TN 16 (11-96)

A. U.S. Canadian Agreement — General

A certificate of coverage serves as proof that the worker identified on the certificate is covered in the country which issued the certificate and is, therefore, exempt from social security taxes in the other country for the period noted on the certificate. To obtain a certificate of coverage, the employer, the employee or self-employed person must send a written request to the agency of the country which issues the certificate. If a certificate of coverage from the U.S. is desired, the request should be mailed to:

If a certificate of coverage from Canada is required and the person will be covered by the Canada Pension Plan, the request should be mailed to:

If a certificate of coverage from Canada is required and the person will be covered by the Quebec Pension Plan, the request should be mailed to:

B. Information Required

Regardless of which country the certificate is being requested from, it must contain the following information.

1. Full name of worker

2. Date and place of birth of worker

3. Citizenship of worker

4. Country of residence of worker

5. U.S. Social Security number (for U.S. certificates)

6. Canadian social security number (for Canadian certificates)

7. Name and address of employer in both countries (if self-employed, address and nature of activity).

8. Beginning and ending date of employment/self-employment in the other country.

C. Disposition of Copies

When a U.S. certificate is issued, an employee and employer copy will be sent to the employer or self-employed person. It will be the responsibility of the employer or self-employed person to present the certificate to the Canadian authorities when necessary.

When a Canadian certificate is issued, the employer or self-employed person will be provided with a copy. It is the responsibility of the employer or self-employed person to retain the copy in their files and present it to IRS when requested to do so.