Bee Ceres) Stems PROTECTED WHEN COMPLETED. B Immigration Canada Immigration Canada PAGE 10F 1 USE OF A FAMILY MEMBER REPRESENTATIVE FOR ONLINE APPLICATIONS “This frm for family mambo who wish oappyenine tgetorn ane MYCIC submission, Todo so, all membors must complet this frm one per fay) to appoint ‘re famiy member whose MyCIC account wil bused submit he aplcaons. NOTE: yeu appoint family member as representative, thal person willbe authzed to conduct business on your behalf and fecelve efoomtin on you ease fl SECTION A -FAMILY MEMBER REPRESENTATIVE Wirite the full name and date of birth ofthe family member to be appointed as representative T] Fata 2] Dats eft (rv NMDD} Fanily rane Surname) Given amet) [information onthe fmiy members Ue name date ft and eh latent (6.9, pout, sn, dug, to each ay ember fe rprosenahe Famiy ae alaionanip | Date of bith member famay member representative (yrenito0) 7 [YKAIRA CATHERINE GASTON STLVESTR POURE 182-08 2 [ALFREDO Gaston victOR ‘NOMER IN Lk 1e54-03-22 SECTION B - GRANTING PERMISSION TO THE FAMILY MEMBER REPRESENTATIVE Each family member 18 years of age and older listed in Section A must sign and date this section to appoint the family ‘member chosen to represent them By sining Secon 8, hereby give permiseen to th amily member epeaenave Item Secon Ato submit the aplcaton, conduct tusnass and reeiventrmaton ‘nm behal | dele tat th maton cn his fom and on he applction hat have authorized my farly meme submit on my behat is uth, complete ana Fan Date member Sartre owen) 2 | ALFREDO Gaston vicTOR 2018-12-05 3 | FRANCIScA sruveERz0 bE GASTON zoiant2 5 IMPORTANT: ‘Once parmasion e glen to your spouse ar common-law parne or patent, the aly way to evoke approval Wo canoe th applcatn and aut. The Sppicaton foes un ot be refunded and fs ul nav obo pa again for another appeabon Note: is permission apps to dependent chlaren 18 yar of age and older. Those under th ae of 18 donot have o prove approval SECTION G - DECLARATION OF FAMILY MEMBER REPRESENTATIVE. Teaare alienation Ihave gene wall, complete and caret oa 2018-12-05 Stone orrrme 0) ‘Warning! itis a serious offence to give false or misleading information on this form. Ths erin you sa har snd ae ay nn ad ne Penn At i ed mag J pain eae ‘toy Ca2N te oy aran herea Pe (ROMP Caw Stary at siencs Svs (5) we eres snags a sargencteth a megr goeren, ‘Scene nth becion 2) racy Act Paras he neraten an Rees Prncion Regtns he cae may ae be share nih 2 agus) Wey a ® ‘paneer uerng ar menawy be cond crevasse foal we tar sos he Chateau ce Cues maha meron Coens ‘Zena opdtayChnc Gch} Unc be Brac and eden rata seals ght een tard sees et pen eon Oe ot tess mars site srtenuce goes ou ough Cuan aa maton Cal CeeIsouen so aah Caran able bres ‘Wis form made aati by Ctznship and migration Canadaandisnetto be soltoamntcans. Canad’ unas 2202) "AUSSI DISPONIBLE EN FRANCAIS. IMI 57137)