MS Canada Application For Visitor Visa

APPLICATION FOR VISITOR VISA (TEMPORARY RESIDENT VISA
UCI
I want service in*
Visa requested*
PERSONAL DETAIL
Full Name*
Family name (as shown on your passport or travel document) Given name(s) (as shown on your passport or travel document )
Have you ever used any other name (e.g. Nickname, maiden name, alias, etc.)?*
- No
- Yes
Name
Family name Given name(s)
sex*
Date of birth*
Year
Month
Day
Place of birth*
City Country
Citizenship*
Country
Current country or territory of residence
Country or Territory*
Country
Status*
Other
From Date
Year
Month
Day
To Date
Year
Month
Day
Previous countries or territory of residence
- No
- Yes
Country or Territory Status Other From Date To Date
Country or Territory where applying
Same as current country or territory of residence?
- No
- Yes
Country or Territory Status Other From Date To Date
Your current marital status
(If you are married or in a common-law relationship) Provide the date on which you were married or entered into the common-law relationship
Date*
Year
Month
Day
Provide the name of your current Spouse/Common-law partner*
Family name Given name(s)
PERSONAL DETAILS (CONTINUED
Have you previously been married or in a common-law relationship?
- No
- Yes
Prov ide the following details for your previous Spous e/Common-la w Partner*
Family name Given name(s)
Date of birth
Year
Month
Day
Type of relationship*
From Date*
Year
Month
Day
To Date*
Year
Month
Day
LANGUAGE(S)
Native language/Mother Tongue*
Are you able to communi cate in English and/or French?*
In which languag e are you most at ease?*
Have you taken a test from a designated testing agency to assess your proficiency in English or French?
- No
- Yes
PASSPORT
Passport number*
Country or territory of issue*
Country
Issue date*
Year
Month
Day
Expiry date*
Year
Month
Day
For this trip, will you use a passport issued by the Ministry of Foreign Affairs in Taiwan that includes your personal identification number?*
- No
- Yes
For this trip, will you use a National Israeli passport?*
- No
- Yes
NATIONAL IDENTITY DOCUMENT
Do you have a nati onal id entit y document ?*
- No
- Yes
Document number
Country or territory of issue
Country
Issue date
Year
Month
Day
Expiry date
Year
Month
Day
US PR CARD
Are you a la wful Permanent Resident of the United States with a valid alien registrati on card (green card)?*
- No
- Yes
Document number
Expiry date
Year
Month
Day
CONTACT INFORMATION
If submitting your application by mail: - All correspondence will go to this address unl ess you indicate your e-mail address below. - Indicating an e-mail addr ess will auth orize all correspond ence, including file and personal informati on, to be sent to the e-mail address you specify. - If you wish to auth or ize the release of informati on from your application to a representative, indicate their e-mail and mailing address(es) in this section and on the IMM5476 form.
Current mailing address
Give Details
P.O. box Apt/Unit Street no Street name City/Town Country or Territory Province/State Postal code District
Residential address Same as mailing address?
- No
- Yes
Give Details
Apt/Unit Street no Street name City/Town Country or Territory Province/State Postal code District
Telephone no
Telephone no
- Canada/US
- Other
Type Country Code No Ext.
Type Country Code No Ext.
Alternate Telephone no
- Canada/US
- Other
Type Country Code No Ext.
Type Country Code No Ext.
Fax no
- Canada/US
- Other
Country Code No Ext.
Country Code No Ext.
E-mail address
DETAILS OF VISIT TO CANADA
Purpose of my visit*
Other
Indi cate how long you plan to stay
From Date*
Year
Month
Day
To Date*
Year
Month
Day
Funds available for my stay (CAD)*
Name, address and relationship of any person(s) or instituti on (s) I will visit*
Name Relationship to me Address in Canada
EDUCATION
Have you had any post secondary education (including university, college or apprenticeship training) ?
- No
- Yes
Give Details
From Date To Date Field of study School/Facility name City/Town Country or Territory Province/State
EMPLOYMENT
Give details of your employment for the past 10 years, including if you have held any government positions (such as civil servant, judge, police officer, mayor, Member of Parliament, hospital administrator, employee of a security organ ization ). Do not leavegaps. If retired, not working or studying, please indicate. If you are retired, please provide the 10 years before your retirement.
From Date To Date Current Activity/Occupation Company/ Employer/Facility name City/Town Country or Territory Province/State
BACKGROUND INFORMATION
You must complete this section if you are 18 years of age or older
Within the past two years, have you or a family member ever had tuberculosis of the lungs or been in close contact with a person with tuberculosis?
- No
- Yes
Give Details
Do you have any physical or mental disorder that would require social and /o r health services, other than medication, during a stay in Canada?
- No
- Yes
Give Details
Have you ever remained beyond the validity of your status, attended school without authorization or worked without authorization in Canada?
- No
- Yes
Give Details
Have you ever been refused a visa or permit, denied entry or ordered to leave Canada or any other country or territory?
- No
- Yes
Give Details
Have you previously applied to enter or remain in Canada?
- No
- Yes
Give Details
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 unit s)?
- No
- Yes
Give Details
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 Details
Are you, or have you ever been a member with any pollitical 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?
- No
- Yes
Have you ever witnessed or participated in the ill treatment of prisoners or civilians,looting or desecration of religious buildings?
- No
- Yes
SIGNATURE
Citizenship and Immigration Canada (CIC), or an organization at CIC' request, may want to contact you in the future to ask you about any services you received from CIC prior to the application process (such as participation in an informati on forum), during the appli cation process (including the application process itself as well as orientation or accreditation services), and services received after arriving in Canada (including settlement, integration and citizenship) . CIC will use this information, along with the information provided by other individuals, for research, performance measurement or evaluation purpo ses. CIC 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? (Y/N)
- No
- Yes
I consent to the release to Citizenship and Immigration Canada (CIC) and Canada Border Services Agency (CBSA) of all records and information for the purpose of processing my request that any government authority, including police, judicial and state authorities in all countries in which I have lived may possess about me. This information will be used to evaluate my suitability for admission to Canada or to remain in Canada pursuant to Canadian legislation
I declare that I have answered all questions in this application fully and truthfully.
Signature of Applicant or Parent/Legal Guardian's for a person under 18 years of age
Date
Year
Month
Day

Country or Territory	Status	Other	From Date	To Date

Country or Territory	Status	Other	From Date	To Date

P.O. box	Apt/Unit	Street no	Street name	City/Town	Country or Territory	Province/State	Postal code	District

Apt/Unit	Street no	Street name	City/Town	Country or Territory	Province/State	Postal code	District

APPLICATION FOR VISITOR VISA (TEMPORARY RESIDENT VISA

PERSONAL DETAIL

Current country or territory of residence

PERSONAL DETAILS (CONTINUED

LANGUAGE(S)

PASSPORT

NATIONAL IDENTITY DOCUMENT

US PR CARD

CONTACT INFORMATION

Current mailing address

Telephone no

DETAILS OF VISIT TO CANADA

EDUCATION

EMPLOYMENT

BACKGROUND INFORMATION

SIGNATURE