Fields marked with an * are required

Personal Information

Applicant Name

 

Birth Date

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Employment Information

Passport Information

The passport number may contain numbers and/or characters. Please closely distinguish between the two, such as the numbers zero and one, and the letters O and I.

(Country of Citizenship)

Passport Issuance Date

 

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Passport Expiration Date

 

 

Contact Information

Home Address

 

 


Consent and declaration

Information provided to CIC is collected under the authority of the Immigration and Refugee Protection Act (IRPA) to determine admissibility to Canada. Information provided may be shared with other Canadian government institutions such as, but not limited to, the Canada Border Services Agency (CBSA), the Royal Canadian Mounted Police (RCMP), the Canadian Security Intelligence Service (CSIS), the Department of Foreign Affairs, Trade and Development (DFATD), Employment and Social Development Canada (ESDC), the Canada Revenue Agency (CRA), provincial and territorial governments and foreign governments in accordance with subsection 8(2) of the Privacy Act. Information may be disclosed to foreign governments, law enforcement bodies and detaining authorities with respect to the administration and enforcement of immigration legislation where such sharing of information may not put the individual and or his/her family at risk. Information may also be systematically validated by other Canadian government institutions for the purposes of validating status and identity to administer their programs.

Where biometrics are provided as part of an application, the fingerprints collected will be stored and shared with the RCMP. The fingerprint record may also be disclosed to law enforcement agencies in Canada in accordance with subsection 13.11(1) of the Immigration and Refugee Protection Regulations. The information may be used to establish or verify the identity of a person in order to prevent, investigate or prosecute an offence under any law of Canada or a province. This information may also be used to establish or verify the identity of an individual whose identity cannot reasonably be otherwise established or verified because of physical or mental condition. Canada may also share immigration information related to biometric records with foreign governments with whom Canada has an agreement or arrangement.

Depending on the type of application made, the information you provided will be stored in one or more Personal Information Banks (PIB) pursuant to section 10(1) of Canada's Privacy Act. Individuals also have a right to protection and access to their personal information stored in each corresponding PIB under the Access to Information Act. Further details on the PIBs pertaining to CIC's line of business and services and the Government of Canada's access to information and privacy programs are available at the Infosource website (http://infosource.gc.ca) and through the CIC Call Centre. Infosource is also available at public libraries across Canada.

Declaration of Applicant

I have read and understand the above declaration. I declare that the information I have given in this application is truthful, complete and correct. I understand that misrepresentation is an offence under section 127 of the Immigration and Refugee Protection Act and may result in a finding of inadmissibility to Canada or removal from Canada. I agree that by typing my name and clicking sign, I am electronically signing my application. I agree to the terms and conditions as described in the terms and conditions section of this website.

Important: This information is for reference only and no immigration decision will be made based on your answers. If you choose to apply, your application will be considered by an immigration officer in accordance with the Immigration and Refugee Protection Act, without regard to any outcome you attain through this questionnaire.