Imm 5440 E - Settlement Plan - Sponsorship Agreement Holder Or Constituent Group
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1
2Citizenship and
Citoyenneté et
B
PROTECTED WHEN COMPLETED -
Immigration Canada
Immigration Canada
PAGE 1 OF 2
FOR CIC USE ONLY
SETTLEMENT PLAN
CIC file identification no.
SPONSORSHIP AGREEMENT HOLDER OR CONSTITUENT GROUP
Principal applicant ID no.
REFER TO THE INSTRUCTION GUIDE FOR INFORMATION ON THIS FORM.
A - GENERAL INFORMATION
1 Name of principal refugee applicant
Date of birth
Surname
Given name(s)
(YYYY-MM-DD)
2 Name of sponsorship agreement holder (SAH)
3 Name of constituent group (CG) (if applicable)
4 Name of cosponsor - Individual (if applicable)
5 Name of cosponsor - Organization (if applicable)
6 Name of designated main contact person
Surname
Given name(s)
7 Mailing address (no. and street)
City
Province
Postal code
8 Home Telephone no. (Area code & no.)
Work or cell Telephone no. (Area & no.)
Ext.
Facsimile no. (Area code & no.)
E-mail address
9 Name of alternate contact person
Telephone no.
Surname
Given name(s)
(Area code & no.)
Identify who will be providing for the settlement needs by checking the relevant box
B - SETTLEMENT CHECKLIST
(note: more than one party may provide for the same need).
Cosponsor #1
Cosponsor #2
Settlement Needs
SAH
CG
(individual)
(organization)
START-UP COSTS
Clothing
Furniture
Start-up costs (household effects, bedding and linens)
School start-up costs
Food staples
Hook-up costs (rent deposit, telephone, utilities, etc.)
MONTHLY EXPENDITURES
Shelter
Transportation (public transit)
Living allowance (food, incidentals, etc.)
SETTLEMENT ASSISTANCE
Meet the refugee(s) at the airport and provide transportation to the final destination
Meet the refugee(s) upon arrival at the final destination (if applicable)
Locate an interpreter (if applicable)
Apply for provincial health plan and Interim Federal Health plan
Apply for Social Insurance Number
Select a family physician
Select a dentist
Plan for medical emergencies
Provide orientation (public transportation, banking services, etc.)
Provide assistance in linking refugee(s) with community activities
Enroll children in school (if applicable)
Make child care arrangements (if applicable)
Register for child tax benefit (if applicable)
Enroll adults in language training
Provide assistance in finding employment
IMM 5440 (10-2009) E
(DISPONIBLE EN FRANÇAIS - IMM 5440 F)
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