Imm 5455 E - Supplementary Identification Form
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1B
PROTECTED WHEN COMPLETED -
PAGE 1 OF 1
SUPPLEMENTARY IDENTIFICATION FORM
FOR OFFICIAL USE ONLY
Client ID
IMMIGRANT IDENTIFICATION
1. Full name
Surname
Given name(s)
2. Date of birth
Date (YYYY-MM-DD)
3. Height
cm
OR
ft
in
4. Eye colour
Blue
Green
Grey
Black
Brown
Hazel (yellowish brown)
Other
(YYYY-MM-DD)
►
Date of permanent residence
Please read these instructions carefully. If the instructions are not followed correctly, your application will be returned to you.
• DO NOT glue the picture in the box (square) below as it may damage the picture. This box is reserved for office use only.
Place the photos in a small envelope and write the name of the applicant on the envelope.
For office use only
IMM 5455 (01-2012) E
(DISPONIBLE EN FRANÇAIS - IMM 5455 F)
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