Appendix B

Application Number: F000735407

Please complete this form for yourself, your spouse/common-law partner, and your dependent children,
whether or not they are accompanying you to Canada. Send the completed form with your passport(s) or if
applicable, photocopy(ies) of passport(s). DO NOT send passports for non-accompanying family members.
IMPORTANT: Your contact telephone number must be from the country stated in the address you provide
below.
Email address:
Please provide your complete mailing address:

Passport(s) with your Visa(s) and/or Confirmation of Permanent Resident form(s) will be returned to you by the
VAC, not by the Embassy directly.
I certify that this information is true and correct.

__________________________ ____________
Signature of Principal Applicant Date