Imm5476 Form Sample PDF Details

Are you looking to submit an application for permanent residence in Canada? Before beginning, it's important to become familiar with all the required forms. One such form is IMM5476 - Family Information Form. This form collects personal information about your family members who will be accompanying or joining you in Canada and should be submitted along with other documents relevant to the application process. In this blog post, we'll provide a sample version of IMM5476 - Family Information Form so that you have a better understanding of what information is being asked for on the form and how it should be completed before submitting it as part of your permanent residence application.

QuestionAnswer
Form NameImm5476 Form Sample
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesCBSA, use of representative, gc, cic

Form Preview Example

Citizenship and

Citoyenneté et

PAGE 1 OF 2

IMM

Immigration Canada

Immigration Canada

 

PROTECTED WHEN COMPLETED - B 5476

 

 

USE OF A REPRESENTATIVE

(11-2010)

E

 

You do not need to hire an immigration representative, it is your choice. No one can guarantee the approval of your application. All the forms and information that you need to apply are available free at www.cic.gc.ca.

A representative is someone who has your permission to conduct business on your behalf with Citizenship and Immigration Canada (CIC) and Canada Border Services Agency (CBSA). You may have one representative only. If you appoint an additional representative, the previous representative will no longer be authorized to conduct business on your behalf and receive information on your case file.

Your dependent children aged 18 years or older must complete their own copy of this form if they have a representative.

I am:

appointing a representative. Complete Sections A, B and D.

cancelling the appointment of a representative. Complete Section A, C and D.

SECTION A: APPLICANT INFORMATION

1.Your full name

Family name (Surname)

Given name(s)

2.Your date of birth

3.If you have already submitted your application: Name of office where the application was submitted

Location of office

Type of application

(permanent residence, extension of study permit, etc.)

 

Day

Month

 

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.Your Citizenship and Immigration Canada Identification number (if known)

Client Identification (ID) or

Unique Client Identifier (UCI) number

SECTION B: APPOINTMENT OF REPRESENTATIVE

I authorize the following individual to serve as my representative and to conduct business on my behalf with Citizenship and Immigration Canada and Canada Border Services Agency.

I authorize Citizenship and Immigration Canada and Canada Border Services Agency to release information from my case file and that of my dependent children under 18 years of age to my representative. This authorization is in accordance with the Privacy Act.

I am aware that any information which would be subject to exemption, if I had the right of access under the Privacy Act or the Access to Information Act, will likely not be released.

5.Your representative's full name

Family name (Surname)

Given name(s)

6.Your representative: (choose one) is UNPAID and is a:

family member or friend

member of a non-governmental or religious organization

member of the Canadian Society of Immigration Consultants, a Canadian provincial or territorial law society, or the Chambre des notaires du Québec.

other

is or will be PAID and is a member in good standing of:

the Canadian Society of Immigration Consultants (CSIC)

Membership ID number

a Canadian provincial or territorial law society

Which province or territory?

Membership ID number

the Chambre des notaires du Québec

Membership ID number

 

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

IMM 5476 (11-2010) E

(DISPONIBLE EN FRANÇAIS - IMM 5476 F)

PAGE 2 OF 2

7.Your representative's contact information

Name of firm or organization (if applicable)

Mailing address

Postal code/ZIP

Telephone numberCountry code Area codeNumber

 

(

)

(

)

 

 

 

 

 

 

Fax number

Country code

 

Area code

Number

 

(

)

(

)

 

 

 

 

 

 

 

E-mail address (if applicable)

 

 

 

 

 

By indicating your representative's e-mail address, you are hereby authorizing Citizenship and Immigration Canada to transmit your file and personal information to this specific e-mail address.

8.Your representative's declaration:

I declare that the information in Section B is truthful, complete and correct.

I understand and accept that I am the person appointed by the applicant to conduct business on the applicant or sponsor's behalf with Citizenship and Immigration Canada and Canada Border Services Agency.

Signature of representative

Date

Day

Month

 

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION C: CANCEL THE APPOINTMENT OF A REPRESENTATIVE

I withdraw my authorization for this person to serve as my representative, to receive information on my case file and to conduct business on my behalf with Citizenship and Immigration Canada and Canada Border Services Agency.

9.Your representative's full name

Family name (Surname)

Given name(s)

Name of firm or organization (if applicable)

SECTION D: YOUR DECLARATION

10.

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

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

Signature of applicant

Date

Day Month

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of spouse or common-law partner (if applicable)

Date

Day

Month

 

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Warning! It is a serious offence to give false or misleading information on this form.

The information you provide on this form is collected under the authority of the Immigration and Refugee Protection Act and will be used in assessing your application according to the requirements of the Act. It will be retained in a Personal Information Bank identified in Infosource. It may be shared with other organizations in accordance with the consistent use of information under the Privacy Act. Under 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 infosource.gc.ca and through the Citizenship and Immigration Call Centre. Infosource is also available in Canadian public libraries.

IMM 5476 (11-2010) E