Form Imm 5707e - Family Information
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1
2B
PROTECTED WHEN COMPLETED -
PAGE 1 OF 2
FAMILY INFORMATION
Complete ALL names in English and in your native language (for example, Arabic, Cyrillic, Chinese, Chinese commercial/telegraphic code, Korean, or Japanese characters). Include
ALL family members even if they are not accompanying you. If additional space is required, print and attach an additional form.
TYPE OR PRINT IN BLACK INK.
SECTION A
Date of birth
Present address
Will
(Year/Month/Day)
(If deceased, give city/town, country and date)
Relationship
accompany
Name
SEE NOTE 1
you to Canada?
Country of birth
Present occupation
Yes
No
Applicant
Spouse or
common-law
partner
Mother
Father
NOTE 1: If no spouse or common-law partner is listed in Section A, read and sign below.
I certify that I do not have a spouse or a common-law partner.
Year
Month
Day
Date
Signature
SECTION B - CHILDREN (Include ALL sons and daughters, including ALL adopted and step-children, regardless of age or place of residence)
Date of birth
Will
Present address
(Year/Month/Day)
Relationship
accompany
Name
Marital status
SEE NOTE 2
you to Canada?
Country of birth
Present occupation
Yes
No
NOTE 2: If no children are listed in Section B, read and sign below.
I certify that I do not have any natural, adopted nor step-children.
Year
Month
Day
Date
Signature
SECTION C- CERTIFICATION
I certify that the information contained in this document is complete, accurate and factual. I also realize that once this document has been completed and signed that it will form part of
my Immigration Record and will be used to verify my family details on future applications.
Year
Month
Day
Date
Signature
The information you provide on this form is collected under the authority of the Immigration and Refugee Protection Act to determine if you may be admitted to Canada as a
temporary resident. It will be stored in Personal Information Bank CIC PPU 055, Visitor Case File. It is protected and accessible under the Privacy Act and the Access to
Information Act.
(AUSSI DISPONIBLE EN FRANÇAIS - IMM 5707 F)
IMM 5707E (09-2014) E
ALSO AVAILABLE ON CIC WEB SITE AT:
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