The following consent must be included with all requests:
The taxpayer whose name appears below (taxpayer) has requested an advance income tax ruling from the Canada Revenue Agency (CRA) in accordance with the procedures described in Information Circular 70-6R5, Advance Income Tax Rulings, dated [Date of publication].
The taxpayer or the taxpayer's authorized representative has provided a statement identifying the information to be deleted from the text of the ruling before it is released to the public.
A ruling issued in respect of the taxpayer's request will be submitted in severed form to the taxpayer, or authorized representative, for review and approval. At that time, the taxpayer may request that specific additional information be severed from the ruling prior to the release of the ruling to the public.
The taxpayer hereby authorizes the CRA to release the severed ruling to the public in accordance with the procedures stated in this consent.
__________________________________________________
Taxpayer's name
__________________________________________________
Taxpayer's signature
__________________________________________________
Date