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["2021 Foreign Income Verification Statement"]
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["If your investments from all foreign countries are greater than $100,000 but less than $250,000, indicate which applies and the income / gain "]
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["Item",null,null,null,"Country code(Note 1)","Applies","Income","Gain"]
["Funds held outside Canada"]
["Shares of non-resident corporations (other than foreign affiliates)"]
["Indebtedness owed by (loans to) non-residents"]
["Interests in non-resident trusts"]
["Real property outstide Canada (other than personal use and real estate used in an active business)"]
["Other property outside Canada"]
["Property held in an account with a Cdn registered securities dealer or a Canadian trust company"]
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["(Note 1) - Select the top three countries based on the maximum cost amount of specified foreign property held during the year in each respective country."]
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["Use the below tables if your investments in all foreign countries are greater than $250,000"]
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["Funds held outside Canada"]
["Name of bank/other entity holding the funds","Country","Maximum funds held during 2021","Funds held at year end","Gross Income"]
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[]
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["Shares of non-resident corporations (other than foreign affiliates)"]
["Name of corporation","Country","Maximum cost amount during 2021","Cost amount at year end","Gross Income","Gain(loss) on disposition"]
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[]
[]
["Indebtedness owed by (loans to) non-residents"]
["Description of indebtedness","Country","Maximum cost amount during 2021","Cost amount at year end","Gross Income","Gain(loss) on disposition"]
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[]
[]
["Interests in non-resident trusts"]
["Name of trust","Country","Maximum cost amount during 2021","Cost amount at year end","Income received ","Capital received","Gain (loss) on dispostion"]
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[]
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["Real property outstide Canada (other than personal use and real estate used in an active business)"]
["Descripton of property","Country","Maximum cost amount during 2021","Cost amount at year end","Gross Income","Gain (loss) on disposition"]
[]
[]
[]
["Other property outside Canada"]
["Descripton of property","Country","Maximum cost amount during 2021","Cost amount at year end","Gross Income","Gain (loss) on disposition"]
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[]
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["Property held in an account with a Cdn registered securities dealer or a Canadian trust company"]
["Name of registered security dealer / Canadian trust company","Country","Maximum FMV in 2021","FMV at end of year","Gross Income","Gain (loss) on disposition"]