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Your current situation
*
I am in Canada
I am outside Canada
UCI Number
*
Language of Correspondence
*
English
French
Date You became a PR in Canada?
*
YYYY-MM-DD
Place you became a PR in Canada
*
Name of city or port of entry AND Province
First Name
*
Full name as shown on your Record of Landing (IMM 1000), Confirmation of Permanent Residence (IMM 5292 or IMM 5688) or last PR card
Middle Name
*
Full name as shown on your Record of Landing (IMM 1000), Confirmation of Permanent Residence (IMM 5292 or IMM 5688) or last PR card
Last Name
*
Full name as shown on your Record of Landing (IMM 1000), Confirmation of Permanent Residence (IMM 5292 or IMM 5688) or last PR card
Gender
*
Male
Female
Other
Current Name
if different from the above. This is the name that will appear on your PR card or PRTD. (if applicable) NOTE: You must provide supporting documents for any change in your name. Consult “Legal Name Change”
Gender
*
Male
Female
Other
Date of Birth
*
YYYY-MM-DD
Country or territory of birth
*
Country, countries or territories of citizenship
*
If you have more than one country or territory of citizenship, please list all others here (if applicable)
Canada/US
Canada
Other
Primary Telephone number
Country Code
*
Primary Telephone Number
Number
*
Primary Telephone Number
Extension
*
Primary Telephone Number
Email Address
*
Current marital and relationship status
*
Common-law
Divorced
Married
Separated
Single
Widowed
3.1 Have you ever been issued a removal order from Canada?
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No
Yes
3.2 Has an immigration officer ever issued you an inadmissibility report under subsection 44(1) of the Immigration, Refugee and Protection Act?
*
No
Yes
3.3 Have you ever lost your status as a PR of Canada?
*
No
Yes
3.4 Have you ever submitted an appeal to the Immigration Appeal Division of the Refugee Board against a decision on the residence obligation?
*
No
Yes
3.5 Have you ever been issued any of the following?
*
Travel Document
PRTD
If you have answered 'Yes' to any of the questions from 3.1 to 3.4 and/or checked a box in question 3.5, please provide details below:
Address History (Inside and Outside Canada) List your address history for the past five (5) years or if you became a PR less than five (5) years ago, your address history since becoming a PR. List your address history from the most recent to the oldest.
*
Format: 1. From (YYYY-MM-DD) To (YYYY-MM-DD) - Apartment, street no. and street name - City or town - Province/District/State - Country or territories. 2. From (YYYY-MM-DD) To (YYYY-MM-DD) - Apartment, street no. and street name - City or town - Province/District/State - Country or territories. PLEASE LIST ALL ADDRESSES FROM THE LAST 5 YEARS AND DO NOT LEAVE ANY GAPS
Work and Educational History (Inside and Outside Canada) List your work and educational history for the past five (5) years or if you became a PR less than five (5) years ago, your work and educational history since becoming a PR. List your work and educational history from the most recent to the oldest. If you have not worked or studied, please complete the activity column with whichever activity applies to you (volunteering, homemaker, retired, unemployed etc.) You may provide additional information in the employer column such as name of volunteering or organization.
*
Format: 1. From (YYYY-MM-DD) To (YYYY-MM-DD) - Name of employer or educational institution or organization (do not use abbreviations) - Activity - City or town - Province/District/State - Country or territories 2. From (YYYY-MM-DD) To (YYYY-MM-DD) - Name of employer or educational institution or organization (do not use abbreviations) - Activity - City or town - Province/District/State - Country or territories . PLEASE LIST ALL ACTIVITIES FROM THE LAST 5 YEARS AND DO NOT LEAVE ANY GAPS
Have you travelled or lived outside of Canada in the past five (5) years?
*
No
Yes
Have you been employed on a full-time basis by a Canadian business outside Canada or in the federal public administration or the public service of a province, while you were absent from Canada? *Please include proof of full time Canadian employment as a supporting document.
*
No
Yes
Have you been accompanying a Canadian citizen who is your spouse, common-law partner, or in the case of a child, your parent, while you were absent from Canada? *Please provide proof of this person's Canadian citizenship and relationship to you as supporting documents.
*
No
Yes
Have you been accompanying a PR who is your spouse, common-law partner, or in the case of a child, your parent, and who is employed on a full-time basis by a Canadian business outside Canada or in the federal public administration or the public service of a province while you were absent from Canada? *Please include proof of this person's PR status, full time employment and relationship to you as supporting documents.
*
No
Yes
Time Spent Outside Canada You must provide all your absences from Canada during the past five (5) years or since becoming a PR if less than five (5) years ago. List your absences from the most recent to the oldest. You must include a reason for the absence in the table below.
*
Format: 1. From (YYYY-MM-DD) To (YYYY-MM-DD) - Your location(s) during your absence (city, country/territory) - Reason for Absence - If “Other” Please add reason - Days 2. From (YYYY-MM-DD) To (YYYY-MM-DD) - Your location(s) during your absence (city, country/territory) - Reason for Absence - If “Other” Please add reason - Days. PLEASE LIST ALL TRAVELS FROM THE LAST 5 YEARS AND DO NOT LEAVE ANY GAPS
History of entries into Canada and income tax information and filing history.
*
Yes
No
By selecting "Yes" in the box below, and by signing this form, I hereby give my consent to the Canada Border Services Agency (CBSA) to disclose the details of my history of entries into Canada to Immigration, Refugees and Citizenship Canada (IRCC) in order to assist IRCC in determining my eligibility for a PR card or a PRTD. I also hereby authorize IRCC to collect the history of my entries into Canada from the CBSA and to collect my social insurance number for the purpose of requesting that the Canada Revenue Agency (CRA) disclose my income tax information and residency information for any taxation years required to assist in determining whether I meet the residency obligation as set out in section 28 of the Immigration and Refugee Protection Act. Consent to disclose my history of entries into Canada (CBSA)
Consent to disclose my income tax information and residency information (CRA)
*
Yes
No
Social insurance number
*
I certify that the information given on this form and in any documents included is correct, complete and accurate.
*
Yes
No
I understand that any false statements or concealments of a material fact may be grounds for my prosecution or removal.
*
Yes
No
If this form pertains to a child under the age of 14, I certify that I am the child's parent or legal guardian.
*
Yes
No
I understand the foregoing statements, having asked for and obtained an explanation on every point that was not clear to me.
*
Yes
No
I further understand that the information provided by me may be verified and hereby consent to such verification activities.
*
Yes
No
I acknowledge that I have verified my absences one more time as my absences may have changed from when I initiated the IMM5444 form.
*
Yes
No
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