I confirm that Integrated Financial & Management Solutions Inc. (IFMS) has advised me that I or certain individuals related to me, may be eligible for certain disability-related tax benefits from the Canadian government, and hereby retain IFMS to pursue these benefits on my behalf, on the following terms:
1. IFMS is authorized to act on my behalf in dealing with the Canada Revenue Agency (CRA), health professionals and such other parties as may be appropriate in connection with the application process. I agree to sign such consent forms as IFMS deems advisable in connection with the application process (including, but not limited to, AUT-1 Level 2, CRA authorization form), and to cooperate fully and promptly with IFMS during and following the application process.

2. IFMS will keep my information strictly confidential and will not disclose any of my information other than as is appropriate in connection with the application process or as may be required by law.

3. While IFMS does not guarantee that I will be entitled to any benefits, IFMS will be entitled to a fee equal to 25% (plus GST/HST) of all benefits I or any individuals related to me, receive, whether in the form of refund from CRA, credits to a CRA account, or otherwise, in respect of the application prepared by IFMS. IFMS will not be entitled to a fee in respect of any period following the time period that is the subject of the application prepared by IFMS. I agree to notify IFMS immediately upon receipt of any benefits by myself or any party related to me. In the event that no benefits are received, I will not be required to make any payment to IFMS.

4. IFMS fee will be due five (5) business days from the receipt of any benefits by myself or any party involved with this application. However, if for any reason IFMS cannot collect their fees on time any fees, or portion thereof, not paid when due will accrue interest at a rate of 2% per month (26.82% APR), and I will be responsible for IFMS' cost of collecting its fees. Any returned cheques will be subject to a fee of $45.00.

5. I understand that I am personally responsible to pay any / all monies owing to IFMS upon receipt of any benefits for the period that was the subject of the application prepared by IFMS.

6. IFMS will be entitled to make such determinations as it deems appropriate in connection with the application process, including, without limitation, whether to amend, delay, or withdraw the application.

7. Unless IFMS has advised me in writing that it has terminated this agreement, I will remain responsible for IFMSs fee in the event that, independently of IFMS, I pursue an application for benefits in respect of all or part of the time period that was the subject of the application prepared by IFMS. I agree that I will not cancel the AUT-1 Level 2, Authorizing a Representative, unless advised by IFMS in writing that I may do so. I understand that cancelling the AUT-1 Level 2 would make me liable for the full amount of IFMS' fees for the benefits for the period that is subject of the application prepared by IFMS.

8. I consent to IFMS obtaining my Credit report from recognized credit agency/agencies for any purpose related to this agreement. I also agree that in the event of my non-compliance with this agreement, I consent to have IFMS use the information in my credit report for any purpose related to this agreement including but not limited to identifying my whereabouts, my assets and/or reporting such non-compliance to the credit reporting agency/agencies. I agree that they may or may not give me notification of any such action(s).

9. This agreement shall be governed by the laws of the Province of Ontario, and the courts of the Province of Ontario shall have jurisdiction over any dispute relating to this agreement.

Applicant Name: SIN #:  

Witness Name:

Please attached an identification document (optional)
Which forms of valid identification are acceptable?

Acceptable valid identification includes:
• passport (an international passport is acceptable if it includes the name, date of birth, photo and signature of the applicant and is accompanied by a professionally translated version if not in French or English)
• driver's license
• enhanced driver's license
• Canadian military identification card
• government-issued identification card
• government-issued enhanced identification card
• health card • Canadian citizenship card (issued before February 1, 2012)
• Canadian permanent resident card
• U.S. permanent resident card (green card)

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Document name: Agreement

Unique Document ID: b9052a4ee7b339d0438dc94cad086a7339323a67

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Timestamp	Audit
June 20, 2022 9:05 pm EDT	Agreement Uploaded by Siraj Fidai - sirajfidai@ifmsolutions.com IP 174.119.202.168

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https://disabilityrefunds.com/

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