CANADA IMMIGRATION CONSULTING SERVICES

Transcription

1 STEP - BY - STEP INSTRUCTION FOR COMPLETING APPLICATION DOCUMENTS 1. Sign the contract. Keep a copy for your file and return the original to CICS - Canada Immigration Consulting Services. 2. Sign Schedule A Individual Consent to Disclosure and/ or Use of Personal Information. Your spouse and family members over age 18 must sign one form each. 3. Prepare the documents listed in Schedule D. 4. Complete the forms under Schedule E. Your spouse and each and every member of the family over age 18 are required to complete one copy each. Make copies for your records. Question 15 must include your high school education and post secondary education (indicate diploma(s) and/or degree(s) obtained). In Question 16, 17 and 18 mention the details of your job and your occupation, and include a Resume. 5. Sign Form IMM0008, Schedule F where it is marked (X) Signature of Applicant. Your spouse and each and every member of the family over age 18 are required to complete one copy each. Make copies for your records. 6. Complete the Additional Family Information form. Your spouse and each and every member of the family over age 18 are required to complete this form. 7. Government Fees and Consulting Fees must be sent to the following account: CICS, Canada Immigration Consulting Services CICS ENTERPRISES INC. CAN$ ACC # : US$ ACC#: Swift No: ROYCCAT2MIC ABA No (Transfer form US) ROYAL BANK OF CANADA EDGEMONT VILLAGE 3145 EDGEMONT BLVD NORTH VANCOUVER, BC V7R 2N7 Government Fees: Refer to Schedule B Consulting Fees: Refer to Schedule C Terms of Payment: 1. 1/2 of the total amount payable now 2. 1/2 of the total amount payable after Medical Exam documents are received. NOTE: Some professionals need to have their academic records assessed in Canada for the immigration process, i.e. Engineers by CCPE, Canadian Council of Professional Engineers, for which a fee of CAN$175 is payable. CONTRACT IMMIGRATION CONSULTING AND SERVICE AGREEMENT Page 1 of 23

2 I, (full name of client) (the Client), of the City of, hereby retain and appoint Mr. Bahram Sadaghiani, of CICS Canada Immigration Consulting Services, as my Advisor and Consultant with respect to my application for Permanent Residence of Canada for myself and if applicable for my immediate family members (names of Family members). The Consultant will provide the following services: 1. Advise the Client with respect to Canadian immigration law 2. Liaise between the Canadian Government and the Client 3. Prepare all forms and submissions 4. Apprise the Client on the progress of his application 5. Prepare the Client for any interview related to the application (if required) 6. Monitor the case progress through completion I ACKNOWLEDGE that Mr. Bahram Sadaghiani, of CICS - Canada Immigration Consulting Services, has not undertaken to advise me regarding to the tax laws of any country, employment or business opportunities, or any other matters whatsoever except as referred to above. Mr. Bahram Sadaghiani is a certified member in good standing of CSIC - Canadian Society of Immigration Consultants, Member Number M CSIC - Canadian Society of Immigration Consultants contact information is: Canadian Society of Immigration Consultants 390 Bay Street, Suite 1600 Toronto, Ontario, Canada, M5H 2Y2 Telephone: Toll Free: CSIC (2742) Fax: information@csic-scci.ca I ACKNOWLEDGE that this retainer is strictly limited to only those services set out above. Page 2 of 23

3 (A) FEES 1. CICS SERVICE FEES US $ * see Schedule C for CICS Fee Schedule 2. GOVERNMENT FILING FEES CAN $ *see Schedule B for Government Fee Schedule 3. EDUCATION ASSESSMENT FEES CAN $ 4. DISBURSEMENTS CAN $ Calculate the Government Processing and Landing Fees: 1 - Principal Applicant CAN $ 2 - Accompanying Spouse CAN $ 3 - Dependent Children CAN $ 4 - Additional Principal Applicants CAN $ 5 - Right of Landing Fee CAN $ (B) TERMS OF PAYMENT 1. AT THE TIME OF SIGNING THE RETAINER: 1 - Government Processing Fees CAN$ 2 - Education Assessment Fees CAN$ 3-50% of CICS Service Fees US$ 2. AFTER THE SELECTION INTERVIEW AND RECEIPT OF MEDICAL DOCUMENTS: 1- Government Landing Fees (RPRF) CAN$ 2 - Balance of CICS Service Fees US$ 3 - Outstanding Disbursements CAD$ 3. I AGREE TO PAY ANY INCREASE, if any, in Government Fees implemented after signing this Agreement. 4. I AGREE TO PAY ALL DISBURSEMENTS incurred on my behalf to CICS Canada Immigration Consulting Services upon rendering an account for same, without regard to the success of the application for permanent residence. Disbursements shall not exceed the sum of CAD $500 without my written authorization. Disbursements include, but are not limited to, all long distance telephone, fax and photocopy charges, postage and courier charges, and translation services. 5. I AGREE TO PAY the full agreed amount of this contract if I withdraw my application and that No Refund will be due or applicable. In cases where the application is withdrawn the balance due shall become payable forthwith. Page 3 of 23

4 6. I AGREE TO PAY all outstanding fees and disbursements incurred on my file if I terminate this agreement. (C) CONDITIONS AND OBLIGATIONS 1. I ACKNOWLEDGE AND AGREE that any information provided by me to Mr. Bahram Sadaghiani and/or CICS - Canada Immigration Consulting Services, may be forwarded or communicated by the said firm or person to any governmental body or any official thereof, if required, as part of or in any way related to my application for permanent residence in Canada, and I hereby give my full and irrevocable consent and authority for the disclosure of such information. 2. I ACKNOWLEDGE AND AGREE that the fees paid to Bahram Sadaghiani and/or CICS - Canada Immigration Consulting Services, do not guarantee my admission to Canada as a Permanent Resident, nor have any representations been made by the said firm or person that the success of my application is guaranteed. 3. I ACKNOWLEDGE AND AGREE that my application will be filed in a Canadian Consulate or High Commission in the continental U.S.A. or any other Visa Office mutually agreed upon, and that I may be required to attend at an interview at the location; however, this does not guarantee that my application will be accepted. 4. I ACKNOWLEDGE AND AGREE that I am responsible for making all necessary applications for Passport(s), Visitors Visas etc, and any costs incurred to attend such an interview. 5. I ACKNOWLEDGE AND AGREE that Mr. BahramSadaghiani and/or CICS Canada Immigration Consulting Services will not be responsible for a refusal decision based on the medical condition, criminality, false information or fraudulent documents of the applicant or any of the family members included in the application. 6. I AGREE to inform Mr. Bahram Sadaghiani and/or CICS - Canada Immigration Consulting Services of any communication received from Citizenship & Immigration Canada and to provide any changes in marital or civic status, address, employment or any other information or circumstances bearing on my case for any person included in my application. Further, if such changes or any other changes require additional services not herein referred to, they shall be agreed upon apart from this commitment. 7. I AGREE that I will complete all required forms as instructed by Mr. Bahram Sadaghiani and/or CICS Canada Immigration Consulting Services and to obtain all documents and information that may be necessary to process my application. 8. I ACKNOWLEDGE AND AGREE that Mr. Bahram Sadaghiani and/or CICS - Canada Immigration Consulting Services, reserves the right to rescind and revoke this retainer at any time if the information I have provided is found to be untruthful, misleading or false, or if any account rendered by the Consultant or the firm remains unpaid. 9. I HEREBY ACKNOWLEDGE having been advised by Mr. Bahram Sadaghiani and/or CICS - Canada Immigration Consulting Services, that until my application for permanent residence is approved, I should not sell or otherwise dispose of any property or sever any business or employment contracts. Page 4 of 23

5 10. I HEREBY ACKNOWLEDGE having been advised by Mr. Bahram Sadaghiani and/or CICS - Canada Immigration Consulting Services, that amendments to the Immigration Act have been passed which provide immigration officials with the powers to retroactively assess or reassess applications which have been filed prior to the date of such regulations coming into effect and that this may have a negative impact on my application. Neither the Consultant nor the Firm can be responsible for unexpected changes due to the retroactivity provisions or change in Government policies according to the Immigration Act and regulations. (D) DISCLOSURE 1. I CONFIRM that all information which I have/and will provide to Mr. Bahram Sadaghiani and/or CICS, Canada Immigration Consulting Services, is truthful, accurate and complete, and that any inaccuracies, misrepresentations or failure to disclose with respect to same may seriously affect the approval of my application for permanent residence or the retention of my Landed Immigrant Status after I and/or any member of my family have landed in Canada. 2. I CONFIRM that neither I nor any other family member included in my application have presented or will present at any future date, false or misleading information or fraudulently obtained or forged documents to either the Consultant Mr. Bahram Sadaghiani or to his firm CICS Canada Immigration Consulting Services, or to the Government of Canada. 3. I CONFIRM that I have been advised of AND AGREE that Mr. Bahram Sadaghiani and/or CICS - Canada Immigration Consulting Services may receive or give commission to a 3 rd party, during the processing of my application. Page 5 of 23

6 NOTE: Any questions concerning the provisions of this Retainer Agreement should be addressed to Mr. Bahram Sadaghiani and/or CICS, Canada Immigration Consulting Services, BEFORE SIGNING THIS AGREEMENT. CLIENT S FULL NAME: CLIENT S FULL ADDRESS: PHONE NUMBER: CELL No: ADDRESS: FAX No: CLIENT S SIGNATURE: DATED at, this day, of, 200. CONSULTANT S SIGNATURE: Mr. Bahram Sadaghiani, Advisor and Consultant CSIC Member M DATED at, this day, of, 200. Page 6 of 23

7 SCHEDULE A SCHEDULE B SCHEDULE C SCHEDULE D SCHEDULE E SCHEDULE F SCHEDULES INDIVIDUAL CONSENT TO DISCLOSURE AND/OR USE OF PERSONAL INFORMATION GOVERNMENT FEE SCHEDULE & PAYMENT OF FEES CICS SERVICE FEES DOCUMENTS REQUIRED PERSONAL, PROFESSIONAL, FINANCIAL AND FAMILY INFORMATION QUESTIONNAIRE FORMS: LAST PAGE of IMM0008 and ADDITIONAL FAMILY INFORMATION Page 7 of 23

8 SCHEDULE A INDIVIDUAL'S CONSENT TO DISCLOSURE AND USE OF PERSONAL INFORMATION (Statement of Authorization) I,, the undersigned, born on, residing in, do hereby authorize: Mr. Bahram Sadaghiani CSIC Member M CICS - Canada Immigration Consulting Services 716 West 20 th Street North Vancouver, BC, Canada, V7P 2B2 Tel: Fax : To represent and act on my behalf as Consultant in all matters under the Immigration Act , c.52, s.1 And authorize Citizenship and Immigration Canada, Quebec Citizenship and Immigration as well as Financial institutions in respect of my net worth and assets information, authorities to release to the above authorized representative all records concerning my application and to respond to the above authorized representative upon any request for information about my file as referred to in the Access to Information Act, Privacy Act and Freedom of Information and Protection of Privacy Act And to authorize above-mentioned authorities to forward copies of all correspondence regarding my application to Mr. Bahram Sadaghiani. Signed on the day of, 20. (Applicant) (Day) (Month) Page 8 of 23

9 SCHEDULE B GOVERNMENT FEE SCHEDULE & PAYMENT INSTRUCTIONS TO CANADA IMMIGRATION OFFICES ABROAD Government Processing and Landing Fees must be made payable to The Receiver General for Canada, in Canadian currency. Payments may be made using a World Money Order or a Certified Cheque. CIC - Citizenship & Immigration Canada, also now accepts payments on-line using Visa or MasterCard. Application payments made directly to CICS Canada Immigration Consulting Services can be processed as follows: CICS, Canada Immigration Consulting Services CICS ENTERPRISES INC. CAN$ ACC # : US$ ACC#: Swift No: ROYCCAT2MIC ABA No (Transfer form US) ROYAL BANK OF CANADA EDGEMONT VILLAGE 3145 EDGEMONT BLVD NORTH VANCOUVER, BC V7R 2N7 1. PERMANENT RESIDENCE APPLICATION FEES NON REFUNDABLE A) INDEPENDENT/ECONOMIC CLASS: SKILLED WORKER or FAMILY CLASS DESCRIPTION FEE AMOUNT $ CAN 1 - Principal Applicant $ Accompanying Spouse $ Dependent Under Age of 19, Not a Spouse (each) $150 4 Dependent Over Age of 19 ea. $550 5 Sponsor Fee $75 B) BUSINESS CLASS: ENTREPRENEUR, INVESTOR or SELF-EMPLOYED (*for all Provinces except Quebec) DESCRIPTION FEE AMOUNT $ CAN 1 - Principal Applicant $ Accompanying Spouse $ Dependent Under Age of 19, Not a Spouse (each) $150 4 Dependent Over Age of 19 (each) $550 Page 9 of 23

10 SCHEDULE B GOVERNMENT FEE SCHEDULE & PAYMENT INSTRUCTIONS TO CANADA IMMIGRATION OFFICES ABROAD Page 2 C) BUSINESS CLASS: ENTREPRENEUR, INVESTOR or SELF-EMPLOYED (*for Quebec only) DESCRIPTION FEE AMOUNT $ CAN 1 Investor - Principal Applicant $ Entrepreneurs - Principal Applicant $950 3 Self-employed Workers Principal Applicant $ Accompanying Spouse $ Dependent Under Age of 19, Not a Spouse (each) $150 4 Dependent Over Age of 19 (each) $ RIGHT OF LANDING FEE REFUNDABLE IF APPLICATION REFUSED The Right of Landing Fee (ROLF), also known as Right of Permanent Residence Fee (RPRF) is CAN $ and is payable by all adult immigrants 19 years of age and over who apply to become Permanent Residents of Canada. Accompanying family members who are under 19 years of age are not required to pay this fee. 3. STUDENT VISA AUTHORIZATION NON REFUNDABLE CAN $ must be paid to the Canadian Visa Offices abroad when an application for Student VISA Authorization is filed. 4. INFORMAL ASSESSMENT FEES NON REFUNDABLE Professional associations charge a fee for informal assessment of qualifications. Different institutions charge different fees. CICS Canada Immigration Consulting Services provides a Free Assessment at our website, Page 10 of 23

11 SCHEDULE C CICS - CANADA IMMIGRATION CONSULTING SERVICES. FEE SCHEDULE 1. Standard Fee for applying for Permanent Residence in Canada (Immigrate) as a Skilled Worker/Family Class Applicants: - Family (husband, wife and dependent children) US $ 4,950 - Single Person US $ 3, Standard Fee for applying for Permanent Residence in Canada (Immigrate) for Business Class Applicants: - Entrepreneur or Investor Category US $ 6, Standard Fee for applying for Permanent Residence under a Sponsorship US $ 3, Standard Fee for applying for Student Visa Authorization US $ 2, Subject Removal Depending on the case, the service fee varies from CAN $1,000-$5, Personal consultations with CICS representatives are charged on an hourly fee. Fee Varies CAN $150/hr. NOTE: In order to assess the eligibility of the applicant and determine the Category under which the applicant stands a better chance for obtaining a Visa for Permanent Residency in Canada, a case study will be conducted by CICS Canada Immigration Consulting Services. Based on the personal, professional, financial and family status considerations, the CLIENT will be advised to proceed for applying for permanent residency Visa. Payment must be made by Money Order or be transferred to the account mentioned herewith below. CICS, Canada Immigration Consulting Services CICS ENTERPRISES INC. US $ Acc# CAN$ ACC# : ROYAL BANK OF CANADA EDGEMONT VILLAGE 3145 EDGEMONT BLVD NORTH VANCOUVER, BC, V7R 2N7 *There will be a US$ 400 courier charge for all categories in case the applicant demands that courier service be used. *Payment must be made for applications for Skilled Workers and Family Class/Sponsored Relatives (Economic category), and Entrepreneurs or Investors (Business Class category) or Student Visa Authorization, payment must be made by Money Order, Travelers Cheque, Certified Cheque or transferred to CICS Canada Immigration Consulting Services account above. Page 11 of 23

12 SCHEDULE D DOCUMENTS REQUIRED FOR APPLYING FOR PERMANENT RESIDENCE IN CANADA Where marked, relevant document must be sent to CICS Canada Immigration Consulting Required Documents Valid passport for: Principal applicant, Spouse and Dependent children Birth Certificate Principal applicant, Spouse and Dependent children Marriage Certificate Original Presented at interview Photocopy of Originals Original of translation Remarks Divorce/ Separation certificate and custody documents Educational degrees, diplomas, certificates and/or transcripts for Principal applicant, Spouse and Dependent children Over age 18 Letters of reference from employers for Principal applicant/ Spouse Evidence of Funds Property deeds and proof of ownership for Principal applicant, Spouse and Dependent children Police certificates for Principal applicant, Spouse and Dependent children over 18 Years Proof of relation to your relatives in Canada. 7 PCs passport size Photos for all family members Please mark when documents are sent to CICS Canada Immigration Consulting Services. Indicate N/A where not applicable. * Original documents in a language other than French or English must be translated and certified in English or French. Page 12 of 23

13 SCHEDULE E QUESTIONNAIRE FOR THE PURPOSE OF ASSESSMENT OF ELIGIBILITY FOR OBTAINING PERMANENT RESIDENCE IN CANADA *All Questions MUST be answered in full. QUESTION 1 SURNAME (FAMILY NAME) GIVEN NAME (S) ALL OTHER NAMES I HAVE USED FULL NAME IN SCRIPT OF MY NATIVE LANGUAGE (eg. ARABIC SCRIPT, CYRILLIC ALPHABET, CHINESE, KOREAN OR JAPANESE CHARACTERS) QUESTION 2 SEX: MALE FEMALE EYE COLOR: HEIGHT: QUESTION 3 DATE OF BIRTH DAY MONTH YEAR CURRENT AGE PLACE OF BIRTH CITY COUNTRY QUESTION 4 COUNTRY OF CITIZENSHIP QUESTION 5 PERMANENT HOME ADDRESS: Street Address City Zip/Postal Code Country CURRENT MAILING ADDRESS: Street Address City Zip/Postal Code Country QUESTION 6 Page 13 of 23

14 CONTACT INFORMATION: QUESTION 7 Home Telephone Work Telephone Cell / Mobile MARITAL STATUS: EVER MARRIED ENGAGED MARRIED WIDOWED SEPARATED DIVORCED (*Check more than one if applicable.) QUESTION 8 DATE OF MARRIAGE DAY MONTH YEAR PLACE OF MARRIAGE CITY COUNTRY I HAVE BEEN MARRIED MORE THAN ONCE NO YES IF YES, HOW MANY TIMES? QUESTION 9 PERSONAL DETAILS OF ALL MY DEPENDANTS) FAMILY NAME FIRST NAME PLACE OF BIRTH DATE OF BIRTH D / M / Y MARITAL STATUS RELATION- SHIP TO ME ACCOMPANYING ME TO CANADA YES NO (SPOUSE) YES YES YES YES YES YES NO NO NO NO NO NO (*Start with Spouse, then children) Page 14 of 23

15 QUESTION 10 PASSPORT DETAILS FOR PRINCIPAL APPLICANT AND ALL PERSONS LISTED IN QUESTION 9 A. NAME ON PASSPORT PASSPORT # PLACE OF BIRTH CITIZEN OF DATE OF EXPIRY IDENTITY CARD NO (PRINCIPAL APPLICANT) B. (SPOUSE) C D E F (*To be completed by Principal Applicant only) QUESTION 11 MY ABILITY IN FRENCH AND ENGLISH QUESTION 12 SPEAK READ WRITE Fluently MY MOTHER TONGUE IS : ABILITY IN ENGLISH Well With difficulty Not at all Fluently Well With difficulty Not at all Fluently Well With difficulty Not at all Fluently Fluently Fluently ABILITY IN FRENCH Well with difficulty Not at all Well with difficulty Not at all Well with difficulty Not at all MY EDUCATION YEARS OF ELEMENTARY SCHOOL YEARS OF SECONDARY SCHOOL YEARS OF UNIVERSITY/ COLLEGE (*Indicate Number of Years of Successful Completion of Studies) YEARS OF FORMAL APPRENTICESHIP / TRAINING Page 15 of 23

16 QUESTION 13 DETAILS OF MY SECONDARY AND POST-SECONDARY EDUCATION FROM M Y TO M Y NAME OF INSTITUTE CITY AND COUNTRY TYPE OF CERTIFICATE (*Include Apprenticeship Training) QUESTION 14 MY PRESENT OCCUPATION IS: MY CURRENT GROSS MONTHLY EARNING: MY INTENDED OCCUPATION IN CANADA IS: QUESTION 15 WORK HISTORY FOR THE PAST 10 YEARS DATES FROM TO M / Y M / Y NAME OF EMPLOYER (WRITE NAME IN FULL, DO NOT USE ABBREVIATIONS) CITY AND COUNTRY OCCUPATION SALARY (*Provide Details on a Separate Sheet, as required) Page 16 of 23

17 QUESTION 16 THE FOLLOWING PERSON, EMPLOYER OR ORGANIZATION IN CANADA HAS OFFERED TO ASSIST ME AFTER ARRIVAL (*Name and Address, Include a Copy of the Job Offer, if you have one.) QUESTION 17 RELATIONSHIP TO ME OF PERSON NAMED IN QUESTION 16 QUESTION 18 MY DESTINATION IN CANADA: CITY/TOWN PROVINCE QUESTION 19 I HAVE THE FOLLOWING ASSETS (Show $ Amount) DETAIL TRANSFERABLE MONEY PROPERTY MONTHLY TRANSFERABLE PENSION OTHER (give details) DOLLAR AMOUNT Page 17 of 23

18 QUESTION 20 I HAVE THE FOLLOWING DEBTS OR LEGAL OBLIGATIONS (eg. Monthly Child Support Payments) OWING TO (give name of person or organization) TOTAL DEBT QUESTION 21 SINCE MY 18 TH BIRTHDAY, I HAVE LIVED AT THE FOLLOWING ADDRESSES: DATES FROM TO M / Y M / Y STREET ADDRESS AND NUMBER CITY OR TOWN COUNTRY QUESTION 22 SINCE MY 18 TH BIRTHDAY I HAVE BEEN (or still am) A MEMBER OF AND/OR ASSOCIATED WITH THE FOLLOWING SOCIAL, YOUTH, STUDENT OR VOCATIONAL ORGANIZATIONS, INCLUDING TRADE UNIONS AND PROFESSIONAL ASSOCIATIONS, INCLUDING ANY MILITARY SERVICE (show Rank, Unit and Location of service in last column). DATES FROM TO M / Y M / Y NAME AND ADDRESS OF ORGANIZATION TYPE OF ORGANIZATION POSITION HELD Page 18 of 23

19 QUESTION 23 DETAILS OF MY PARENTS MY PARENTS DATE OF BIRTH CITY TOWN AND COUNTRY OF BIRTH PRESENT ADDRESS IN FULL (IF DECEASED GIVE DATE) D / M / Y QUESTION 24 HAVE YOU OR HAS ANY ONE OF THE PERSONS IN QUESTION 9 EVER: YES NO (ANSWER YES OR NO") A. HAD ANY SERIOUS DISEASE OR PHYSICAL OR MENTAL DISORDER? B. BEEN CONVICTED OF OR IS CURRENTLY CHARGED WITH ANY CRIME OR OFFENCE IN ANY COUNTRY? C. APPLIED PREVIOUSLY FOR AN IMMIGRATION VISA TO CANADA? D, BEEN REFUSED AN IMMIGRANT OR VISITOR S VISA TO CANADA, OR ANY OTHER COUNTRY? E. BEEN REFUSED ADMISSION TO OR ORDERED TO LEAVE CANADA, OR ANY OTHER COUNTRY? F. IN PERIODS OF EITHER PEACE OR WAR, HAVE YOU EVER BEEN INVOLVED IN THE COMMISSION OF A WAR CRIME OR CRIME AGAINST HUMANITY, SUCH AS WILLFUL KILLING, TORTURE, ATTACKS UPON OR ENSLAVEMENT OR STARVATION OR OTHER INHUMANE ACTS, COMMITTED AGAINST CIVILIANS OR PRISONERS OF WAR, OR DEPORTATION OF CIVILIANS? IF THE ANSWER TO ANY OF THE ABOVE IS YES PROVIDE DETAILS HERE: QUESTION 25 WHERE WOULD YOU LIKE TO HAVE YOUR INTERVIEW CONDUCTED? DAMASCUS TEHRAN OTHER SIGNED BY: WITNESS: Date: Date: Page 19 of 23

20 SCHEDULE F PART C 1 - SINCE MY 18 TH BIRTHDAY, I HAVE BEEN (OR STILL AM) A MEMBER OF, OR ASSOCIATED WITH, THE FOLLOWING POLITICAL, SOCIAL, YOUTH, STUDENT OR VOCATIONAL ORGANIZATIONS, TRADE UNIONS OR PROFESSIONAL ASSOCIATIONS. INCLUDE MILITARY SERVICE (SHOW RANK, UNIT AND LOCATION OF SERVICE IN LAST COLUMN) DATES FROM M Y M TO PRESENT Y Name and address of organization Type of organization Position held (if any) 2 MY PARENTS Father s full name Date of birth Day Month Year Mother s full name before marriage: Date of birth Day Month Year City or town of birth: Country of birth: If deceased give date: Day Month Year / / City or town of birth: Country of birth: If deceased give date: Day Month Year / / 3 AUTHORITY TO DISCLOSE PERSONAL INFORMATION A. I understand that the Canadian Government will contact any government authority, including police, judicial and state authorities in all countries in which I have resided, to seek the release to the Canadian Government authorities of all records and information that they may possess on my behalf concerning any investigations, arrests, charges, trials, convictions and sentences. I understand that this information will be used to assist in evaluating m suitability for admission to Canada or remaining in Canada, pursuant to Canadian immigration legislation. B. I also authorize the release of information from my Immigration records to : (check one or more) The individual named hereinafter: My sponsor My Canadian representative (if any) Name of individual Bahram Sada-Giani Name of firm: CICS, Canada Immigration Consulting Services Inc x Signature of applicant 4. DECLARATION OF THE APPLICANT - I declare that the information I have given in this application is truthful, complete and correct. - I understand that any false statements or concealment of a material fact may result in my exclusion from Canada, and may be grounds for my prosecution and/or removal. - I understand all the foregoing statements, having asked for and obtained an explanation on every point which was not clear to me. Signature of applicant: x DO NOT COMPLETE THE FOLLOWING SECTION NOW. YOU WILL BE ASKED TO SIGN IT IN THE PRESENCE OF A REPRESENTATIVE OF THE CANADIAN GOVERNMENT OR OFFICIAL APPOINTED BY THE CANADIAN GOVERNMENT. 5. SOLEMN DECLARATION I,, SOLEMNLY DECLARE THAT THE INFORMATION I HAVE GIVEN IN THE FOREGOING APPLICATION IS TRUTHFUL, COMPLETE AND CORRECT, AND I MAKE THIS SOLEMN DECLARATION CONSCIENTIOUSLY BELIEVING IT TO BE TRUE AND KNOWING THAT IT IS OF THE SAME FORCE AND EFFECT AS IF MADE UNDER OATH. _ SIGNATURE OF THE APPLICANT Day Month Year 20 Date Day. Month Year... Date INTERPRETER DECLARATION I,, do solemnly declare that I have faithfully and accurately interpreted in the language the content of this application and any related forms to the person concerned. I have been informed by the person concerned, and I do verily believe, that he/she completely understands the nature and effect of these forms, and I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath. Declared before me at this day of of the year SIGNATURE OF THE OFFICIAL OF THE GOVERNMENT OF CANADA The information you provide on this form is collected under the authority of the Immigration Act and will be used for the purpose of assessing your application for permanent residence in Canada. The information will be retained in the Personal Information Bank EIC PPU 015 entitled Immigrant Case File. Under the provisions of the Privacy Act and the Access to Page 20 of 23

21 Source, a copy of which is Information Act, individuals have the right to protection of and access to their personal information. Instructions for obtaining information are provided in Info located in all Citizenship and Immigration Offices. Page 21 of 23

22 Citizenship and Immigration Canada Citoyennete et Immigration Canada SCHEDULE "F" ADDITIONAL FAMILY INFORMATION Complete ALL names in English and in your native language (for example, Arabic, Cyrillic, Chinese commercial/telegraphic code, Korean, or Japanese characters) SECTION A Name Relationship Date of birth Place of birth Marital status Present address Day Month Year Applicant Spouse SEE NOTE 1 Mother Father NOTE 1: If no spouse is listed in Section A, read and sign below I certify that I do not have a husband or a wife and that I have never been married before. Signature Day Month Year SECTION B: regardless of age or place of residence) Name CHILDREN (Include ALL sons and daughters, including ALL adopted and step-children, Relationship SEE NOTE 2 Date of birth Day Month Year Place of birth Marital status Present address NOTE 2: If no children are listed in Section B, read and sign below I certify that I do not have any children, either natural or adopted. Signature Day Month Year SECTION C: BROTHERS AND SISTERS ( Include half- and step-brothers and sisters) Name Relationship Date of birth Place of birth Marital status Present address Day Month Year Date SECTION D: CERTIFICATION I certify that the information contained on this document is complete, accurate and factual. I also realize that once this document has been completed and signed that it will form part of my immigration Record and will be used to verify my family details on further applications. Day Month Year Signature Date Page 22 of 23

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