Rap Change Of Status Form (Page 3 of 4) in pdf

Rap Change Of Status Form Page 3

IP 3 - Appendix B - Annex 6

Have you married since your arrival in Canada?

Yes

If yes, please provide copy of the marriage certificate.

What is the immigration status of your spouse? ________________________________________

Is your spouse living in Canada?

Yes

SEPARATION:

Have you separated from your spouse since your arrival in Canada?

Yes

If yes, please provide date of separation: _____________________________________________

Full name of spouse: ______________________________________________________________

Birth date of spouse: _______________________________________________________________

DEATH:

Has a member of your family passed away? Yes

If yes, please provide a copy of the death certificate.

Funeral Home name and address: ____________________________________________________

_________________________________________________________________________________

5. OTHER CHANGES

NAME CHANGE:

Have you or any family member ‘legally” or otherwise changed your name?

Yes

INCARCERATION (JAIL):

Have you been incarcerated (jailed)? Yes

If yes, please provide a copy of your conviction report.

Has any other member of your family been incarcerated? Yes

If yes, please provide a copy of their conviction report.

HOSPITALIZATION:

Have you been hospitalized? Yes

If yes, please provide a note from your doctor confirming the length of stay, if longer than one

month.

TRAVEL OUTSIDE OF CANADA:

When will you be leaving Canada? Date: _________________

What is your expected date of return? ___________________

Please provide a copy of your airline ticket.

2010-04-30

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Rap Change Of Status Form Page 3