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7. Your dechration
. I underctand tre following statemente, having aeked ior and ohtained an explanalion far every point that was not deal to me.
lf you are gMng your authorization
I authorize Citirenship and lmmigration Canada and Canada Barder $ervices A$ency ta releasa infprmation tom my case file to the individual named
' abova-
r I undershnd that this ccnsenl only allows the disdoeure of my parsonal informalion and &at of my dependant cftildren under 18 yaars of age.
. I am aware lhat some infurmatiqn may not be released if it is subject to excmptian under lhe Pnvacy Aol or the Access to lnfasnaftbn Aof.
. I fur*rer auhorize the designated indiddual ts updata the address listed in my tle, as requited.
lf you are withdrawing your au$oriza$on
. I wiihdraw my authoriatian to release infiorrnation kcm my case file to the indMdual named abeve.

2p?.2- lL- oo
Date {YYYY-irhl-DD}

Signcture olrpeuae common-law parher (if applieahle) Date {YYYY-MM-DB}

lf yrru have nqt yet sqbmitted yourapplication: $end this form along with your applicalion ts tre oficc listed in your reapeclive applicalion kit
lf you have already submitted your applimtion: $end this torm to the qJEGe y',here you submitted your criginal applicatian.
Pereonal informa{on provided on his form is eollected by lmmigration, Refugees, and Cilizenship Canada {IRCC} undetthe auftori$ of the ?raadgratba
and Refugee Eolee#or Aef (IRPA) and of the Cidzenehip Aet The personal information of the appli*ant is used fer iden$fcatian and au&orizaiion
purposes. The personal informadon ofthe dedgnated individual is used far identiffcatisn purpo$e$,

The pereonal information of bo& &e applieant and the designated indlvidual may be disdosed to o&er federal govemment insiifulians, Ron-govemmental
and intergovemmental organizations, regulatary bldies, invesligalive bodies, and provineidlterritorial governments fur the p{rpose$ of validating identity,
informaton, and supporting an investgaton. Per$onal informatian may be uaed for otrer pulpases including reteareh, $alisti€€, program and policy
evalualion. intemal audit, complianc*, risk management strategy development and reportng.

Failure to complete &e furm in full will result in a delay to processing. The Pnvaey Aet gives individuals the right ol accees to, protection, and esneclisn ol
treirperconalinfurmadon. lfyouarenstsatiufiedwitllhernannerinurhidrIRCChandleeyourpereonalinformation,youmayexereisayourrighttofilea
complaintto the Ofiee oltre ftfu.*cry eomr*d4l*s odeM., The colleethn, use, discloture and retenton ef your personal infurmalicn is fur&er
deecribed in IRCGb Personel lnformalion Bank - IRCC PPU 013. 041, 054. 068.

IMM 5475 (0$'20?1i E This lortr ii made ayaltcu+ by CitEenship and lm.nigntioa C.rad. rrd i: not b be rold to aFdieanb