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ECONOMIC CLASSES
ATLANTIC IMMIGRATION PROGRAM

All Atlantic Immigration Program principal applicants must complete this form.

1. Your full name 3. Which Atlantic provincial government has endorsed you?

Family name

Given name(s)
4. Which National Occupational Classification (NOC) (NOC2016 skill
level 0, A, B or C) or (NOC2021 TEER 0,1,2,3 or 4) is your job offer?
Given name(s)

2. Your date of birth 5. Funds

Date Amount of unencumbered transferable and $

(YYYY-MM-DD) available funds you have, in Canadian dollars

Declaration

I declare that my family members and I intend to live in the Atlantic Province that endorsed me.

I authorize the Government of Canada to share all necessary information respecting my application for permanent residence in Canada, including the
status to the application decision, with officials of the provincial government that endorsed me.

Signature

Date
(YYYY-MM-DD)

Personal information provided on this form is collected by Immigration, Refugees, and Citizenship Canada (IRCC) under the authority of the Immigration and
Refugee Protection Act (IRPA). The personal information will be used for the purpose of processing an application. The personal information provided may
be disclosed to other federal government institutions, law enforcement bodies, non-governmental organizations, provincial/territorial governments and foreign
governments for the purpose of validating identity, admissibility and eligibility.
Personal information may also be used for other purposes including research, statistics, program and policy evaluation, internal audit, risk management,
subsequent program eligibility, strategy development and reporting.
Failure to complete the form in full may result in a delay or the application not being processed. The Privacy Act gives individuals the right of access to,
protection, and correction of their personal information. If you are not satisfied with the manner in which IRCC handles your personal information, you may
exercise your right to file a complaint to the Office of the Privacy Commissioner of Canada. The collection, use, disclosure and retention of your personal
information is further described in IRCC’s Personal Information Bank – IRCC PPU 042.

This form is made available by Immigration, Refugees and Citizenship Canada and is not to be sold to applicants.

IMM 5501 (11-2022) E (DISPONIBLE EN FRANÇAIS - IMM 5501 F)