Statutory Declaration to Confirm the Relationship of an Extended Family Member in Canada (IMM 5990)
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Statutory Declaration of the anchor (IMM 5990)
This form must be completed by:
- The anchor in Canada
Section A – Personal Information of the Canadian citizen or
Permanent Resident (Anchor)
Family Name:
Enter your full family name (surname or
last
name) as shown on your passport, travel document or identity document.
Given name: Enter all of your given name(s) (first, second or more) as shown on your passport, travel document or identity document. Do not use initials.
Note: If you do not have a family name on your passport or travel document, enter all given names in the family name field and leave the given name field blank.
If you do not have a given name on your passport or travel document, leave the given name field blank.
UCI: UCI stands for “unique client identifier.” provided to an applicant for immigration/refugee purposes. It is also known as a client identification number (client ID). It is on official documents you get from us.
Place of birth:
Enter your place of birth, including the city or town and country of birth, as shown in your
passport or your travel document.
Date of birth:
Enter your date of birth. If you do not know your complete date of birth, use “01” to fill
in
the spaces for the unknown year, month or day. Include a letter of explanation saying why
you
could not include the complete date.
Status in Canada: Indicate your current status in Canada: Citizen, Permanent Resident. You must provide a photocopy of your document to confirm your Canadian Citizenship or Permanent Resident status
Residential address: Enter your current residential address (where you live) by typing the following information:
- Apartment (Apt.) or Unit, if applicable
- Street number (no.), if applicable. It is the number on your house or apartment building.
- Street name, if applicable
- City or Town
- Province or State
- Postal code or zip code
E-mail address: If you have an email address, enter it here (for example, name@provider.net).
Note: By indicating your email address, you are hereby authorizing IRCC to transmit your file and personal information to this specific email.
Telephone number:
Enter your telephone number including the country code, area/regional codes, etc.
If you have an extension number, indicate it after your phone number under “Ext.”
Section B – Personal Information of the Foreign
National
Family name: Enter full family name (surname or last name) as shown on the passport, travel document or identity document.
Given name: Enter all given name(s) (first, second or more) as shown on the passport, travel document or identity document. Do not use initials.
UCI: If you know the unique client identifier (UCI) number or client identification number (client ID), enter it here without any spaces. If this is the foreign national’s first application with IRCC, or if you do not know the UCI, leave this space blank.
Place of birth:
Enter the foreign national’s place of birth, including the city or town and country of
birth, as
shown in the passport or travel document.
Country of citizenship: Indicate the country of citizenship of the foreign national
Date of birth:
Enter the foreign national’s date of birth. If you do not know the complete date of birth,
use
“01” to fill in the spaces for the unknown year, month or day. Include a letter of
explanation
saying why you could not include the complete date.
Identity/ travel document: Select the box to tell us the type of identity document the foreign national holds.
Travel document number: Enter the document number. If you do not know the number, leave this space blank.
Section C – Personal Information of Accompanying
Family
Members
List all accompanying family members of the foreign national.
Family name: Enter full family name (surname or last name) as shown on the passport, travel document or identity document.
Given name: Enter all given name(s) (first, second or more) as shown on the passport, travel document or identity document. Do not use initials.
Date of birth: Enter date of birth. If you do not know the complete date of birth, use “01” to fill in the spaces for the unknown year, month or day.
If you need more space for this section, add an additional page with the appropriate information.
Section D – Anchor Eligibility Assessment
Answer each question by checking the appropriate box.
If you answered “Yes” to one or more of the question 5-14, you must explain what happened in the space provided. If you need more space, add an additional page with the appropriate information.
Section E – Country of Residence
Enter the list of all countries of residence, including the cities or towns, you lived for 6 months or more since your 18th birthday or the past 10 years, whichever is most recent.
Example:
| Country of Residence (City, Country) Toronto, Canada |
From (yyyy-mm) 2013-07 |
To (yyyy-mm) 2023-07 |
If you need more space for this section, add an additional page with the appropriate information.
Section F – Declaration
Read all of the statements in all sections carefully.
Write your complete name and the name of the foreign national identified in section 2.
Check the box to tell us the relationship between yourself and the foreign national identified under Section 2. If you check “other” you must specify.
Sign and date in the spaces provided. By signing, you certify that you fully understand the questions asked, and that the information you have provided is complete, truthful, and correct.
By signing, you certify that you will support the person identified in Section 2 and their accompanying family members.
If you do not sign and date, the application will be considered incomplete.
Section G – Declaration of Canadian Authorized
Official
This section must be completed and signed by a person who, by law, is authorized to receive a solemn declaration.
Reminder
You must complete and sign this form by solemn declaration in the presence of a person who, by law, is authorized to receive a solemn declaration.
In Canada:
Authority to certify varies by province and territory. Consult your local provincial or territorial authorities.
Outside of Canada:
- Consular officer of the Government of Canada
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