Citizenship and

Immigration Canada

PROTECTED WHEN COMPLETED - B

Citoyennet et
Immigration Canada

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SCHEDULE 4

ECONOMIC CLASSES - PROVINCIAL NOMINEES

All Provincial Nominee principal applicants must complete this form.

Provincial Nominees nominated under a business, entrepreneur, or self-employed stream/category must also complete Schedule 4A.

1. Your full name

3. Which provincial government has nominated you?

Family name
Provincial stream/category:

Given name(s)
Given name(s)

4. Funds

2. Your date of birth

Amount of unencumbered transferable and

available funds you have, in Canadian dollars

Date
(YYYY-MM-DD)

Declaration
I declare that my family members and I intend to live in the Province that nominated me.
I understand that my participation in an immigration-linked passive investment scheme (as defined in the Immigration and Refugee Protection Regulations) could exclude me
from consideration as a member of the Provincial Nominee Class.
I authorize the Government of Canada to share all necessary information respecting my application for permanent residence in Canada, including the status to the application
decision, with officials of the provincial government that nominated me.
Signature
Date
(YYYY-MM-DD)

IMM 0008 (05-2009) E

SCHEDULE 4

This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants.
(DISPONIBLE EN FRANAIS - IMM 0008 F ANNEXE 4)