Statement of Income for the Guaranteed Income Supplement, the Allowance or Allowance for the Survivor for payment period of July (20XX) to June (20XX) with Information Sheet

This Statement of Income is for single or married persons or persons living in a common-law relationship who wish to renew the Guaranteed Income Supplement, the Allowance or the Allowance for the Survivor. Please use the drop down list in the title of the form to select a previous payment period if required.