Personal details
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Surname(s) |
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Given name(s) |
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Date of birth |
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Country of birth |
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City of birth |
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Additional citizenships. Are you a citizen of a country/territory other than the one on your passport? |
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Select additional citizenships
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Gender |
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Marital Status |
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Have you previously applied to enter or remain in Canada?
Select YES if, in the past, you submitted an application to come to Canada, such as a study permit, work permit or visitor visa. |
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Unique client identifier (UCI) / Previous Canadian visa or permit number |
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Funds available for travel to Canada |
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Employment Information
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Occupation |
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Job title |
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Job title |
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Job title |
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Job title |
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Job title |
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Job title |
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Job title |
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Job title |
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Job title |
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Job title |
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Job title |
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Please provide the name of the company, employer, school or facility as applicable. |
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Country/territory |
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City/town |
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Start date |
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Passport Information
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Passport number |
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Country/territory of issue |
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Date of issue |
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Date of expiry |
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Upload color scanned copy of the main page of your passport (bmp,jpg,jpeg,png,pdf,tiff, 3MB max) |
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Contact Details
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Preferred language to contact you |
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Email address |
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Residential address
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Apartment number/unit |
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Residence/House/Street number |
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Street address/name |
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Street address/name 2 |
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City/town |
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Country/territory |
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Background Questions |
Have you ever been refused a visa or permit, denied entry to, or ordered to leave Canada or any other country/territory? |
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Provide as many details as possible to help with processing. |
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Have you ever committed, been arrested for, been charged with or convicted of any criminal offence in any country/territory? |
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Provide as many details as possible to help with processing. |
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Have you or a family member ever had or been in close contact with a person with tuberculosis? |
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Indicate the nature of the relationship, if applicable, and approximate date on which you or a family member had or were in close contact with a person with tuberculosis. Provide as many details as possible to help with processing. |
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Do you have a serious health condition for which you are receiving regular medical treatment? |
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Do you have a kidney condition that requires dialysis? |
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Are you travelling for medical reasons or treatment? |
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Do you have a history of illness, hospitalisation, injury or surgery in the last 6 months? |
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Have you made financial arrangements to cover the cost of the treatment, as well as, all related expenses? |
If you are travelling for the purpose of obtaining medical services or treatment, you must provide, at the border, proof from the Canadian institution that arrangements have been made for treatment. You must also show proof that satisfactory financial arrangements have been made to cover the cost of the treatment as well as all related expenses, including follow-up care and living expenses during your stay in Canada.
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Provide as many details as possible to help with processing. |
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Do you have, or will you obtain, health insurance that is valid in Canada for the duration of your stay? |
You may be asked for proof of insurance upon entering Canada. Visitors to Canada are responsible for the cost of any health-care services received.
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Please briefly indicate if there are additional details pertinent to your application. Provide as many details as possible to help with processing. If not applicable, put N/A. |
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Consent and declaration
Information provided to CIC is collected under the authority of the Immigration and Refugee Protection Act (IRPA) to determine admissibility to Canada. Information provided may be shared with other Canadian government institutions such as, but not limited to, the Canada Border Services Agency (CBSA), the Royal Canadian Mounted Police (RCMP), the Canadian Security Intelligence Service (CSIS), the Department of Foreign Affairs, Trade and Development (DFATD), Employment and Social Development Canada (ESDC), the Canada Revenue Agency (CRA), provincial and territorial governments and foreign governments in accordance with subsection 8(2) of the Privacy Act. Information may be disclosed to foreign governments, law enforcement bodies and detaining authorities with respect to the administration and enforcement of immigration legislation where such sharing of information may not put the individual and or his/her family at risk. Information may also be systematically validated by other Canadian government institutions for the purposes of validating status and identity to administer their programs.
Where biometrics are provided as part of an application, the fingerprints collected will be stored and shared with the RCMP. The fingerprint record may also be disclosed to law enforcement agencies in Canada in accordance with subsection 13.11(1) of the Immigration and Refugee Protection Regulations. The information may be used to establish or verify the identity of a person in order to prevent, investigate or prosecute an offence under any law of Canada or a province. This information may also be used to establish or verify the identity of an individual whose identity cannot reasonably be otherwise established or verified because of physical or mental condition. Canada may also share immigration information related to biometric records with foreign governments with whom Canada has an agreement or arrangement.
Depending on the type of application made, the information you provided will be stored in one or more Personal Information Banks (PIB) pursuant to section 10(1) of Canada's Privacy Act. Individuals also have a right to protection and access to their personal information stored in each corresponding PIB under the Access to Information Act. Further details on the PIBs pertaining to CIC's line of business and services and the Government of Canada's access to information and privacy programs are available at the Infosource website (http://infosource.gc.ca) and through the CIC Call Centre. Infosource is also available at public libraries across Canada.
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Declaration of Applicant
I have read and understand the above declaration.
I declare that the information I have given in this application is truthful, complete and correct.
I understand that misrepresentation is an offence under section 127 of the Immigration and Refugee Protection Act and may result in a finding of inadmissibility to
Canada or removal from Canada.
I agree that by typing my name and clicking sign, I am electronically signing my application.
Signature
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