PROTECTED WHEN COMPLETED- B

Government Gouvernement PAGE 1 019

of Canada du canada

GtN~RIC Al>PLlCATION FORM 'FOR tANAl>A

APPLICATION OETAILS
Officeuwonlv
1 "Pr09ram . .der which you.,. •pplying 2 " utegory under which you •re •pplying w1lidc1ted
R~fugee Outside Canada - Refugee No

3
• How many family members, including you. are
4
in this appmtion (see inmuctions gaide)?

4 LangRgePNferencefo r. 5 When do you intend to live In CAMCl•7

'a) Correspondence •b) Interview 'c) Interpreter requested a) Province/Territory •b) City/Town

English Farsi Yes ON Guelph

·, a) Have you received your bi if y~. p"'°a~e indicctl~ the numbtc'r c) I( no. when did you apply
Certirtcat de Selection du No Yes foryourCSQ?
Quebec (CSQ)?
yyyy -,¼',I 00

PERSONAL DETAILS
[!J FullNMW
• Family name(s) (exactly as shown on your passport or travel document) Given name(s) (e><.tetly shown on your pclSSport or rravel documt'f"ltl

Khaliqi Ahmad Shah

a) Have you ever used any other name (e.g. Nickname, maiden name, alias, etc.)? 0 •No • Yes

b) If you answered "yes" to question 2a). please provide the name (e.g. Nickname. maiden name. ctlias, etc.)
Family name{s) Given name(s)

~UCJ ~•sex 2-1 L!J •Eye colour

'cm ft II\.

M Male H.&ght OR Brown

175 5 ')

2.J Date of Birth [!J Place of Birth

'(ounlry
'City/Town
1970 07 28
Faryab Afghani st.=m
• yyyy 'MM ·oo
Otizemhip(sl

I) Afghanistan 2)

101 Cwrent cou11try of r.sidence:

-- Olhl'r From To
Slalm
. Country

:rn:B-01·14
Pakistan Other no Stc\tUS
YYYY-MM-00 yyyy ,\\,\1 01)
Odle Pl.ice

Dale and place of your last entry to Canada

YYYY-MM·OO
al Previoas-counlrin of residence: During lhf' pasl five yt'ars h11w you ltvC'd in any rmmlry other 1h.,n yllur
country of c11tzensl11p Of you, cu,r.•111 counlry of re\1dence (i1u.l1cc11ed dbove) for more I hdll \r,c monllH?
[Z) 'No D ·v~s

b) tf you answencl "yes" lo question 12 a), plt'cl\t' provide de1a1h

Counlry )ldlUS Other From To

YYYY MM 00 YYYY•MM-UO

YYYY MM DD vvvv MM on

IMM 0008 !06-20231 E

C.EH[IUC AWU< ATON r-OflM H>R CANAl>A

Thb fo,m ts made •vallable by Immigration, A.fugHJ and Citizenship Canada and Is not lo be sold to •ppll<ants.
IDISPONIBLE EN fAAN~AlS - IMM 0008 f) Canada 'i'.i7Jo,,tti-M
 ·D at e

Appltcant Name 19 90 -0 1- 09
h.
ide the ~t e
Khaliqi. A. ionship) Prov rel ati on s ,p
bn -fa w 1·elat YYYY-MM-OO
ar e ma rri ed ot in a to mm ed int o the co mm on -la w
nt marital sta tus b) (If you
we re ma rri ed
or en ter
, al Your curre on wh ich yo u

M ar ri ed er
sp ou se /co mm
on -la w pd rtn Given na me (s)
na me of your currt-nt
c) Provide th e
(s) M on ir a
"Family name

K ha liq i
w relationsh
ip? 0 'N o 0 •Y es
• co mm on -la
iou sly beetl married or in on -la w pd rtner:
t4 a) Have yo u pr ev sp ou se /co mm s)
your previous Given namt>1
e th e follow ing details for
b) Provid
Family name(s)
rth
e) Da te of Bi
To
dJ From

c) T ~ of rel
alionship MM 00 I
YY Y'(
YYYY-MM-O0
YYYY-MM-00 I

RMATION spe,cify. m.
<ONTACT INfO ad dr es s below
.
to th e e-rTldil
ad dr es s yo u on an d on th
e IMM5476 for
ma ilin g .d dr es s
s yo u ind ica te yo ur e-mail
na l inf orm ati on. to be se nt ng .>ddre ru( esJ in this se cti
C1ftfflt to this address
unles ing file an d pe
rso mail .,n d maili
dence will go de nc e. includ ica te the ir t--
- All correspon e all co rre sp on resentative. ind
il ad dre ss wi ll authoriz m yo ur ap pli cation to a rep
e--ma information fro
- Indicating an th e rf'lease rA °S tft 'et name
clUthorize"A Si,~--t no .
ff you wish to pt./Unit
P.O.box Se ct or F- 11 /3
ll District
H ou se 11 0 Post.ti co de
ovince/State Pr
'C ou ntr y
'City/Town
Pa ki st an
Is la m ab ad
iling addrfM,s? ·N o @ 'Y es
City/Town
ddreu Sa mo as ma
ResideftlJ.Ja Street na me
Street no .
Ap nit
t./U

Post.ti cod_. District

Province/SI ale
Cowitry

~ T..
.ph on et to . D C.tn,lddll.JS 0 Ot he r

Tef•pho..•no
. @ Cd lla da /U
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hr .
C1Xint1y (oJ
t., No.
fxt. Typ,•
~Type Co un t,y Co
de 'No.
50 ] - 90 99 I
( 2:.!6 )
C el iu 'ia r l I I
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s
I
I
L!.J E· IM II •ddres
l!. ..] Fu no , Ext. m
ai . co
0 Can.ida/US Coun11y Co
de No. ad 12 H 5J gm 1
kh al iq ia hm
Q Other I I
I

PASSPORT
valid passport
/fr ,wel do cu me nt? 0 'N o O 'Yes
Do you h,we d Is n,~ dil te Cxp1ryddte
.wt1y ,n shown
On u
ue 4 S
ef dcxunl@fl,
OIMli.l)Eor fe.w )'O '
J Country of Iss
P,m po, 1/T ,av vel do ..u nw ou
!ra
l)J \~ I o,
nr ,,..\1A1-oo
No 'fY'fY-MM 00
I -'- t 1C<1llon nu
mb er !
s ,n Tctiwan
th· t '"-"- n t·r. Yes
e,g n Allol11 ur ,>erson.:il j..J.
a In< u~ s yo
e cl
WIii yo u U\ M11us1ry of fo1
' f Of llus lllp , uf' d Ly lflf'
Pc lHp ofl iss No
rt?
N • lsrolt'fi P<lsspo Yes
fo r 1lus trip • w,11.,,o u ust- ct ctlroncll
•

ENTITY DOCUMENT
NATIONAL ID t'nl?
n1r 1y doc um
' Do yo u hll vP a
ml)e,
114hont1I ide
ue 4 hs u.. OJ le s hp uy J,H "'
2 ·Docwni-m nu 3 'Country of iss
n
13 99 06 00
89 76 8 A fg hc 'll iis ta
\)'Y Y,M M Oo 'l''O ) MA I 00

-20.? 11 £ . -
IMM OO!JB (06 N. REFuc.ccs t.
, ..., ..,.,GHATIO SH II' ''NA1~
N[lJ Cf Tl, fN
N ron1,1 rr.u
C... N Uf fU l,l[ ',,\ J( C <\NADA
C.f N[f (I( Al'l
'llCATICJ ...., ~~A IJA , li\1.',:JGHA TIU I CI Tll \£N NE
I
Apfllicant Name
PAGE 3 of 9
Date of Birth
1970-07-28

Khahq1. I\.

US PR CARD
_!,J A,e you a lawful permanent resident of rhe United States? 0·~0 0 'Yes
Expiry date
U.5. Citizenship and Immigration Services (USCISI number
YYYY-MM-00

EOUCATION/OCCUPATIONOETAIL • Number of years of education in rotal

L!..J Highest level of e-ducation 12
Secondar y or less
• Intended occupation
• Current occupation
P.etail Store -
Unemployed . . . .
. -
. -
LANGUAGE DETAIL cl In which language a;c you most ar ease?
'b) Are you able tocommuniC'iltc in Engfish and/or French?
L!J 'al Native language/MotheJ Tonguc
Farsi Neither

di Have you taken a test from a designate-d testing agency to assess your proficiency
in English or French? @•No 0 ·v~

DEPENDANT(S)
or common-la w partn«,
they will be accomp.1nying you to Canada or not. You must indude your spouse
You must provide the following details about each of your fomily members. whether
or common-law partner, who are not already permanent residents or citizens of Canad..
if applicable. and all of yollt' dependent children, and those of your spouse

MoniraJ<
·PERSONALOEfAll.:S
L!_jnllMai ne
Givl'n namt'(s) (e,cactly as shown on your p<1S$port or travt-1 documt'nt)
• Family n~(s) !exactly as shown on your passport or travt'I docu~nt)

Kha.liqi Monira

. ..
a) Mave you ever used any other name (e.g. Nickname, maiden
nune, alias, etc.) ? 0 'No 'Yes

maiden name. alias, etc.)

h) If you answffed •yes• to question 2a), plea.~ provide the name (e.g. Nickname,
Given l\cllneh)
family nameh)

~ua ~"Sex
•.!] L!.J •Eye colour
'cm ft. in.
Height 0A Brown
F Female 155 5 l

l!_jt>.-ofl rarth I..!J Place of birth

• City/Town ·country
1971; 12 27
Faryab Afghnnis t:m
•yyyy •MM ·oo
l!J Citi:tenship(s)
1) Afghanis tan 21

•al Relatiomh1p to p11ncipal applicant b)OthN

Spouse

[Z] 'Yes lnpend•ntT ype

<1) Will dCCOml)dny principal <1pplicanl to Canada?
b) Rea~on why dependant i\ llon-accomp.inying

1SI Current country of -re1idence:

Country <;1,,1u~ Otho.>r From To

~0::!3-01- 1-!
Par.istan Other No status
Y" Y-W.t OD YYYY-MM DD

IMM 0008 (Ob-.20211 C

IMMIGRATION. RETUGECS ANO CITIZENS~II' C,\NADA
IM.\llt,1<,\llON 1,£FU<.,IE\ ET \.UOHNNET( LANADA
GfNEl<IC APl'LICATK.lN FOIIM FOH CANl,OA
5 S 7J<H(,.l.l
 PAGE 4 of 9
Date of Birth

Apphcant Name 197~07-28

Khahqi. A..

Date Place

O..and ,ac• of your lastenlrytoe anada

D
YYYY-MM-00
i!J al Previous countries ofyour
residence: During the pas\ five years have you lived in any country other than your
current country of residence (indicated dbove) for more than six months?
[Zj•No 'Yes
col1ntry·of citizemhip or
bl If you answered "~" to question 15 a), please provide details From To
Other
Country Status

YYYY-MM-D0 YYYY-MM-00

YYYY-MM-00 YYYY-MM-00
'D.ate
I"I •al Your current marital status b) t1f you are married or in a common-law relationship) Provide the date 1990-01-0 9
Married on which you were marrie-d or entered into the common-law relationship
YYYY-MM-00

cl Provide the name of your current s.pouse/common-law partner

Given name(s)
'Family name(s)
Khaliqi Ahmad shah

a) Han you previously been married or in a common.'.law relationshlp1 [{]'No D •Yes

b) Provide the following detaih for your previous spouse/comm on-law partner:
Given name(s)
Family name{s)

di from To
c) Type of re1ationship

YYYY-MM-00 YYYY-MM-0O

PASSPORT
L..!_l Do you have a valid passport/travel document? [ZJ·No D 'Yes

Pn\port/Trallt!t docUfflffll OIMnber (eoxactly n \hown on your L?J Country of issue [!} Issue ddte Expiry dd1e
~spar• 01 travi!I document\

YYYV-M.\1 00 YYYY-MMOO

that includes your person.:il idenrificati,>n num~r? No Vt's

• For this trip. will you us.ea passport issued by1he Ministry of Foreign Affairs in Taiwan

• For lhis trip, will you use ct Ncttional lsrcteli passport? No Yes

NATIONAL IDENTITY DOCUMENT

DJ Do you have a national identity document? ·No [{] ·ves

'Document number 'Counlry of 1Hue hsueddte 0 Expiry d,1te

20:?0-09-1 0
139906006 9751 Af9hanis tan
Y'YYY-MM-OO YYYY-MM-00

EDUCATION/OCCUPATION OETAIL
L!J •Highe\l level of education 0 ·Number of ye.:ir\ of educ;it1on in tot-;:JI
Bachelor 's Degree 1~

0 •Cuuenl occupctlton ' lnlended occu1>.111on

Unemploye d Teachet·

LANGUAGE DETAIL
[!J •ol Nativf' langu4<Je/Mother Tongue 'bl Are you abl"' lo communi<ale en English .:irld/0t French? cl In which 1,mguage are you most al t',,se?

Parsi English

o, r ri'nch?
d) Hdv~ you taken a 1£-st from o dt>~1gnc11ed le\tmg agency lo aHeH your profic1i'ncy in EnghUt (Z]·No • Ye,

IMM 0008 (06 ion I [

IMMl(,RATION RCFUGE( \ AND CITIZ[N°'HII' (/\tlADA
LW,11<...tv\111..lN, H(I U<..I(\ ( l ._111..11 lNN[l ( 1. Al'IAIJJ\
GEHEklC APPLKATION fORM fC>H CANAD/,
 'V f;.U J-6 ,
PAGE 5 of 9
Apr,IK ant Na~ Dc11"' of Birth
1<h11l1q1. A. 1970-07-28

Ahmad Naeil.K
PERSONAL DETAILS
L!.JhllNa,_
·f amity namel\) te.:actly as shown on your paisport or travel documentl Given nameh) (exactly as shown on your passport or travel document)

Khaligi Ahmad Naeil

al Haw ,ouewr •MCI eny other nMMte-9. Ni<WtM, IMlden name, •s, etc.)? 0 'No 'Yes

bl If yot1 answered "ye• to question 2a). pk·ase providt' tht' nilme (t>.g. Nicknanfo. maiden namt'. olias. etc.)
Family nameh) Given namels)

~ua •s.x L!J •~colour

'cm ft. in.
M Male Height OR Bro1a111
170 5 7

L.!_Jo.teof8il1h _!J Place t>fblrth

'City/Town 'Country
2005 11 05
Faryab Atghanistan
•vnv •MM •oo
l!J CitizenshipCsl
'1) Afghanistan 2)

l!!J •a) Relation\hip to principal applicant bl Other

Child

.!.!J al Will accompany principal applicant to Canada? 'No [{] ·Yes Dependantlype
bl RNson why dependant is non-accompanying

13 l Cunent country of residence:

Country Status Other Frcm To

::u::3-01-H
Pa):istan Other no ;;;tatus
YYH ~l\l-0(' \"i)\.,\l.\l 00
Dolle Place
0-. and place of your last entry to unada
YY'N-MM OD
al Previous countries of resid.nc•: During the past five ye,us h,we you lived 1n any country other th,m your
country of citizemlup or your current country of residence (indicated abovel for more than \i>t month\!
@·No D ·v~•,
bl If you Mswered •yes• to qu,Hlion 15 •), ple.ue provide details
Country Stc1tus 0th.-, from To

nn- M\I 00 YYYY-\IM·OO

YYY'r M.\t DO nn \IM-OO

.!!J · it) Your cummt ffidrltdl \ldtU\
bl (If you 11rt- marn~ or rn ct common-1.,.,v rl'l.lt1omh1pl Provt<k- tht> d.ite
O,,t..-

Single on wluch you were 111c1med or entered rnto lhe common·l.iw relallomh,p
\'n\ MM OD
c, Pruvidt> tht- n.imt- of your cuuent spouse/common-law pc1rtner
f,muly lldll\e(s, G1w11 11a111t.•(\l

IMM OOull 100-20211 E

I,\1,\11(,RA TION RHU\IE[~ 1\Nl' (ITl:![N\HJI' ( AN,\D,\
l\1,\\1~1 lllN l\(flK,I(\ Er ll lll\ltlN(l( 1,. ~AU,\
c.uwilC APl'LICA TlOtHOf\M roHANAUA
::;sn...k4t
 of Bir th
Odle
----~
-----

-----
-----
--- -----
----
1970-07-28 I
---- -----
-- -----
-- -----
- - Na -----
- -l,c
lpp anr me

:haliqi. A.
ati on sh ip1
fZJ •No O . Ye>
mmon.Jaw rel
L . -n ma
a.. .._
rried or In a co er.
Ha ve you prevfous,y ou se /co mm on -la w pa rtn
Gi ve n name(s)
7 a)
ur prt1vious sp
fol low ing details for yo
bl Provrde rhe
Family name{sl
To
d) Fro m

iomhip
cl Type of relctt YYYY-MM-DD
YYYY-MM-OO

hp 1t yd at e
?ASSPORT
el do cu me nt? {l] •N o O 'Ye s Issue dd re
vc1/id pdS\porl/rrc1v ue
!.J Do you have d
bf, r (t-x .Kl ly a1 \t1o wn on
you r
t2J Co un try of iss
YY YY -U M- 00
l do cun wn l num YYYY-MM-DD
~~ IT r.l ve )
vel d<X um enl Ye~
p.1~1po,1 o, tra mb er ! No
nti fic ati on nu
ur pe rso na l ide
t inc lud es yo
s in Taiwan tha --
try of Fo rei gn Affair ..
d by tht ' Mi nis .. . ... --
pa ss po rt issue -. .. . .. .
wi ll yo u use a Ye-s. .. - ..
, fo r rh,s trip, -
t ?___ No .. ..
~ f:)dS~~,: .. . . .. . .. ..
N~~onal _lsrae_
wi lly ~ use a
• f_or rhi~ _trip:
NT
TITY DOCUME /_!J Expiry d.t<e
NATIONAL IDEN cu me nt?
[ZJ 'Yes luued.lt<.>-
a na tio na l ide nri ty do
Do yo u have
l..=J 'Counf1)' of iss.u<.> 20 20 -0 9- 10
mi xv m Y...Y.M -00
'Oocunx>nt nu
A fg ha ni st an YY 'Yr -M M- 00
4
13 99 06 00 89 97
at, on in tot al
ye.trs o/ educ
• Number ol
DETA ll
:D UC ATIONJ
OCCUPATION 10
of ed uc ati on
• Highest level e
- No D eg re
Po st -S ec on da ry • Int en de d oc·
cup<1tion

• Current oc cu
pa tio n an y jo b
ed
un em pl oy
t.>d\c.>?
u m o, t 4t
nc h? gu ag e dre yo
an d/o r Fre In wh ich ktn
TAIL te in Engl1\11 c)
..ANGUAGE OE To ng ue 'b) Ar e yo u ab
le lo co mm un ica
gu ag e/M oth er
l 'a) Native lan
En gl is h
D ar i
en cy to clSSE'SS
yo ur pro fic ien
cy in fng lis h
or French?
0 •No Q · Yt>s
ted tes tin g ag
fro m a de-signc1
:1} H.tvt.> yo
u laken a rest

Nabilah.JC
TAILS
>fRSONAL DE
wn 011 yo ur P.,
\.s po rt °' lrdvd docum<:'nf)
!_J FullH.nw ur p., s~ po rt or
frd ve / d< Xu me nt)
Grvt>n n,1111e(\) (e x« rly J\ \ho
sh ow n on yo
'(s) (exactly as
·Fam,ly narnE N ab ila h
J~ ha liq i

lZ J 'N o .J
0 • Yes
me. c1liJs. elc
e, ma ide n na
e rhe 11ame (e.g. Nicknclm
. plP,ue pro vid
qu es tio n 2•1 Gi ve n na me
(\]
re d "yes" to
bJ If yo u -.s we
fam ,/y ncJme{s/

!I •Eye co lo ur
0 uc, J ·sex - s1 ft. 1n.

I
4
An....,,,..,n
'cm
OR
Hetght

-- --
F Fe ma lt>

bi rth - - -- -- - l 16 2 5 ·l
-
D• t• of Birth / ~ Pl ~e of
·cou111ry
"C rty /To wn
19
20 07
A fg ha ni st an
02
Fa ry ab
·vvvv •MM ·oo
0Cltiunshipts)
)
hf r,h an lo
ta n
---
})
--- --_
----- ---._
----
--~
/,
HII' l1\ N 1\I)
l/,1 00( ,81 06
lO. l J) [ ,\N O CITIZENS
N H(F1JG£(~ 1..ANAPA
l\iN UG HA Tiu UG IES ET CITU'r£NNETE
UfF
L\11,IJGHAn()N
SS 7i, ~IN I
 I
r

Applicant Name PAGE 7of9

Khaliqi. A. Date of Birth
1970-07-28
[!!J •al Re\atiooship to principal applicant
b) Other
Child

al Wtll accompany principal applicant to Canada?

•No I{] 'Yes Depelldanl Type
b) Reason why dependant is non-accompanying

13 \ C\lffent ~oantry af res\dence:

Country
Status Other From To
Pakistan Other 2023-01-1 -l
no status
YYYY-MM-00 't'YYY-MM-00
Date Place
Oat. and place of yo• last entry to Canada

YYYY-MM-00
is] a) ~~us
I of residence: During the past five years have you lived in any country other thdll your
country of at12ensh1p or your current country of residence (indicated above) for more than s"ix
months? 0 ·No D •ves
b) Kyou anSWffed "yes•·to-question 15 a), please provide details
Country Status Other From To

YYYY-MM-00 YYYY-M.\t-DO

L!.!1 •a) Vour-cuffent mMital status YYYY-MM-00 YYYY-MM-00

b) (I( you are married or in a common-law relationship) Provide the date Date
Single on which yoll were married or entered into the common-lciw rel.JtioMhip

cl Provide the name o( your current spouse/common-law partner m~..\IM-OO

Family name(s)
Given name(sl

.!!]" al Have you.previously bNn married or In• common-law reletionshlpl [Z) 'No 0 •Yes
b) Provide the following details for your previous spouse/common-law partner:
Family namehl Given Mme(sl

c) Type of relationship di From To

YYYY•MM•OO YYYY•MM-00

PASSPORT
L!.J Do you have "valid pa~sporVtravel document? [Z]·No 'Ye~
P,m9ort/Trawl document number (E'Jt.)l.tly .a\ \hown on you,
~\\p0fl Of tr.we! dorumeno
L!J Country of issue
luuedate Expiry date

[!} •For thi\ trip. will you u~ <1 pd\\potl iuu~ by the Ministry of Foreign Affair\ in Tc1iw,m lh4t 111duJe\ your pe~on,111den11fic.:dt1011 num~r? YYYY·MM·DO YYYY•MM-00
No Ytc>s
[!] ' For this tnp. will you u\e a National hraeli pas\port! No Yes

NATIONAL IDENTITY DOCUMENT

Do you have a national 1dent1ty document? [Z] ·ve5
[..!J 'Document number L!J 'Counlry ol 1ssue [!J Issue d.:ite 0 Expiry d..ite
l 399060069 887 Afghanist an 2020-09-1 0
YnY•MM-00 YYYY MM-Oil

IMM 000H IOo-10.lll E

IMMK,AAThJN, REFUGEE~ ANO CITIZENSHIP CANADA
c:.(N[RIC Al'l'LK /\ TION FORM FUH CANALJA L\>\MlulU I ILIN, HH UGII: !> CT (110 YEN NET ECANA DA

~5736-kM
 PAGE 8 of 9

EDUCATION/OCCUPATION DETAIL
Date of Birth
1970-07-28
I
..!.J •Hi9Mst level of Pduc.ation
• Number of years of education in total
Second ary or less
10
_!J •Cunent occupation
Intended occupation
unempl oyed
any job

LANGUAGE DETAIL
_!_J •a) Native language/Mother Tongue ·b) Are you able to communic ate in English and/or French? c) In which language are you most at ease?
Dari English

d) Have you taken a test from a designated testing agency to assess your
profKienc)t in Engli!>h or French? 0 ·No 0 ~ves

IMM 0008 (~2023) E

IMMIGHATION, ntFUGEES ANO CITIZENSHIP CANADA

GENERIC APPllCATION FORM FOkCANAUA 1MMIGll,\lll1N. HEftK,1[~ CTlllOYHINElECANADA

:i57Jo-l~
 -
PAGE9of9
Date of Birth
l(haliqi. A. 1970-07-28

CONSENT ANO DECLARATION OF APPUCANT

th
Citiz~m,~ip a nd Immig ration Can_a~a (~IC)'. or an organization at CIC' request, may want to contact you in the future to ask you ab.out any services you received from CIC p~ior_ to e .
applic.lti_on proc~s (such as ~~"•~tion man information forum), during the applic.ttion process (including the application process itself as well~ oli@ntation or accredrtat_,on_ s~rvrc~). r
0ther rnd•viduals. fo
and serv1ces received aher amvmg tn Canada (including settlement. integration and citizenship). CIC will use this information, along with the information provided by
research, performance measurement or evaluation purposes. OC will not use this information to make any decisions about you personally.

Do you consent to be contacted by CIC, or an organization at CIC's request. in the future? D No [ZJ Yes

Consent to relNse infonn1ition to intended province/territory of destination

I. (first name. last name) ____________________ _____ on behalf of myself and all dependants included in this application._ authorize ~i~i~enshi~ an~ .
Immigration Canada to share the information collected in this application as well as supporting documentation with Provincial cSOd Territorial authorities with respoM1bihty for immigration
for the purpo~s of tht- lmmi~rotion and Rdugre f>rorection Act.
Consent to release information for Evaluation purposes
t
I agree that the information contained in this apprteation related to my intended occupation, education and work experience may be shared with prospective employer> in order to assiS
them in hiring workers.
0No [Z] Yes
L - • f · h • . . . . .__,. Ii t· • II • t""" ~-,"-..1 scheduk-s and accompanying documents.
Th .IS d N:IaratlOfl - tnc
· covers m onnat,on 1 c1ve provided on this form and all the mformc:ition submrtfou in my app GJ ,on as we as 10 "" "" m.-u
0
.
nd 1
I understand that any false statements or concealment of a material fact may result in my exclusion from Canada an~ may be grou s for my prAose1cutio~~~t~,~~m entering Canadd for a
I also understand that should I be found to be inadmissible Tor misrepresentation under section 127 of the /mm19ror1on on~ Refugee Protection er. may rr
period of two years following a final determination of my inadmissibility or. if this determination is ~de in Cana:cfa following ~y removal from Canclda. . lat body in C,mada and
I understand that if I wish to work in a regulated occupation. it is my responsibility to obtain information on the licensing r~uirf_!ments from the approprrate regv O<Y
thclt \hould I be issued a visa for Canacla. I am not guaranteed employment in Canada in my o<cupation nr in M1yother occupat!O"- .
I understand that should I be issued a visa for Canada, conditions may be imposed on me at the time of its issuance and thdt I w,11 be- required to meet them.
I understand all the foregoing statement1, having asl<cd for and obtairi<'d an·explanation ori every point that was not ctcar to me. . . . lications
I rea~ze that once this document has been completed. and signed, it will form part of my Immigration Record ,md w,11 u~ to verify_my_fam,ly detads on future app •
I will immediately inform the visa office where I submitted my application if any of the information or the answers provided ,n my application forms change·

I declare that the informa~ion I have given is truthful, complete and correct.

Dect...-tion of applicant

Date: YYYY-MM-00
Siqnature of Annlicant or Parent/Leqal Guardian's for a oerson under 18 vears of aqe.

I i
IMPORTANT NOTE:
This appliution must 1M sf9MCI and dAted IMfore It Is submitted.
Oonot forget to include: photos. fees (if applicable), and any other documents required by tht- vis11 offict'. Review .1pplication guide and kit for more informdtion and verify
vou have completed all of the reQuired documents as per the document checklist.

01saosuRE
Information provided to CIC is collected under the aurhority of the Immigration and RPfugee Proll'Ction Act (IRPAI to de~ermine admissibility to Canada. Information provided may be shared
with other Canadidn government institutions such as, but not limited to. the Ca11o1dd Border Se,vices Agency ((BSA), The Royal Canadian Moun~ Police (RCMP). the Canadian Security
Intelligence Service (i'.:SIS), The Department offoreign Affairs, Trade and Development I0FATO). Employment and ~i..11 Development (an.>d., tESO(J. C.1ndda Aevl'nue Agency (<.:RA). provinoal
and territorial gov'!mments and foreign governmPnts in accordc,nce wirh subsection 8(7) of the Priv<1cy Act. lnformalK>n may be disclosed to fore19n govemments, l.iiw l'nforcement bodies and
detaining authorities with respect to the administrc1tion and enforcement of immigrc1tion legislcition where such sharing of infomwttion .mc1y not put the individwl and or his1her family at risk.
lnfo,mation may also be systematically validated by other Canadic1n government institutions for rhe purposes ot validdtin9 status .-.nd identity to administer their progrdms.

Where biometrics are provided as part of dn c1pplication, the fingerprints collected will be stored dnd shared with the RCMP. The fingerprint reco,d may .-ilso be disclosed to law enforcement
agencies in Canad.a in accordance with ,.uhsection 13.11(1 I of the- Immigration and RefugN' Protection Regufatioru. inform..,tion may be use-d to eost.ilil~h or Vt'rify the identity of a person in
order to pre~nt. investigate or prosecute ·an offen~ under ,,ny law of ( anad.l or II provin~. Th~ inform11tion m11y ·.1lso used to establish or wrify the identity ol "" individwl whose identity
cannot reason.tbly be otherwise establi~ed or verified because of physical or mental condition. Cdnadd may also shc1re immigrntion information related to biometric records with foreign
governments with whom C.tnada llds •n agreement or arrangement.

De~nding on the type of application made, the information you provided will be stored in one or more Personal lnfom1at1on Banks (PIB) purswnt to section 10(1) of Can.:ida's Privacy Act.
Individuals also hdve • right to protection and access to their personal information stored in each corre6ponding PIS under the-Acc~ss to Information Act. Further detdils on th.:, PIBs. pertaining
lo CIC's line of business and services a11d the Govemnumt of Ctn,1dd's c1ccess to i11formc1tio11 and privacy p,ogra111s are avdllc1ble dt the tnfosource w~b\ite ( 1ahd through
rhe CIC Call Centre. lnfosource is also available at public libraries across Canada.

IMM 0008 (()(>..20231 [

IMMIC,H1\ TION. O[fUC,EfS ANO CITIZENSt,ill' CANADA
C.ENERIC A~llCATION fORM FOR CANADA IMMlt,Ui\l tUN t;(r Ut.lD CT lllOYENNETE CANALJA

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