Family Information

FAMILY INFORMATION


VistorWorkerStudentOther

Complete ALL names in English and in your native language (for example, Arabic, Cyrillic, Chinese, Chinese commercial/telegraphic code, Korean, or Japanese characters). Include ALL family members even if they are not accompanying you. If you need more space for any section, print out an additional page containing the appropriate section, complete and submit it with your application.

BEFORE YOU START, READ THE INSTRUCTION GUIDE, TYPE OF PRINT IN BLACK INK.

Section A

Name

Relationship

SEE NOTE 1

Date of Birth

(YYY-MM-DD)

Present address

(if deceased:given city/town, country and date)

will accompany you to canada?

YES

NO

Marital status:

Applicant

Country of birth:

Present occupation:

Marital status:

Spouse or

common-law

partner

Country of birth:

Present occupation:

Yes
No

Marital status:

Mother

Country of birth:

Present occupation:

Yes
No

Marital status:

Father

Country of birth:

Present occupation:

Yes
No

NOTE 1: If no spouse or common-law partner is listed in Section A, read and sign below.

I certify that I do not have a spouse or a common-law partner.

SECTION B - CHILDREN

(Include ALL sons and daughters, including ALL adopted and step-children, regardless of age or place of residence)

Name

Relationship

SEE NOTE 2

Date of Birth

(YYY-MM-DD)

Present address

(if deceased:given city/town, country and date)

will accompany you to canada?

YES

NO

Marital status:

Country of birth:

Present occupation:

Yes
No

Marital status:

Country of birth:

Present occupation:

Yes
No

Marital status:

Country of birth:

Present occupation:

Yes
No

Marital status:

Country of birth:

Present occupation:

Yes
No

NOTE 2: If no children are listed in Section B, read and sign below.

I certify that I do not have any natural, adopted nor step-children.

SECTION C - BROTHERS AND SISTERS

(Include ALL brothers and sisters, ALL half-brother and sister and stepbrother and sister.)

Name

Relationship

SEE NOTE 2

Date of Birth

(YYY-MM-DD)

Present address

(if deceased:given city/town, country and date)

will accompany you to canada?

YES

NO

Marital status:

Country of birth:

Present occupation:

Yes
No

Marital status:

Country of birth:

Present occupation:

Yes
No

Marital status:

Country of birth:

Present occupation:

Yes
No

Marital status:

Country of birth:

Present occupation:

Yes
No

Marital status:

Country of birth:

Present occupation:

Yes
No

Marital status:

Country of birth:

Present occupation:

Yes
No

Marital status:

Country of birth:

Present occupation:

Yes
No

SECTION D - CERTIFICATION

I certify that the information contained in this document is complete, accurate and factual. I also realize that once this document has been completed and signed that it
will form part of my Immigration Record and will be used to verify my family details on future applications.

The information you provide on this form is collected under the authority of the Immigration and Refugee Protection Act to determine if you may be admitted to Canada as a temporary resident. It will be stored in Personal Information Bank CIC PPU 055, Visitor Case File. It is protected and accessible under the Privacy Act and the
Access to Information Act.