Protected B when completed
 
  Statement of Deferred Security Options Benefits T1212

Complete this form to keep track of the security options benefits you have deferred as a result of exercising a security option after February 27, 2000, and up to and including 4:00 p.m. EST on March 4, 2010, to acquire eligible securities as a result of your employment. Eligible securities are common shares of a class listed on a designated stock exchange in or outside Canada and units of mutual fund trusts.

The deferred benefits have to be included in your employment income for the year in which you dispose of the security, become a non-resident, or die.

You have to file this form with your tax return each year that you have an outstanding balance of deferred security options benefits, whether or not you have deferred any security options benefits in the year or disposed of any securities in the year relating to a security option benefit that was previously deferred.
             
Tax year
 
Opening balance of deferred security option benefits
((from your previous year's notice of assessment or notice of reassessment)		  1 
Benefits that can no longer be deferred (enter this amount on line 10100 of your return) (see note) 65210 -  2 
Closing balance of deferred security option benefits: line 1 minus line 2 65220 =  3 
 
If the amount on line 3 is more than "0", we will show it on your your notice of assessment.
 
Note
To claim your "security options deduction" on this amount, enter 50% of line 2 on line 24900 of your return.
 
You may be able to claim a deduction for donating securities you acquired through your employer's security options plan.
For more information, see "Gifts of securities acquired under a security option plan" in Guide P113, Gifts and Income Tax.