Applicant Information

Enter your Last Name / Surname / Family name as shown on your passport

Enter your First Name as shown on your passport

Gender*

Female Male

Passport information

Other data

Yes No

Background Questions

Yes No

Do you have one of these health conditions?*

Yes No

If you have conmmitted or been convited of a crime, you may not be allowed into Canada. This includes both minor and serious crimes, such as: Theft, assault, manslaughter, dangerous driving, driving while under the influence of drugs or alcohol, possession of or trafficking in drugs or controlled substances. 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.

Declaration of Applicant

I confirm that the above information is true and correct I have understood and accept the Terms and Conditions, Privacy Policy, Refund Policy