PROTECTED WHEN COMPLETED -
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REQUEST TO AMEND THE RECORD OF LANDING (IMM 1000), CONFIRMATION OF PERMANENT
RESIDENCE (IMM 5292 or IMM 5688) OR VALID TEMPORARY RESIDENT DOCUMENTS
Client ID number/UCI
PART A - PERSONAL DETAILS CONTAINED ON YOUR IMM 1000, IMM 5292
OR IMM 5688, OR VALID TEMPORARY RESIDENT DOCUMENTS
Surname(s) (Family name) (As it currently appears on your document)
Given name(s) (As it currently appears on your document)
Other name(s) used
Other given name(s) used
Place of birth (City, state/province and country)
Date of birth
If you are married, is your spouse a
Canadian citizen or permanent resident?
Language of correspondence
Current mailing address
Residential address Same as mailing address?
Alternate Telephone no.
E-mail address: (Indicating an e-mail address will authorize all correspondence, including file and personal information, to be sent to the e-mail address you specify.)
Date permanent residence or
Date of original entry
temporary residence was granted
PART B - INFORMATION TO BE AMENDED
Please indicate for which of the following you need a correction. If you have more than one valid temporary resident document, indicate the document ID number or if
unknown, the document issue date and expiry date of the requested document.
Immigrant Visa and Record of Landing -
Confirmation of Permanent Residence
Permit to Come Into or Remain in Canada -
Authorization to Return to Canada
Temporary Resident Permit
This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants.
IMM 1436 (10-2015) E
(AUSSI DISPONIBLE EN FRANÇAIS - IMM 1436 F)