5000-S4 Protected B when completed T1-2015 Schedule 4 Statement of Investment Income State the names of the payers below, and attach any information slips you received. Attach a separate sheet of paper if you need more space. Attach a copy of this schedule to your return. I - Taxable amount of dividends (eligible and other than eligible) from taxable Canadian corporations Line 1: Taxable amount of dividends other than eligible dividends ^ (specify): ^ Line 2: ^ Line 3: ^ Line 4 and line 180: Add lines 1 to 3, and enter this amount on line 180 of your return. = ^ Line 5: Taxable amount of eligible dividends ^ (specify): ^ Line 6: ^ Line 7: ^ Line 120: Add lines 4 to 7, and enter this amount on line 120 of your return. = ^ II - Interest and other investment income ^ Specify: ^ Line: ^ Line: ^ Income from foreign sources ^ (specify): ^ Line 121: Enter this amount on line 121 of your return. = ^ III - Carrying charges and interest expenses ^ Carrying charges ^ (specify): ^ Interest expenses ^ (specify): ^ Line 221: Enter this amount on line 221 of your return. 221 = ^ See the privacy notice on your return.