeal of a Ruling Under the Canada Pension Plan and/or Employment Insurance Act" - Canada

Form CPT100 is a Canadian Revenue Agency form also known as the "Form Cpt100 "appeal Of A Ruling Under The Canada Pension Plan And/or Employment Insurance Act" - Canada". The latest edition of the form was released in January 1, 2016 and is available for digital filing.

Download a PDF version of the Form CPT100 down below or find it on Canadian Revenue Agency Forms website.

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Download Form CPT100 "Appeal of a Ruling Under the Canada Pension Plan and/or Employment Insurance Act" - Canada

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Appeal of a ruling under the Canada Pension Plan and/or Employment Insurance Act
Please read the instructions on the back before completing this form.
Appellant identification
Indicate whether you are:
Employer/Payer
Worker
Mailing address
Appellant's last name, first name/Business name (print)
Social insurance number (SIN) or
Telephone
Fax
Business number (BN)
Please check applicable boxes
an assessment of CPP and/or EI for this same period/employment relationship – employers only (Form CPT101)
I have filed other appeals
a notice of assessment/determination under the Income Tax Act relating to this same issue/year (Form T400A)
and/or objections of:
a notice of objection GST/HST (Form GST159)
Details of ruling
(Attach a copy of the ruling decision letter with this form.)
Ruling date
Applicable legislation(s)
Canada Pension Plan (CPP)
Employment Insurance Act (EIA)
Period(s) under appeal
Ruling reference number
From:
To:
Issue(s) under appeal (tick one or more boxes)
The number of insurable hours
Whether the worker(s) is/are employee(s) or self-employed
The amount of insurable earnings
Whether the worker(s) is/are dealing at arm's length with the payer
Other:
Other party
If you are the worker, list the name, address and telephone number of the payer.
If you are the payer, list the name, address, telephone number and social insurance number (SIN) of the worker(s) to which the ruling(s) applies.
(Attach separate sheet(s) if necessary.)
Name
Address
Telephone
SIN
Please state all the facts about the working relationship and the reason(s) for your appeal. For more information, see the back of this form.
(Attach separate sheet(s) if necessary.)
Authorized representative
(Please complete this section to authorize a representative for this appeal.)
Representative's name (print)
Address
Telephone
Signature of the appellant or authorized officer of the corporation
Signature
Print name/Title
Date
YYYY-MM-DD
Privacy Act, personal information bank number CRA PPU 130
CPT100 E (16)
(Ce formulaire est disponible en français à arc.gc.ca)
Clear Data
Help
Protected B
when completed
Appeal of a ruling under the Canada Pension Plan and/or Employment Insurance Act
Please read the instructions on the back before completing this form.
Appellant identification
Indicate whether you are:
Employer/Payer
Worker
Mailing address
Appellant's last name, first name/Business name (print)
Social insurance number (SIN) or
Telephone
Fax
Business number (BN)
Please check applicable boxes
an assessment of CPP and/or EI for this same period/employment relationship – employers only (Form CPT101)
I have filed other appeals
a notice of assessment/determination under the Income Tax Act relating to this same issue/year (Form T400A)
and/or objections of:
a notice of objection GST/HST (Form GST159)
Details of ruling
(Attach a copy of the ruling decision letter with this form.)
Ruling date
Applicable legislation(s)
Canada Pension Plan (CPP)
Employment Insurance Act (EIA)
Period(s) under appeal
Ruling reference number
From:
To:
Issue(s) under appeal (tick one or more boxes)
The number of insurable hours
Whether the worker(s) is/are employee(s) or self-employed
The amount of insurable earnings
Whether the worker(s) is/are dealing at arm's length with the payer
Other:
Other party
If you are the worker, list the name, address and telephone number of the payer.
If you are the payer, list the name, address, telephone number and social insurance number (SIN) of the worker(s) to which the ruling(s) applies.
(Attach separate sheet(s) if necessary.)
Name
Address
Telephone
SIN
Please state all the facts about the working relationship and the reason(s) for your appeal. For more information, see the back of this form.
(Attach separate sheet(s) if necessary.)
Authorized representative
(Please complete this section to authorize a representative for this appeal.)
Representative's name (print)
Address
Telephone
Signature of the appellant or authorized officer of the corporation
Signature
Print name/Title
Date
YYYY-MM-DD
Privacy Act, personal information bank number CRA PPU 130
CPT100 E (16)
(Ce formulaire est disponible en français à arc.gc.ca)
Clear Data
Help
Appeal of a ruling under the Canada Pension Plan and/or Employment Insurance Act
You can use this form if you want to appeal a ruling of Canada Pension Plan (CPP) and/or Employment Insurance (EI). If you want to appeal
an assessment of CPP and/or EI, you can use Form CPT101.
To file an objection to a notice of assessment or a notice of determination issued under the Income Tax Act, you can use Form T400A.
It is important that you provide all of the facts about your working relationship and the detailed reason(s) for your appeal. Also include any
relevant documents that support your appeal, such as contracts, copies of cancelled pay cheques or shareholder’s agreements. For more
information about your appeal rights and the appeal process, please see Booklet P133, Your Appeal Rights – Canada Pension Plan and
Employment Insurance Coverage. You can get this booklet and other publications at
cra.gc.ca/E/pub/tg/p133/p133-e.html
or by calling
1-800-959-8281.
The CRA website also provides information and clear explanations of CPP/EI matters, which will help you in preparing your appeal
submission. You will find a number of publications and a series of interpretive articles on CPP and EI matters. For information regarding
employment status, we recommend you read our publication RC4110, Employee or Self-employed? at cra.gc.ca/E/pub/tg/rc4110.
Filing deadlines:
The Chief of Appeals must receive your appeal within 90 days from the date you were notified of the decision from the CPP/EI Rulings
Division. Enclose a copy of the ruling decision letter. You can do it in three ways.
Online: Go to
cra.gc.ca/myaccount
or cra.gc.ca/mybusinessaccount. If you are a level 2 or 3 representative, go to
cra.gc.ca/representatives. Click on "Register a formal dispute (Appeal)". To send supporting documents, click on "Submit documents".
In writing: Send Form CPT100, Appeal of a Ruling Under the Canada Pension Plan and/or Employment Insurance Act, or a letter to the
Chief of Appeals to the following address:
CPP/EI Appeals Division
Canada Revenue Agency
451 Talbot ST
London ON N6A 5E5
By fax: Send your documents to 1-888-287-7800
Make sure you keep the Appeals case number (GB#) which you will get when you send an appeal through "Register My Formal Dispute".
Change of address or telephone number:
If you move after filing an appeal, please update your address and the telephone number (including the area code) where you can be
reached during the day. You can do this:
online at cra.gc.ca/myaccount; or
by calling 1-800-959-8281
You can change a business mailing address:
online at cra.gc.ca/mybusinessaccount; or
by calling 1-800-959-5525
Representative:
If you would like to authorize the CRA to deal with another person as your representative for the appeal, please complete the section
"Authorized Representative" on this form, or include Form CPT139, Canada Pension Plan (CPP)/Employment Insurance (EI) – Authorizing or
Cancelling a Representative, available on the CRA website at cra.gc.ca/E/pbg/tf/cpt139/README.html.
Privacy Notice:
We collect your personal information, including the social insurance number under the authority of section 237 of the Income Tax Act (ITA),
section 27.2(1) of the Canada Pension Plan (CPP) and section 93 of the Employment Insurance Act (EIA) and use it to determine coverage
under the CPP and EIA. It may also be used for any purpose related to the administration or enforcement of these Acts. We may also
disclose your information to Employment and Social Development Canada and the Department of Justice to determine coverage under the
CPP and EIA. If you do not provide your information it could affect the outcome of your appeal or your appeal could be considered invalid.
Personal information is described in Appeals Regarding the Canada Pension Plan and the Employment Insurance Act (CRA PPU 130) and is
protected under the Privacy Act. Individuals have a right of protection, access to and correction or notation of their personal information.
Please be advised that you are entitled to complain to the Privacy Commissioner of Canada regarding our handling of your information.
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