(DISPONIBLE EN FRANÇAIS - IMM 5349 F)

PROTECTED WHEN COMPLETED - B

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RIGHT OF PERMANENT RESIDENCE FEE LOAN APPLICATION

IMM 5349 (06-2020) E

Language of correspondence

This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants.

Client ID number

English OR French

1 LOAN APPLICANT

Surname (Family name) Given name(s)

Gender

F Female M Male X Another gender

Date of birth (YYYY-MM-DD) Country of birth Status in Canada Social insurance no.

Home telephone no. (Area code and no.) Work telephone no. (Area code and no.) Fax number (Area code and no.)

2 ADDRESS

Street and no. Apt. no.

City Province Country Postal code

MAILING ADDRESS

Street and no. Apt. no.

City Province Country Postal code

3 SIZE OF FAMILY

Yourself _______________________________________________________________________________________________________________________

Your spouse or common-law partner ________________________________________________________________________________________________+

Children (regardless of age or degree of dependency) that depend on you or your spouse or common-law partner ___________________________________+

Previously sponsored relatives who are still dependent on you or on your spouse or common-law partner for support (previous undertaking still valid) _______+

Any other relatives who are dependent on you or your spouse or common-law partner for support ________________________________________________+

Relatives you are sponsoring on the Undertaking ______________________________________________________________________________________+

Other dependent children of the principal applicant who are not applying for permanent residence at this time _______________________________________+

TOTAL SIZE OF FAMILY UNIT (Total of all boxes) ►

4 RIGHT OF PERMANENT RESIDENCE FEE LOAN REQUEST FOR:

INCULDE YOURSELF (IF APPLICABLE) AND ALL OF YOUR FAMILY MEMBERS INCLUDED IN YOUR APPLICATION WHO ARE NOT EXEMPT FROM THE RPRF. (Add an additional sheet of paper if required.)

INSERT $500 IN COLUMN A OR B

DATE OF BIRTH RELATIONSHIP TO RESIDESSURNAME (FAMILY NAME) GIVEN NAME(S) (YYYY-MM-DD) LOAN APPLICANT (A)

In Canada(B)

Abroad

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IMM 5349 (06-2020) E

5 CURRENT REVENUES AND OBLIGATIONS

MONTHLY FAMILY INCOME MONTHLY FAMILY DEBT PAYMENTS MONTHLY FAMILY LIVING EXPENSES

Earnings from employment

Rental income

Pension income

Child tax benefits

Other income (Details below at A)

Other assets (Details below at A)

TOTAL

Loans (Details below at B)

Credit card

Credit cart

Other debts (Details below at C)

TOTAL

Rent

Electricity / Gas / Water

Telephone

Groceries

Daycare

Insurance (Auto)

Bus passes

Other (Details below at D)

TOTAL

A Other assets/income

B Loans AMOUNT PAYMENTS START DATE (YYYY-MM-DD)

PAYMENTS END DATE (YYYY-MM-DD) MONTHLY PAYMENTS

C Other debts

D Other living expenses

6 FUTURE REVENUES AND OBLIGATIONS

Anticipated revenue or funds: When anticipated

YEARSource

Other (Please specify)

Anticipated future obligations:

7 SOCIAL ASSISTANCE

Are you or is any other member of your immediate family currently on social assistance? Yes No

(a) SELF

(b) SPOUSE OR

COMMON-LAW PARTNER

(c) OTHER FAMILY MEMBER

If "YES", indicate with a as applicable

Date commenced social assistance(YYYY-MM-DD) (YYYY-MM-DD) (YYYY-MM-DD)

Dollar ($) amount of monthly assistance:

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IMM 5349 (06-2020) E

8 EMPLOYMENT INSURANCE BENEFITS

Are you or is any other immediate family member in receipt of employment insurance? Yes No

(a) SELF

(b) SPOUSE OR

COMMON-LAW PARTNER

(c) OTHER FAMILY MEMBER

If "YES", indicate with a as applicable

Date commenced employment insurance(YYYY-MM-DD) (YYYY-MM-DD) (YYYY-MM-DD)

Dollar ($) amount received each month:

9 PROVIDE THE FOLLOWING INFORMATION IF APPLICABLE

EMPLOYMENT HISTORY - LOAN APPLICANT (For the last 24 months. Add an additional sheet of paper if required)

Current employer Salary From (YYYY-MM-DD)

Street and no. Occupation To (YYYY-MM-DD)

City Province Country Postal code Telephone no. (Area code and no.)

Previous employer Salary From (YYYY-MM-DD)

Street and no. Occupation To (YYYY-MM-DD)

City Province Country Postal code Telephone no. (Area code and no.)

EMPLOYMENT HISTORY - SPOUSE OR COMMON-LAW PARTNER AND OTHER IMMEDIATE FAMILY MEMBER (For the last 24 months. Add an additional sheet of paper if required)

Name of family member

Current employer Salary From (YYYY-MM-DD)

Street and no. Occupation To (YYYY-MM-DD)

City Province Country Postal code Telephone no. (Area code and no.)

Previous employer Salary From (YYYY-MM-DD)

Street and no. Occupation To (YYYY-MM-DD)

City Province Country Postal code Telephone no. (Area code and no.)

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IMM 5349 (06-2020) E

10 PROVIDE THE FOLLOWING INFORMATION IF APPLICABLE

VOLUNTARY OR OTHER UNPAID WORK - LOAN APPLICANT (Add additional sheet of paper if required)

Name of organization

Street and no.

City Province Country Postal code

Type of work

Hours per week Duration

VOLUNTARY OR OTHER UNPAID WORK - SPOUSE OR COMMON-LAW PARTNER AND OTHER IMMEDIATE FAMILY MEMBER (Add additional sheet of paper if required)

Name of family member

Name of organization

Street and no.

City Province Country Postal code

Type of work

Hours per week Duration

11 PROVIDE THE FOLLOWING INFORMATION IF APPLICABLE

IF CURRENTLY ENROLLED IN A SCHOOL, TRAINING OR LANGUAGE PROGRAM - LOAN APPLICANT (Add additional sheet of paper if required)

Name of school or facilityEnrolled ► Full-time Part-time

Street and no.

City Province Country Postal code

Course of studies

Date commenced ►(YYYY-MM-DD)

Duration of course or program ►Days Months Years

Completion date ►(YYYY-MM-DD)

IF CURRENTLY ENROLLED IN A SCHOOL, TRAINING OR LANGUAGE PROGRAM SPOUSE OR COMMON-LAW PARTNER AND OTHER IMMEDIATE FAMILY MEMBER (Add additional sheet of paper if required)

Name of family member

Name of school or facilityEnrolled ► Full-time Part-time

Street and no.

City Province Country Postal code

Course of studies

Date commenced ►(YYYY-MM-DD)

Duration of course or program ►Days Months Years

Completion date ►(YYYY-MM-DD)

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IMM 5349 (06-2020) E

12 ANSWER THE FOLLOWING QUESTIONS AS THOROUGHLY AS POSSIBLE. IF ANY OF THE QUESTIONS ARE NOT APPLICABLE TO YOUR SITUATION PLEASE INDICATE WITH A "N/A" OR A SIMPLE STATEMENT.

A Do you have any savings, bank accounts, business shares or real estate? Indicate the location and approximate value in Canadian dollars.

B Do you have close contact with your or your spouses' or common-law partner's parents? Indicate if they are living in or outside of Canada. Have they been approached for financial assistance, and if so what was their response.

C Have you approached a bank or other financial institution for the loan? (Answer only if you have been in Canada for 3 years or more)

D Do you currently have the processing fee(s) associated with your application for permanent residence? If so, how did you acquire these funds? If not, how do you intend to obtain these funds?

E How do you plan to cover the transportation costs of bringing your family to Canada?

F If you are not currently employed, outline the efforts you have made to obtain employment.

G In the space provided add any information which you feel would be helpful in processing your loan application.

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IMM 5349 (06-2020) E

13 DECLARATION

I certify that the above information is true and give consent to Citizenship and Immigration Canada to verify any of the information provided on this application.

Signature of loan applicant Date (YYYY-MM-DD)

Signature of spouse Date (YYYY-MM-DD)

FOR OFFICIAL USE ONLY

RPRF LOAN CALCULATIONA) Number of persons residing in Canada for whom loan requested (from 4(A)) X 500 $ = in Canada

B) Number of persons for whom loan requested residing abroad (from 4(B)) X 500 $ = abroad

TOTAL LOAN AMOUNT REQUESTED (A+B)

Approved

Refused

Reason

Signature of officer ►Signature Date (YYYY-MM-DD)

Personal information provided on this form is collected by Immigration, Refugees, and Citizenship Canada (IRCC) under the authority of the Immigration and Refugee Protection Act (IRPA). The personal information will be used for the purpose of processing an application. The personal information provided may be disclosed to other federal government institutions for the purpose of quality assurance and validating identity. The personal information may be disclosed to law enforcement bodies, non-governmental organizations, provincial/territorial governments and foreign governments for the purpose of validating admissibility and eligibility. Personal information may also be used for other purposes including research, statistics, program and policy evaluation, internal audit, risk management, subsequent program eligibility, quality assurance, strategy development and reporting. Failure to complete the form in full may result in a delay or the application not being processed. The Privacy Act gives individuals the right of access to, protection, and correction of their personal information. If you are not satisfied with the manner in which IRCC handles your personal information, you may exercise your right to file a complaint to the Office of the Privacy Commissioner of Canada. The collection, use, disclosure and retention of your personal information is further described in IRCC’s Personal Information Bank – IRCC PPU 007.