Information Release Form

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Information Release Form
(MBREL)
I ______________________________________________ Date of Birth _________________________
Principal Applicant’s Full Name – Family Name, Given Name(s)
Day/Month/Year
of
____________________________________________________________________________________
Address
in the city/town of _____________________________ country of _______________________________
do hereby authorize the designated representatives of the:
Manitoba Labour and Immigration (the Department)
Immigration Promotion and Recruitment Branch
and/or
Citizenship and Immigration Canada
Immigration Section
to exchange all personal information contained in my application for the Manitoba Provincial Nominee
Program OR my Immigrant Application Form (IMM 0008) regarding myself or any dependent member of
my family.
I also authorize this information to be shared with other parties in Manitoba for the purpose of assessing
my application for the Manitoba Provincial Nominee Program. I understand that Manitoba may contact
such parties to verify information provided by me in this application. I understand that I have the right to
examine and request corrections or amendments to my personal records, whether held by a provincial or
federal government office.
Any information provided to Manitoba will only be disclosed under the Freedom of Information and
Protection of Privacy Act. I consent to the disclosure of the above noted information by these persons,
departments, agencies and organizations to the Department and the Department disclosing to these
persons, departments agencies or organizations such personal information as may be necessary to
obtain the information required by the Department for the Program.
___________________________________________
______________________________________
Signature of Principal Applicant
Witness
___________________________________________ _______________________________________
Signature of Spouse
Witness
Signed at: _________________________________ Date:_____________________________________
City/Town and Count
MBREL (Nov. 2013)

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