By completing this form, you are giving Instacart permission to send a copy of your T4A to you
via email. To be encrypted, this form must be downloaded and completed and sent back to
Instacart via the secure link provided. Please only send this form using the secure link provided;
sending this form as an attachment to an email will not be encrypted.
Please provide us with the following information to complete your request:
-​Full Name:
-Email Address on Account:
-​Last Four Digits of SIN:
-​Address:
-​Year(s) T4A needed: