The documentation provided by you will be used to establish that your authorization to enter Canada would not be contrary to the Act. Failure to provide complete, truthful and accurate material will result in your application being assessed based on the documentation submitted, which may result in your application being refused.
As most of the form is self-explanatory, supplementary instructions have only been provided when necessary. Follow the instructions carefully. Your application may be returned or refused if it is not properly completed, or if all of the necessary documents have not been submitted. Attach a separate sheet of paper if you need more space and indicate the letter and/or number of the question you are answering.
1. Print all names as they appear on your passport or identity document. Do not use initials.
2. Provide your current mailing address. All correspondence will be sent to this address. If you wish to authorize a Canadian representative to receive correspondence concerning your application, indicate their address in this box and on the form Use of a Representative (IMM 5476).
3. Provide your residential address if different from your mailing address.
4. Print your date of birth in the space provided.
5. Indicate your place of birth including the city, province or state and country.
6. Indicate your country of citizenship. If you are a citizen of more than one country enter the names of all countries.
8. Indicate your present marital status by placing an “X” in the appropriate box. Only select one box.
9. Print all your names as they appear on the passport of identity document. Do not use initials.
Write your relationship with the principal applicant (spouse, son, daughter, etc.)
Write your complete date of birth
Write your place of birth, including the town or city, and country
Write your native language (the language you learned at home in childhood and still understand)
Check the box to indicate which of Canada’s official languages (French or English) you use most frequently. If you do not use French or English, check the “Neither” box .
One of Canada’s objectives with respect to immigration is to support and assist the development of minority language communities in Canada.
Note: This question is not used for selection purposes.
Write your country of citizenship
Write your passport number
Write the expiry date of your passport
Write the name of the country which issued your passport
Write your marital status (married, divorced, etc.)
Check the appropriate box to indicate whether your family members will be accompanying you to Canada
Note: If you have more than three family members, photocopy the first page of the application before you start completing it. Make enough copies to fill in details about all your family members.
11. Provide the title of your present job. Briefly describe your position.
12. Indicate how long you have held your present job.
13. Print the address of your present employer. Indicate what type of business it is. (for example, bakery)
14. Print the name and address of your prospective employer in Canada. You must include the original copy of your offer of employment.
15. Indicate what your job will be in Canada. Give the job title and a brief description of your position.
16. Provide the amount your salary will be in Canada in Canadian dollars.
19. Each question in this section must be answered for each applicant. Place an “X” in the yes or no box. If you answer “yes” to any of the questions from 19 c) to g), give the name of the person with an explanation in the space marked “related information”.
22. You must sign and date the application. Failure to do so will result in your application being returned to you.
Complete this form if you are appointing a representative.
If you have dependent children aged 18 years or older, they are required to complete their own copy of this form if a representative is also conducting business on their behalf.
A representative is someone who has your permission to conduct business on your behalf with Citizenship and Immigration Canada. When you appoint a representative, you also authorize CIC to share information from your case file to this person.
You are not obliged to hire a representative. We treat everyone equally, whether they use the services of a representative or not. If you choose to hire a representative, your application will not be given special attention nor can you expect faster processing or a more favourable outcome.
The representative you appoint is authorized to represent you only on matters related to the application you submit with this form. You can appoint only one representative for each application you submit.
There are two types of representatives:
Unpaid representatives
Paid representatives
If you want us to conduct business with a representative who is, or will be charging a fee to represent you, he or she must be authorized. Authorized representatives are:
If you appoint a paid representative who is not a member of one of these designated bodies, your application will be returned. For more information on using a representative, visit our website.
Section B.
5. Your representative’s full name
If your representative is a member of CSIC, a law society or the Chambre des notaires du Québec, print his or her name as it appears on the organization’s membership list.
8. Your representative’s declaration
Your representative must sign to accept responsibility for conducting business on your behalf.
Section D.
10. Your declaration
By signing, you authorize us to complete your request for yourself and your dependent children under 18 years of age. If your spouse or common-law partner is included in this request, he or she must sign in the box provided.
To authorize CIC to release information from your case file to someone other than a representative, you will need to complete the form Authority to Release Personal Information to a Designated Individual (IMM 5475) which is available on our website and from Canadian embassies, high commissions and consulates abroad.
The person you designate will be able to obtain information on your case file, such as the status of your application. However, he or she will not be able to conduct business on your behalf with CIC.
You must notify us if your representative’s contact information changes or if you cancel the appointment of a representative.