Application For Canadian Temporary Resident Visa by newart2013

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									                Citizenship and                Citoyenneté et                                                                            PROTECTED WHEN COMPLETED - B
                Immigration Canada             Immigration Canada
                                                                                                                                                                     PAGE 1 OF 2
                SCHEDULE 1
                APPLICATION FOR TEMPORARY RESIDENT VISA
The principal applicant, his or her spouse or common-law partner,                           If there is not enough space to provide all the necessary information,
if applicable, and all dependent children aged 18 years or older                            attach to this form a separate sheet of paper with further details. Print
listed in the application for temporary residence must complete                             your name at the top of each additional sheet and indicate the form's
their own copy of this form.                                                                title and the number of the question you are answering.
Before you start completing this form, make enough photocopies for your needs. You can also print all or part of this form from our Web site at
www.cic.gc.ca.

BEFORE YOU START, READ THE INSTRUCTION GUIDE
TYPE or PRINT in black ink

                                                                                                   The spouse, common-law partner or dependent child
 Indicate whether you are                            The principal applicant
                                                                                                   aged 18 years or older of the principal applicant


 1   Your full name
 Family name                                                                          Given name(s)


 2                                      Year          Month     Day

Your date of birth

Canada places a high value on bringing those who commit acts of genocide, war crimes or crimes against humanity to justice. Canada was the first country
to incorporate the obligations of the Rome Statute into its national laws.
 3   Military Service

     Did you serve in any military, militia, or civil defence unit or serve in a security organization or police force (including non obligatory national service, reserve or
     volunteer units)?

          No            Yes             Give the following details:
       From                   To
                                                                       Location/Place where stationed                                     Province                 Country
      Y         M        Y          M




 4   Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or desecration of religious buildings?
          No            Yes             Provide details of the circumstances below:
       From                   To
                                                                                 Location                                                 Province                 Country
      Y         M        Y          M




 Additional details




 5   Membership or association with organizations

     Are you, or have you ever been a member or associated with any political party, or other group or organization which has engaged in or advocated violence as a
     means to achieving a political or religious objective, or which has been associated with criminal activity at any time? Do not use abbreviations.

           No           Yes              Give the following details:

       From                   To                                                            Activities and/or positions held
                                                   Name of organization                                                                    Province                 Country
      Y         M        Y          M                                                              within organization




IMM 5257 (06-2012) E               This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants.
Schedule 1                                              (AUSSI DISPONIBLE EN FRANÇAIS - IMM 5257 F - Annexe 1)
                                                                                                                                                                 PAGE 2 OF 2

 6   Government positions

     Have you ever held any government positions (such as civil servant, judge, police officer, mayor, member of parliament, hospital administrator)? Do not use
     abbreviations.

         No            Yes            Give the following details:

       From                  To              Country and level of jurisdiction
     Y           M       Y        M                                                                Department/Branch                         Activities and/or positions held
                                            (e.g. national, regional, municipal)




     Authority to disclose personal information

     By submitting this form, you consent to the release to Canadian government authorities of all records and information any government authority, including police,
     judicial and state authorities in all countries in which you have lived may possess on your behalf concerning any investigations, arrests, charges, trials, convictions
     and sentences. This information will be used to assist in evaluating your suitability for admission to Canada or remaining in Canada pursuant to Canadian
     legislation.



     Declaration of applicant

     I, (your full name),                                                                , declare that all of the above statements are true, complete and correct, and
     I make this declaration knowing that it is of the same effect as if made before a court of law.
                                                                                                                             Year          Month     Day

     Signature                                                                                               Date



 DO NOT COMPLETE THE FOLLOWING SECTION NOW. YOU MAY BE ASKED TO SIGN IN THE PRESENCE OF A
 REPRESENTATIVE OF THE CANADIAN GOVERNMENT OR AN OFFICIAL APPOINTED BY THE CANADIAN GOVERNMENT.

     Solemn declaration                                                                       Interpreter declaration

     I,                                                                          ,            I,                                                                          ,
     do solemnly declare that the information I have given in the foregoing                   do solemnly declare that I have faithfully and accurately interpreted in the
     application is truthful, complete and correct, and I make this solemn
     declaration conscientiously believing it to be true and knowing that it is of                                                    language the content of this
     the same force and effect as if made under oath.                                         application and any related forms to the person concerned.

                                                                                              I have been informed by the person concerned, and I do verily believe,
                                                                                              that he or she completely understands the nature and effect of these
                                                                                              forms, and I make this solemn declaration conscientiously believing it to
                                                                                              be true and knowing that it is of the same force and effect as is made
                                                                                              under oath.


     Signature of                                                                             Signature of
     applicant                                                                                interpreter




  Declared                                                                                                                                    of the year
                                                                            this                day of
  before me at                                                                                                                                (YYYY)

  Canadian
  Government         Name                                                                 Signature
  Official
                                                  Please print or type




  The information you provide on this form is collected under the authority of the Immigration and Refugee Protection Act and will be used for the purpose of assessing
  your application for permanent residence. It will be stored in Personal Information Banks (PPU 039 entitled Overseas Immigration Case File and PPU 042 entitled
  Immigrant Case File). It may be shared with other organizations in accordance with the consistent use of information under the Privacy Act. Under the provisions of
  the Privacy Act and the Access to Information Act, individuals have the right to protection of and access to their personal information. Details on these matters are
  available at the Infosource website (http://infosource.gc.ca) and are also available at public libraries across Canada.


IMM 5257 (06-2012) E
Schedule 1

								
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