RC4521 Application for a Financial Institution of a Prescribed Class to be Designated as a Qualifying Institution or Revocation of a Previously Granted Designation

Use this form if you are, or you reasonably expect to be, a financial institution of a prescribed class throughout a particular fiscal year and you want to be designated as a qualifying institution under subsection 141.02(25) of the Excise Tax Act, or you want to revoke a previously granted designation. You have to file this form for each fiscal year that you want to be designated as a qualifying institution.

Ways to get the form

• Download and fill out with Acrobat Reader

  You must download and open fillable PDFs in Acrobat Reader 10 or higher.

  • Accessible Fillable PDF (rc4521-fill-22e.pdf)

• Print and fill out by hand

  • Standard print PDF (rc4521-22e.pdf)

• Ask for an alternate format

  You can order alternate formats such as digital audio, electronic text, braille, and large print.

  • Order alternate formats for persons with disabilities