Visa Section

Level 6, Tower 2, RCBC Plaza

6819 Ayala Avenue

Makati City 1200

Philippines

P.O. Box 2168

Makati Central Post Office

Makati City 1200, Philippines

File Number: Fax: (632) 843-1094

www.philippines.gc.ca

GUARDIANSHIP QUESTIONNAIRE (To be completed by the applicant in Canada)

Child's name:

Mother's name:

Father's name:

Identify if child is your:

a. biological child

b. adopted child

Are you a solo parent:

Yes if "Yes" do you have a Solo parent ID? Yes

No No

Child's current address in the Philippines:

Length of time child has lived at this address

Name of person(s) with whom child is physically residing:

Relation of child to person(s) with whom he/she/they are living:

This Form must be completed if the applicant is a minor (under 18 years of age) and in the care of a

guardian (i.e. any person who is not his/her mother or father)

Is this person a legal guardian? Yes. If "Yes", attach a copy of guardianship documents.

No

AUTHORITY TO RELEASE INFORMATION

Signature of Relative in Canada

Over Printed Name

Date

Note: If you authorize CIC (Citizenship Immigration Canada) to release personal information from you child's file

to his/her guardian noted above, please complete and sign the Authority to Release Personal Information to a

Designated Individual (IMM5475) and return this form with the package.

If this is not a legal guardianship, is this person exercising de facto guardianship (i.e. does this person take care of your

child's primary needs?)

* Please note that without the Authority To Disclose Information to a third party, our office will be unable to speak

or discuss your child's application with his/her guardian or any third party.