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  • Credit Card Payment

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    Harlav Ioan
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    Visa MasterCard number: Number: Expiry: Month Year Month Year American Express CARDHOLDER I authorize the Ministere de l'Immigration et des Communautes culturelles to charge the amount of $CAN to my credit card. If the cardholder is not the applicant, please provide the applicant's name and date of birth below.

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    Visa MasterCard number: Number: Expiry: Month Year Month Year American Express CARDHOLDER I authorize the Ministere de l'Immigration et des Communautes culturelles to charge the amount of $CAN to my credit card. If the cardholder is not the applicant, please provide the applicant's name and date of birth below.

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    35 views1 page

    Credit Card Payment

    Uploaded by

    Harlav Ioan
    Visa MasterCard number: Number: Expiry: Month Year Month Year American Express CARDHOLDER I authorize the Ministere de l'Immigration et des Communautes culturelles to charge the amount of $CAN to my credit card. If the cardholder is not the applicant, please provide the applicant's name and date of birth below.

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    PAYMENT BY CREDIT CARD


    Reserved for Administration Individual reference no: File no:

    CONFIDENTIAL

    CREDIT CARD
    Visa MasterCard Number: Number: Expiry: Expiry:
    Month Year Month Year

    American Express

    CARDHOLDER
    I authorize the Ministre de lImmigration et des Communauts culturelles to charge the amount of $CAN to my credit card:

    Last name of cardholder

    First name of cardholder

    X
    Cardholders signature required

    Date:
    Year Month Day

    REASON FOR APPLYING


    Application for an undertaking Family class Application from an employer regarding employment: Temporary job offer Permanent job offer Application for a Certificat dacceptation du Qubec (CAQ Qubec acceptance certificate): Study Temporary work Medical treatment Application for a Certificat de slection du Qubec (CSQ Qubec selection certificate): Skilled worker Live-in caregiver Self-employed worker Entrepreneur Investor valuation comparative des tudes effectues hors du Qubec (Comparative evaluation for studies done outside Qubec) Immigration consultant Application for recognition Renewal of recognition

    INFORMATION ABOUT THE PRINCIPAL APPLICANT (person making the application)


    Mandatory if the cardholder is not the applicant, please provide the applicants name and date of birth below.

    Last name

    First name
    Year Month Day

    Date of birth:

    Ministre de lImmigration et des Communauts culturelles

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    A-0591-A0 (2010-12)

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