Claim for Tax Shelter Loss or Deduction T5004
  • Fill in this form if you are an investor claiming a loss or deduction, a donation or political contribution deduction, or a tax credit for an interest in a tax shelter. We may verify and adjust your claim.
  • If you receive a T5003 slip (tax shelter), and a T5013 slip (partnership) or an official donation or political contribution shlip for the same tax shelter, do not claim amounts more than once. Under the Income Tax Act, we can apply a penalty of 50% of the understeated tax if you make a false claim knowingly or in circumstances amounting to gross negligence.
  • Attach a completed copy of this form to your income tax and benefit return together with documents (a copy of your T5003 slip and the tax shelter's statement of earnings, or a copy of your T5013 slip) to support the amount you are claiming as a loss or deduction, donation or political contribution deduction, or tax credit.
  • You have to identify a tax shelter interest you bought after August 31, 1989, with a tax shelter identification number. You have to provide this number on your claim for any investment in the tax shelter you bought after that date.
  • If you need more information on how to complete this form, call us at 1-800-959-5525.
Investor's name Investor's identification number*
Investor's address
Tax shelter identification number** Tax shelter's name Purchase date Loss or deduction claimed Line from T1 return***
 1   TS 
Total amount claimed 67650
Personal information (including the SIN) is collected to administer or enforce the Income Tax Act and related programs and activities including administering tax, benefits, audit, compliance, and collection. The information collected may be used or disclosed for purposes of other federal acts that provide for the imposition and collection of a tax or duty. It may also be disclosed to other federal, provincial, territorial, Indigenous or foreign government institutions to the extent authorized by law. Failure to provide this information may result in paying interest or penalties, or in other actions. Under the Privacy Act, individuals have a right of protection, access to and correction of their personal information, or to file a complaint with the Privacy Commissioner of Canada regarding the handling of their personal information. Refer to Personal Information Bank CRA PPU 005 on Information about Programs and Information Holdings at

Use another form if you need more room to list your tax shelter losses or deductions. Enter the "Total amount claimed" on the last form only. That amount is the total of all losses or deductions you are claiming for the year.

* This is the social insurance number (SIN) if the investor is an individual, the Business Number if the investor is a corporation, the partnership account number if the investor is a partnership, or the trust account number if the investor is a trust.

** Income Tax Act paragraph 237.1(5)(c) - "The identification number is issued for this tax shelter shall be included in any income tax return filed by the investor. Issuance of the identification number is for administrative purpose only and does not in any way confirm the entitlement of an investor to claim any tax benefits associated with the tax shelter."

*** Fill in the last column above to indicate the line where you are making your claim on an income tax and benefit return.
  • If your claim is for a Gift, use line 34900, and if your claim is for a Political contribution (monetary contribution), use line 40900.
  • If you are a limited partner of a partnership that invested in a tax shelter, make your claim on line 12200, Net partnership income: limited or non-active partners only.
  • Otherwise, make your claim on the line that corresponds with the type of loss or deduction you are claiming.
    For example:    line 12600, Rental income    Line 21700, Business investment loss
       Line 13500, Business income    Line 22100, Carrying charges and interest expenses
       Line 14100, Farming income    Line 22400, Exploration and development expenses
       Line 14300, Fishing income    Line 23200, Other deductions