PROTECTED WHEN COMPLETED - Immigration Citizenship and Immigration Canada Citoyennetأ© et Immigration page 1
PROTECTED WHEN COMPLETED - Immigration Citizenship and Immigration Canada Citoyennetأ© et Immigration page 2

PROTECTED WHEN COMPLETED - Immigration Citizenship and Immigration Canada Citoyennetأ© et Immigration

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  • Citizenship and Immigration Canada

    Citoyenneté et Immigration Canada

    PAGE 1 OF 2

    IMM 5707E (12-2012) E

    PROTECTED WHEN COMPLETED - B

    (AUSSI DISPONIBLE EN FRANÇAIS - IMM 5707 F) ALSO AVAILABLE ON CIC WEB SITE AT: http://www.cic.gc.ca

    FAMILY INFORMATION 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 additional space is required, print and attach an additional form.

    TYPE OR PRINT IN BLACK INK.

    SECTION A

    Name Relationship SEE NOTE 1

    Date of birth (Year/Month/Day)

    Country of birth

    Present address (If deceased, give city/town, country and date)

    Present occupation

    Will accompany

    you to Canada? Yes No

    Applicant

    Spouse or common-law

    partner

    Mother

    Father

    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.

    Signature

    Year DayMonth

    Date

    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 (Year/Month/Day)

    Country of birth Marital status

    Present address

    Present occupation

    Will accompany

    you to Canada? 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.

    Signature

    Year DayMonth

    Date

    SECTION C- 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.

    Signature

    Year DayMonth

    Date

    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.

    ゼロ ホリ

     カ ナダ

    無料 エー

    ジェ ント

    IA JP

    IAJP テキストボックス 申請者の名前を英語と日本語で記載 Hanako Kanada (金田 花子)

    IAJP テキストボックス 配偶者の名前を英語と日本語で記載 注意!もしいない場合はN/Aと記載し、下記のNOTE1に署名と日付を記入

    N/A

    IAJP テキストボックス お母様の名前を英語と日本語で記載Takako Kanada(金田 高子)

    IAJP テキストボックス

    お父様の名前を英語と日本語で記載Yoshio Kanada(金田 良夫)

    IAJP 引き出し線 それぞれ誕生日 を記入

    IAJP 引き出し線 上記にて配偶者がいない場合, パスポートと同じ署名と日付を記入

    IAJP 引き出し線 現在の職業

    IAJP 引き出し線 現在の住所

    もし故人であれば、亡くなった場所(市)と日にちを記入下さい。

    IAJP 引き出し線 カナダに同行しますか? YESかNOどちらかにチェック

    IAJP テキストボックス N/A

    IAJP 引き出し線 お子様をお持ちであれば全てのお子様の情報(養子等も含む)を記入。

    いなければN/Aと記入

    注意!もしいない場合はN/Aと記載し、下記のNOTE2に(パスポートと同じ)署名と日付を記入。

    IAJP 引き出し線 オンライン申請の場合、署名欄は空白でOK ※オンライン申請の場合、署名の代わりにオンライン上でまとめて宣誓にすることで署名したことになります

    IAJP 引き出し線 氏名 英語(パスポートと同じ)と日本語表記両方を記名してください。

    IAJP 引き出し線 それぞれの婚姻状況を下記より該当するものを記入。

    Annulled Marriage(婚姻の無効) Common-Law(内縁) Divorced(離婚) Legally Separated(法律上の別居) Married(既婚) Single(未婚) Widowed(寡婦/ 寡夫)

    IAJP 引き出し線 それぞれ誕生日 を記入

    IAJP 引き出し線 生まれた国名

    IAJP 引き出し線 生まれた国名

    IAJP 引き出し線 現在の住所

    もし故人であれば、亡くなった場所(市)と日にちを記入下さい。

    IAJP 引き出し線 現在の職業

    IAJP 引き出し線 カナダに同行しますか? YESかNOどちらかにチェック

  • PAGE 2 OF 2

    IMM 5707E (12-2012) E

    INSTRUCTIONS Who needs to fill out this application form? This form must be completed by:

    ι each person, 18 years of age or older, or ι a minor (less than 18 years of age) travelling alone, and ι be a passport holder from one of the following countries:

    o Argentina o Brazil o Malaysia o Russia o Saudi Arabia o South Africa

    If you require a Temporary Resident Visa (TRV) and your passport is not from the countries listed above, you must complete the Additional Family Information (IMM 5645) instead.

    SECTION A

    Write the personal details for: ι yourself, ι your spouse or common-law partner, (if applicable) ι your mother and ι your father. Include: full name, date of birth, country of birth, present address and occupation (job). Check Yes or No to indicate if the person will accompany you to Canada. If a person is deceased, indicate in which city/town, country and the date of death under "Present address". If a person is not employed, indicate whether the person is retired, studying, etc. If a section does not apply to you write "Not applicable" or "N/A". Note: If you do not have a spouse or a common-law partner, read "Note 1", sign and date the declaration.

    Write the personal details for your children. It is very important that you list all of your children (even if they are already permanent residents or citizens of Canada). This includes: ι married children, ι adopted children, ι children of your spouse(step-children) or common-law partner, ι any of your children who have been adopted by others, ι any of your children who are in the custody of an ex-spouse, former common-law partner or other guardian. Include: full name, relationship (e.g. brother, step-sister) date of birth, country of birth, marital status (married, single, widowed, common-law, divorced, separated, annulled marriage), present address and occupation (job). Check Yes or No to indicate if the person will accompany you to Canada. If a person is not employed, indicate whether the person is retired, studying, etc. Note: If you do not have any children, read "Note 2", sign and date the declaration.

    SECTION B

    Signature Sign and date in the boxes provided at the bottom of the page. Note: By signing, you certify that you fully understand the questions asked, and that the information you have provided is complete, accurate and factual. If you do not sign or date the form, your application will be returned to you.

    SECTION C

    ゼロ ホリ

     カ ナダ

    無料 エー

    ジェ ント

    IA JP