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Complete the following sections:
1. Name and address
2. Holder Account Number
Computershare Investor
Investor Services
Computershare
ServicesPLC
PLC
The Pavilions
Pavilions
The
Bridgwater Road
Bridgwater
Road
Bristol
Bristol
BS99 6ZY
BS99 6ZY
Telephone 0870 707 1804
Telephone
0370 707 1804
www.computershare.com
www.computershare.com
1>
Holder Account Number
2> C1234567890
J JNT
*
*
*
*
Form NR301 - Declaration of eligibility for benefits under a tax treaty for a non-resident taxpayer
Please use a black pen. Print in
CAPITAL letters inside the grey
areas as shown in this example.
A B C
1 2 3
X
This form must be returned by the next dividend record date in order for the correct tax rate to be applied.
1
Country of residence for treaty purposes
2
Recipient Type and Canadian Tax Number
Check one box only. Complete Canadian Tax Number only if you have a
Canadian Tax Number.
Enter your Canadian Social Insurance
Number or individual tax number.
Individual
Corporation
Enter your Canadian corporation’s
business number.
Enter the Canadian trust’s account number.
Trust
3
Foreign Tax Identification Number (optional)
4
Type of income being declared
T
Enter your non-Canadian tax identification number in the box (e.g. National
Insurance number if you are a UK tax payer).
X
5
R C
Dividends, Interest,
and/or Royalties
Certification and Undertaking
This form must be signed and dated for us to accept as proper certification.
 I certify that the information given on this form is correct and complete.
 I certify that the non-resident taxpayer indicated in section 1 is the beneficial owner of all income to which this form relates.
 I certify that to the best of my knowledge and based on the factual circumstances the non-resident taxpayer indicated in section 1 is entitled to the benefits of the tax treaty between Canada and
the country indicated in section 4, on the income listed in section 5.
 I undertake to immediately notify the payer, or partnership or hybrid entity through which I derive income, as the case may be, and to whom I am submitting this form, of any changes to the
information provided on this form.
Signature of non-resident taxpayer or authorised person
Name and Position/Title of authorised person
Sign Here
/
C1904
/
T OCQ
00000XXX/000000/000000
11XKSD D03
SG151
How to complete this form
Information and instructions for the non-resident taxpayer
Why should I complete this form?
It is now a requirement for non-residents of Canada who are receiving dividend payments sourced in Canada to have a validly completed NR301 form in place
which enables the Trustee of the Scheme to reduce withholding tax on dividend payments from 25% to the treaty rate. Therefore all such participants in the
Company Sponsored Nominee in which you are participating are required to submit a new NR301 form every three years, or earlier if there are changes in
address, in order to obtain the benefit of a reduced withholding rate under the tax treaty between Canada and the country in which the participant is resident.
Country of residence (1)
Indicate your country of residence. You must be a resident of the country as defined in the tax treaty between Canada and that country. For more information,
consult the publication Income Tax Technical News No. 35 at www.cra-arc.gc.ca/E/pub/tp/itnews-35/, published February 26, 2007.
Recipient type and Canadian tax number (2)
Tick the appropriate type of non-resident taxpayer and provide a Canadian tax number, if you have one.
Foreign tax identification number (3)
Enter the tax identification number that you use in your country of residence, if you have one. For individuals who are resident in the UK, this is your
National Insurance Number.
Type of income (4)
This form is applicable to dividends paid on your Thomson Reuters Corporation holding. We have pre marked that this is dividend income.
Certification and undertaking (5)
This area should be completed and signed by:
- the non-resident taxpayer in the case of an individual;
- an authorised officer in the case of a corporation;
- the trustee, executor, or administrator if the person filing the form is a trust;
- an authorised partner in the case of a partnership.
A non-resident who does not satisfy the requirements of the limitation on benefits provisions, if any, contained in the tax treaty will not be entitled to all the benefits
of the tax treaty. By signing this form you are certifying that the non-resident is entitled to a reduced rate of tax under a tax treaty.
During an audit or review, or while processing a related request, the CRA (Canada Revenue Agency) may ask you for more information to substantiate the tax
treaty benefit you claimed.
Change in circumstances
If a change in circumstances makes any information on the form incorrect, notify Computershare immediately and complete a new form.
Expiry date
This declaration expires when there is a change in the taxpayer’s eligibility for the declared treaty benefits or three years from the end of the calendar year
in which the form is signed and dated, whichever is earlier. If the taxpayer’s mailing address has changed to a different country, the taxpayer should submit
a revised form NR301.
If you need more information, see Part XIII Withholding Tax at www.cra-arc.gc.ca/tx/nnrsdnts/pyr/prtxiii/wthhldng/menu-eng.html and select Beneficial
Ownership or Rates for Part XIII Tax.
Please return the completed form in the enclosed Business Reply Envelope to:
Computershare Investor Services PLC
Corporate Actions 4
The Pavilions
Bridgwater Road
Bristol
BS99 6AU
00000XXX/000000/000000
11XKSD D03