Imm0008Dep Form – Fill Out and Use This PDF

PROTECTED WHEN COMPLETED - B

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ADDITIONAL DEPENDANTS / DECLARATION FORM

PERSONAL DETAILS

9Citizenship(s)

13 Current country of residence:

YYYY-MM-DD

This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants.

IMM 0008DEP (07-2011) E

(DISPONIBLE EN FRANÇAIS - IMM 0008DEP-F)

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PASSPORT

NATIONAL IDENTITY DOCUMENT

IMM 0008DEP (07-2011) E

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CONSENT AND DECLARATION OF APPLICANT

Consent to release information to intended province/territory of destination

I, (first name, last name) ____________________________________________________ authorize Citizenship and Immigration Canada to share the information collected in this application

as well as supporting documentation with Provincial and Territorial authorities with responsibility for immigration for the purposes of the Immigration and Refugee Protection Act.

I agree that the information contained in this application related to my intended occupation, education and work experience may be shared with prospective employers in order to assist them in hiring workers.

This declaration covers the information I have provided on this form and all the information submitted in my application as well as in the attached schedules and accompanying documents.

I understand that any false statements or concealment of a material fact may result in my exclusion from Canada and may be grounds for my prosecution or removal.

I also understand that should I be found to be inadmissible for misrepresentation under section 127 of the Immigration and Refugee Protection Act, I may be barred from entering Canada for a period of two years following a final determination of my inadmissibility or, if this determination is made in Canada following my removal from Canada.

I understand that if I wish to work in a regulated occupation, it is my responsibility to obtain information on the licensing requirements from the appropriate regulatory body in Canada and that should I be issued a visa for Canada, I am not guaranteed employment in Canada in my occupation or in any other occupation.

I understand that should I be issued a visa for Canada, conditions may be imposed on me at the time of its issuance and that I will be required to meet them.

I understand all the foregoing statements, having asked for and obtained an explanation on every point that was not clear to me.

I realize that once this document has been completed and signed, it will form part of my Immigration Record and will be used to verify my family details on future applications.

I will immediately inform the visa office where I submitted my application if any of the formation or the answers provided in my application forms change.

Declaration of applicant

I declare that the information I have given is truthful, complete and correct.

IMPORTANT NOTE:

This application must be signed and dated before it is submitted.

Do not forget to include: photos, fees (if applicable), and any other documents required by the visa office. Review application guide and kit for more information and verify you have completed all of the required documents as per the document checklist.

“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. It will be stored in Personal Information Banks (PPU 042 entitled Immigrant Case File and PPU 009 entitled Refugee Claim in Canada Case File ) CIC. The information may be shared with other organizations such as the Canada Border Services Agency (CBSA), the Royal Canadian Mounted Police (RCMP), the Canadian Security Intelligence Service (CSIS) and foreign governments in accordance with the subsection 8(2) of the Privacy Act. Information may also 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. In accordance with the Privacy Act and the Access to Information Act, individuals have a 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 through the Citizenship and Immigration Canada Call Centre. Infosource is also available at public libraries across Canada.”

IMM 0008DEP (07-2011) E