Permanent Residence Form

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Preferred Language

Family Name

Given Name

Other Name (if any)

Maiden Name, Patrionymic Name or Nickname

Interpreter Requested?

Current Province of Residence in Canada?

City

Certificat de Sélection du Québec (CSQ)?

If yes, enter the number. CSQ Number

If no, when did you apply for your CSQ? Date (YYYY/MM/DD)

Sex

Canada? country. Have

Eye Color

Height in Centimetre (CM)

Date of Birth (YYYY-MM-DD)

Place of Birth

City and Province

Country of Birth

Current Country of Residence

If you are living in Canada put 'Canada', if overseas, please the country you are currently residing.

From (YYYY-MM-DD)

To (YYYY-MM-DD)

Status in the country

Date of your last entry to Canada? (YYYY-MM-DD)

This is the date of when you last entered in Canada if you left and re-entered.

Place of your last entry to Canada?

If you flew by air, enter the airport where you entered and the city and province where it is located.

Date of your original entry to Canada? (YYYY-MM-DD)

This is the date of when you first came to Canada.

Place of when you originally came to Canada.

If you flew by air, enter the airport where you entered and the city and province where it is located.

Previous countries of residence: during the past five years, have you lived in any country other than your country of citizenship or your current country of residence (indicated above) for more than six months?

If yes, please provide the country of where you stayed, duration (complete dates) and your status in the country. You can add multiple entries.

FORMAT: Country - YYYY-MM-DD to YYYY-MM-DD - Worker

Marital Status

Legally Separated means you are still married but are no longer together and not cohabiting anymore. Conjugal Partner means you are in a relationship for a least one year and are financially, socially and physically dependent. Common-law means you have cohabited with your partner for at least one year.

Have you previously been married or in a common-law relationship?

If yes, provide the information of your previous partner including full name, date of birth, type of relationship (married or common-law partner) and duration of your relationship.

FORMAT: Full Name - YYYY-MM-DD - Married - YYYY-MM-DD to YYYY-MM-DD. E.g. Mary Jones - 1987-01-03 - Married - 2000-06-01 to 2019-07-27.

Phone Number

Add the Country Code

Full Address, Include Apartment/Unit Number (if any), House or Building Number, Street Address, City, Province and Postal or ZIp Code and Country

E.g. Unit 500, 123 Bathurst Street, North York, Ontario, M2M 1Y1, Canada

Email Address

Do you have a valid passport/travel document?

Passport/Travel document number

Country of issue

The issuing country. For example, you are a Philippines citizen and got your passport issued by the Consulate located in Canada, you should put Philippines are the country of issue not Canada.

Issuing Date (YYYY-MM-DD)

Do you have a national identity document?

If yes, provide information:

National identity document number, Country of Issue, Issue date (YYYY-MM-DD), Expiry date (YYYY-MM-DD).

Highest level of education

If you have a Bachelor's Degree, put Bachelor's Degree,.

Number of years of education in total:

Include all the years you attended primary/elementary, secondary or high school, college, university, post graduate school and other vocational or technical school years.

Current Occupation

Intended Occupation

If you are not sure yet, you can put TBD

Are you able to communicate in English or French

In which language are you most at ease?

If you have taken a test from a designated testing agency to assess your English or French skills, provide information:

Provide the following: Type of Test you took (e.g. CELPIP General), Date of When you taken the test (YYYY-MM-DD), Date of signing or when you got the result (YYYY-MM-DD), Registration Number and /PIN number, and scores, Listening, Speaking, Writing and Reading.

Full Name of Spouse (If married or in common-law relationship))

Date of Birth of Spouse or Partner (YYYY-MM-DD)

Email Address of Spouse or Partner

Mother's Full Name

Mother's Maiden Name

This is her last name before she got married.

Mother's Date of Birth (YYYY-MM-DD)

Mother's Place of Birth

If mother is deceased, provide the Date of Death and the city, province and country of where they passed away

Father's Full Name

Father's Date of Birth (YYYY-MM-DD)

Father's Place of Birth

If mother is deceased, provide the Date of Death and the city, province and country of where they passed away

Children's Information of you have any

Provide their Full name/s, Relationship to you -Date of Birth (YYYY-MM-DD), Date of Death - if applicable (YYYY-MM-DD), Country or Territory of Birth, Marital Status, Email Address and Full Address. (E.g. Anita Jones - Daughter - 2003-03-20 - Canada - Single - anitajones@gmail.com - Unit 500, 123 Bathurst Street, North York, Ontario, M2M 1Y1, Canada) If you have more than one child, add all information of each child.

Sibling/s' information of you have any

Provide their Full name/s, Relationship to you -Date of Birth (YYYY-MM-DD), Date of Death - if applicable (YYYY-MM-DD), Country or Territory of Birth, Marital Status, Email Address and Full Address. (E.g. Anita Jones - Sister- 2003-03-20 - Canada - Single - anitajones@gmail.com - Unit 500, 123 Bathurst Street, North York, Ontario, M2M 1Y1, Canada). Add all information of each sibling.

Write your name in Native Language

Your full name written in your native language or script (for example, Arabic, Cyrillic, Chinese, Korean or Japanese script or Chinese commercial/telegraphic code)

Have you or, any of your family members listed in this application, ever been convicted of a crime or offence in Canada for which a pardon has not been granted under the Criminal Records Act of Canada?

Have you or, any of your family members listed in this application, ever been been convicted of or are currently charged with, on trial for, or party to a crime or offence, or subject of any criminal proceedings in any other country or territory?

Have you or, any of your family members listed in this application, ever been made previous claims for refugee protection in Canada or at a Canadian visa office abroad, in any other country(ies) or territory(ies), or with the United Nations High Commissioner for Refugees (UNHCR)?

Have you or, any of your family members listed in this application, ever been been refused refugee status, an immigrant or permanent resident visa (including a Certificat de Sélection du Québec [CSQ] or application to the Provincial Nominee Program) or a visitor or temporary resident visa, for Canada or any other country or territory?

Have you or, any of your family members listed in this application, ever been been refused admission to, or ordered to leave, Canada or any other country or territory?

Have you or, any of your family members listed in this application, ever been been involved in an act of genocide, in a war crime or in the commission of a crime against humanity?

Have you or, any of your family members listed in this application, ever been used, planned or advocated the use of armed struggle or violence to reach political, religious or social objectives?

Have you or, any of your family members listed in this application, ever been been associated with a group that used, uses, or advocated or advocates the use of armed struggle or violence to reach political, religious or social objectives?

Have you or, any of your family members listed in this application, ever been been a member of an organization that is or was engaged in an activity that is part of a pattern of criminal activity?

Have you or, any of your family members listed in this application, ever been been detained, incarcerated or put in jail?

Have you or, any of your family members listed in this application, ever been had any serious disease or physical or mental disorder?

If you answered yes to any of the questions above, please provide information

Provide details on all membership and association with organizations

Duration from (YYYY-MM-DD) to (YYYY-MM-DD), Name of Organization, Type of Organization, Activities and/or positions held within organization, City and country/territory

Provide all details on Government positions

Duration from (YYYY-MM-DD) to (YYYY-MM-DD), Country/territory and level of jurisdiction (national, regional, municipal), Department/branch, Activity and/or positions held

Details on Military and Paramilitary service

Duration from (YYYY-MM-DD) to (YYYY-MM-DD), Branch of service, unit numbers and names of your commanding officers, Rank(s), Dates and places of any active combat, Reason for end of service