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FINANCIAL EVALUATION FOR PARENTS AND GRANDPARENTS SPONSORSHIP

BEFORE YOU START, READ THE INSTRUCTION GUIDE.

TYPE or PRINT in black ink.

ABOUT YOU AND, IF APPLICABLE, YOUR CO-SIGNER

1. A) Is your spouse or common-law partner co-signing the undertaking?

Yes

Give the following details.

Full name of your spouse of common-law partner

Family name

Given name(s)

Date of birth

(YYYY-MM-DD)

B) Your full name

Family name

Given name(s)

The information you provide on this form is collected under the authority of the Immigration and Refugee Protection Act and Regulations and will be used in assessing your

eligibility as a sponsor according to the regulatory requirements. It will be retained in the Personal Information Bank CIC PPU 013. It may be shared with other organizations in

accordance with the consistent use of information under the Privacy Act. Under the Privacy Act and the Access to Information Act individuals have the right to protection of and

access to their personal information. Details on these matters are available at infosource.gc.ca and through the Immigration, Refugees and Citizenship Call Centre. Infosource is

also available at Public Libraries in Canada.

YOUR FAMILY MEMBERS AND PERSONS INCLUDED IN UNDERTAKINGS IN EFFECT OR NOT YET IN EFFECT SIGNED BY YOU AND, IF APPLICABLE, YOUR CO-SIGNER

2. You

3. A) Current undertaking

Number of persons included in box #3 of the Generic Application Form for Canada (IMM 0008), under section Application Details.

B) Previous undertakings

Number of persons included in previous undertakings you signed as a sponsor and that are still in effect. Provide details in question 10 on page 2.

ii) Number of persons included in previous undertakings you signed as a sponsor and that are not yet in effect (persons who have not yet become permanent

residents). Provide details on the back of this page.

iii) Number of persons included in previous undertakings you co-signed, where these undertakings are still in effect. Provide details on the back of this page.

iv) Number of persons included in previous undertakings you co-signed, where these undertakings are not yet in effect (persons who have not yet become

permanent residents). Provide details on the back of this page.

4. Complete this section only if your spouse or common-law partner is co-signing the undertaking

Number of persons included in previous undertakings your spouse or common-law partner signed as a sponsor and that are still in effect. Do not include persons

already accounted for in 2. or 3.B(iii). Provide details on the back of this page.

ii) Number of persons included in previous undertakings your spouse or common-law partner signed as a sponsor and that are not yet in effect (persons who have

not yet become permanent residents). Do not include persons already accounted for in question 3.B(iv). Provide details in question 10 on page 2.

iii) Number of persons included in previous undertakings your spouse or common-law partner co-signed, where these undertakings are still in effect. Do not include

persons already accounted for in question 3.B(i). Provide details on the back of this page.

iv) Number of persons included in previous undertakings your spouse or common-law partner co-signed, where these undertakings are not yet in effect (persons who

have not yet become permanent residents). Do not include persons already accounted for in question 3.B(ii). Provide details on the back of this page.

5. Your spouse or common-law partner, if not included in 3. above. Provide details on the back of this page if he or she is not co-signing the undertaking.

6. Every other family member not included above and dependent on you financially, whether they are living with you or not. Enter their number in the box on the right

and provide details on the back of this page.

FINANCIAL REQUIREMENT

7. Total number of persons for the purpose of determining your minimum necessary income.

Add the numbers entered in the boxes 2, 3, 4, 5, and 6 above and write the total here.

8. Sponsor - Statement of Consent

By selecting "Yes" in the box below, and by signing this statement, I hereby give consent to Immigration, Refugees and Citizenship Canada (IRCC) to collect my Social Insurance

Number (SIN) for the purpose of requesting that the Canada Revenue Agency (CRA) disclose my income tax information for the three consecutive years immediately preceding

the date of the application in order to determine whether the sponsor meets the minimum necessary income requirements (Low-Income-Cut-Offs + 30%) to sponsor a parent of

grandparent as outlined in section 133(1)(j(i)(B) of the Immigration and Refugee Protection Regulations (IRPR).

If you check "No", you must provide the information requested on the Income Sources for the Sponsorship of Parents and Grandparents (IMM 5516).

Yes

S.I.N.

Signature

Date (YYYY-MM-DD)

(DISPONIBLE EN FRANÇAIS - IMM 5768 F)

IMM 5768 (01-2017) E