If you answer yes to question 5 in Section C, you have to complete Section G and provide the additional information requested below.

Name of the entity holding the security deposit or instrument, or issuing the insurance policy

Enter the name and complete address of each entity holding a security deposit, supplying the investment, or issuing an insurance policy for this tax shelter, and provide the additional information requested below. Follow the instructions for Complete address.

Arm's length with the principal promoter?

For each entity, tick (✔) the appropriate column.

Additional information required

Attach to the application any draft agreements or similar document that will be offered to the participants. If all agreements are the same, send one blank copy of the agreement. If agreements vary from one participant to another, send one copy of each agreement that is different. Include arrangements between potential participants and third parties (where such arrangements are to be used to promote the sale of the tax shelter or forms part of the arrangement).

For more information about non-arm's length, see the Income tax folio S1-F5-C1, Related Persons and Dealing at Arm’s Length.

If there is not enough space, attach a separate sheet using the same format as on this form.

Forms and publications

• Form T5001, Application for Tax Shelter Identification Number and Undertaking to Keep Books and Records
• Income tax folio S1-F5-C1, Related Persons and Dealing at Arm’s Length