Rap Change Of Status Form
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4IP 3 - Appendix B - Annex 6
RAP Change of Status Form
Client Name:
___________________________
FOSS/CLIENT’S ID No. _____________________
CIC (HOF) FILE No. _________________________
Telephone No: (_____) ___________________
D.O.B. (DD-MMM-YY) _______________________
1. ADDRESS CHANGE
New Address: _______________________________________________________________________
City: ____________________ Province/Country: _______________ Postal Code: _______________
New Telephone No: _______________________
Date of Move: ___________________________
»
Reason for Move to another Province:
Relatives/Friends
Employment
Language
Other: __________________________________________________________________
»
Rent Amount $___________
Are you sharing this cost with anyone? Yes
No
If yes, name of person with whom you are sharing the rent: ______________________________
NOTE: Provide RENTAL AGREEMENT and/or a suitable receipt of your rental costs.
»
Previous Address: _______________________________________________________________
City: _____________________ Province: _____________
Postal Code: ________________
NOTE: If you are moving from Quebec to another province, please provide proof of residency
with a copy of your IMM5292 (confirmation of permanent residence) and a copy of the letter from
Quebec Social Services.
2. EMPLOYMENT CHANGE
Are you starting
full-time employment? Yes
No
Start Date: _____________________
»
Are you
starting
part-time employment? Yes
No
Start Date: _____________________
For part-time employment, how many hours are you working/day or week? ________________
What is your rate of pay?
(Per hour)
Pay-Period Type: _________________________ (Weekly, Bi-weekly, Semi-Monthly, Monthly)
Employer’s Name: _________________________________________________________________
Employer’s Address: ______________________________________________________________
Telephone Number: (____)______________________
2010-04-30
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