Note: All correspondence will go to this address unless you indicate your email address.

If you wish to have a representative who can conduct business on your behalf, you must provide their address in this section and on the Use of a Representative (IMM 5476) form.

For more information, read the Use of a Representative guide.

Use of a Representative

This application package includes:

Use this form if you want to name a representative (such as an immigration consultant, lawyer, friend or family member) to do business with us for you.

If you have already named a representative, you can also use this form to cancel that choice.

Where to send your form 

If you have not yet sent your citizenship, immigration or other application, send this form along with it to the office listed in your application package or upload it electronically.

If you have already sent your application, send this form to the office where you sent your original application or send it electronically through IRCC Web Form.

Question 2
Select the box to tell us if your residential address (where you live) is the same as your mailing address. If “No,” enter the following information:
  • Apartment (Apt.) or Unit, if applicable
  • Street number (no.). It is the number on your house or apartment building.
  • Street name
  • City or Town
  • Country
  • Province or State
  • Postal code or zip code
  • District, if applicable
Question 3
Enter your telephone number including the country code, area/regional codes, etc.

If you have an extension number, indicate it after your phone number under “Ext.”

Select the box to tell us if your telephone number is from Canada or the US or Other (any other country).

From the list, select the type of telephone:

  • Residence (home)
  • Cellular (cell/mobile)
  • Business (work)
Question 4
If you have a second telephone number, enter it here, including the country code, area/regional codes, etc.

If you have an extension number, indicate it after your phone number under “Ext.”

Providing an alternate telephone number will help make sure we can contact you with information about your application.

Select the box to tell us if your second telephone number is from Canada or the US or Other (any other country).

From the list, select the type of telephone:

  • Residence (home)
  • Cellular (cell/mobile)
  • Business (work)
Question 5
If you have a fax number, enter it here, including country code, area/regional codes, etc.

Select the box to tell us if the facsimile (fax) number is from Canada or the US or Other (any other country).

Question 6
If you have an email address, enter it here (for example, name@provider.net).

Note: By indicating your email address, you are hereby authorizing IRCC to transmit your file and personal information to this specific email.


Passport

Question 1
Select the box to tell us if you have a valid passport or travel document. If you don’t have one or can’t obtain one, you must select the “No” box.
Question 2
If you select “Yes,” provide your passport or travel document number exactly as shown on the document. Make sure there is no space between each number or letter.
Question 3
From the list, select the name of the country or territory that issued your passport or travel document.
Question 4
Enter the date your passport or travel document was issued.
Question 5
Enter the date your passport or travel document will expire.
Question 6
For this trip, select Yes or No to tell us if you are using a passport issued by the Ministry of Foreign Affairs in Taiwan that shows your personal identification number.
Question 7
For this trip, select Yes or No to tell us if you are using a National Israeli passport.

National Identity Document

Question 1
Select the box to tell us if you have a valid national identity document.
Question 2
If you selected “Yes,” provide your national identity document number exactly as shown on the identity document. Make sure there is no space between each number or letter.
Question 3
From the list, select the name of the country or territory that issued your national identity document.
Question 4
Enter the date your national identity document was issued.
Question 5
Enter the date your national identity document will expire.

Education/Occupation Detail

Question 1
From the list, select your highest level of education.
  1. None: No education
  2. Secondary or less: High school diploma obtained after elementary school and before college, university, or other formal training.
  3. Trade/Apprenticeship Certificate/Diploma: Diploma completed in a specific trade, such as carpentry or auto mechanics.
  4. Non-University Certificate/Diploma: Training in a profession that requires formal education but not at the university level (for example, dental technician or engineering technician).
  5. Post-Secondary – No Degree: Post-secondary studies at a college or university but no degree earned.
  6. Bachelor’s Degree: Academic degree awarded by a college or university to those who have completed an undergraduate curriculum; also called a baccalaureate. Examples include a Bachelor of Arts, Science or Education.
  7. Post Graduate – No Degree: Post-graduate studies at a college or university but no degree earned (Master or PhD).
  8. Master’s Degree: Academic degree awarded by a graduate school of a college or university. You must have completed a Bachelor’s degree before a Master’s degree can be earned.
  9. Doctorate – PhD: Highest university degree, usually based on at least 3 years of graduate studies and a thesis. Normally, you must have completed a Master’s degree before a PhD can be earned.
Question 2
Enter the total number of years of formal education that you have completed, including elementary and secondary school.
Question 3
Enter your current occupation.

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