You are on page 1of 1

(Please indicate the type of credit card with an "X")

Card security/card verification value code (CVV)


IMM 5620 (01-2012) E
FEE PAYMENT FORM - APPLICATION FOR PERMANENT RESIDENCE
STEPS TO FOLLOW:
1. Calculate the applicable fee by referring to the fee table below.
Citizenship and
Immigration Canada
Citoyennet et
Immigration Canada
This form must accompany your application for Permanent Residence under certain programs. Refer to the instruction guide to know if you can use this fee
payment form.
Please refer to step 3 of your instruction guide for acceptable methods of payment. Applications submitted with incorrect payments will be returned.

PROTECTED WHEN COMPLETED - B
2. Pay by certified cheque, bank draft or money order payable to THE RECEIVER GENERAL FOR CANADA or by Visa, Mastercard or American Express.
3. Include the payment form and the documents specified in the Document Checklist with your application, specific to the class you are applying under.

4. Check the appropriate box to indicate your method of payment:
Note: The credit card must be valid for at least nine (9) months from the
date of submission of your application. Otherwise your application
will be returned.
SECTION B - CREDIT CARD PAYMENT AUTHORIZATION
I agree to pay the Receiver General for Canada
CAD$ on my credit card for fees related to an application
for permanent residence.
Name of cardholder (please print)
Year Month Day
FOR OFFICIAL
USE ONLY
Authorization number
SECTION A
MASTERCARD VISA AMERICAN EXPRESS
Credit card number
Expiry date of the card
Month Year
A three (3) or four (4) digit number usually found on the
back or front of the credit card.
Note: The amount authorized must be equal to a single fee or a
multiple of a single fee. Authorizations for other amounts
are incorrect.
Principal applicant
Each family member age 22 or older
Each family member under age 22 who is
married or in a common-law relationship
Processing Fee
Number of
persons
Amount due
$ CAD
Each family member under age 22 who is
unmarried and not in a common-law
relationship
$ 550 x $ 550
x $ 550
x $ 550
x $ 150
1
Amount per
person
Total payment:
METHOD OF PAYMENT OPTIONS
A combination of more than one method of payment is acceptable. However, payment by each method MUST be equal to a single or a multiple amount per
person that you have indicated in Step 1 above.
For example: An amount of $550 paid by credit card for the principal applicant, and 2 x $150 paid by a certified cheque for 2 dependents for a total of $850
is acceptable. However, $500 paid by credit card and $350 by certified cheque will not be accepted.
Name of payer (if different from the principal applicant) Name of principal applicant (given name(s), surname)
Address of payer (if different from the principal applicant)
Date
Signature of cardholder
Credit card
(complete section A and B below)
Certified cheque, bank draft or money order
(enclosed and complete section A below)