Fillable Printable Application for a Permanent Resident Card - Canada
Fillable Printable Application for a Permanent Resident Card - Canada
Application for a Permanent Resident Card - Canada
Citizenship and
Immigration Canada
Citoyenneté et
Immigration Canada
PAGE 1 OF 5
IMM 5444 (02-2015) E
PROTECTED WHEN COMPLETED -
B
APPLICATION FOR A PERMANENT RESIDENT CARD
(DISPONIBLE EN FRANÇAIS - IMM 5444 F)
This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants.
Confused by a question? See step 2 of the instruction guide.
TYPE or PRINT in black or blue ink
1. Language you prefer for correspondence
English French
2. Date you became a permanent resident of Canada
(YYYY-MM-DD)
3. You are applying to (check one box)
Obtain your first
Permanent Resident Card
Renew your present
Permanent Resident Card
Replace a lost, stolen, destroyed or never
received Permanent Resident Card
NOTE: If you are applying to renew your present card, you should keep it until you receive your replacement card. You will be asked to destroy your old card when you receive your
new one. If you are applying to replace your damaged card, you must send the damaged card with your application.
A. PERSONAL DETAILS
4. Your full name as shown on your Record of Landing (IMM 1000), Confirmation of Permanent Residence (IMM 5292) or (IMM 5688), or last Permanent Resident Card (include a
photocopy of your last Permanent Resident Card).
Family name (surname) Given name(s)
5. Your current name, if different from above
(Note: you must provide supporting documents for any change in your name. Consult "Step 1. Gather documents" in the instruction guide
Family name (surname) Given name(s)
6. Your sex
Male Female
7. Your date of birth
(YYYY-MM-DD)
8. Your country of birth
9. Your country or countries of citizenship
10. Colour of your eyes
Blue Grey Brown Green Black Hazel (yellowish brown) Other
►
11. Your height
cm
or
ft in
12. Your current residential address in Canada
Apartment Street no. Street name
City
Province
Postal code
13. Your mailing address in Canada (if different from above)
Apartment Street no. Street name
City
Province
Postal code
All correspondence will go to this address unless you indicate your e-mail address below. Indicating an e-mail address will authorize all correspondence, including file and personal
information, to be sent to the e-mail address you specify.
14. Your telephone numbers and e-mail address
At home Alternative E-mail
15. Your current marital status
Never married Married Widowed Legally separated Divorced Common-law
B. YOUR IMMIGRATION HISTORY
16. Place you became a permanent resident of Canada
City/Port of entry Province
17. Have you ever been issued a removal order in Canada?
Yes No
18. Has an Immigration Officer ever issued you a Report Under subsection 44(1) or made the decision
that you have not met the residency obligations required of Canadian permanent residents?
Yes No
PAGE 2 OF 5
IMM 5444 (02-2015) E
C. PERSONAL HISTORY - If you need additional space for any of the questions below, print out an additional page containing the appropriate section, complete it and
submit it with your application.
19. ADDRESS HISTORY: Your address history for the past five (5) years or if you became a permanent resident less than five (5) years ago, your address history since
becoming a permanent resident.
From
(YYYY-MM-DD)
To
(YYYY-MM-DD)
Apartment, street no. and street name City or town Province Country
20. WORK AND/OR EDUCATIONAL HISTORY: Your work and/or educational history for the past five (5) years or if you became a permanent resident less than five (5)
years ago, your work and/or educational history since becoming a permanent resident. If you have not worked or studied, provide your other activity history,
including location.
From
(YYYY-MM-DD)
To
(YYYY-MM-DD)
Name of employer or name of educational institution
attended (do not use abbreviations)
City or town Province Country
21. TRAVEL HISTORY: Have you travelled or lived outside of Canada in the last five (5) years (or if you became a permanent resident less than five (5) years ago, since
becoming a permanent resident)? Include all absences (including those due to employment, vacations, trips to the United States and any other time you left Canada).
Yes
►
List all your absences:
No
From
(YYYY-MM-DD)
To
(YYYY-MM-DD)
Your location during your absence (city, country) Reason for absence Number of days
Total number of days
If your total equals 1095 days or more, you must complete Section D.
Period to be assessed:
From
(YYYY-MM-DD)
To
(YYYY-MM-DD)
D. RESIDENCY OBLIGATION
Complete this section if you have been outside of Canada for 1095 days or more in the past five (5) years.
22. If you have been outside of Canada for 1095 days or more, list your absences from Canada in the past five (5) years in the following situations, if applicable. If you
became a permanent resident less than five (5) years ago: list absences from the time you became a permanent resident to present.
Option 1 - Absence while accompanying a family member who is a Canadian citizen
Name of family member
►
Provide proof of Canadian citizenship.
Relationship to you
►
Provide proof of your relationship.
From
(YYYY-MM-DD)
To
(YYYY-MM-DD)
No. and street City/Town, country
Total number
of days
Total number of days
PAGE 3 OF 5
IMM 5444 (02-2015) E
Option 2 - Absence while employed by a Canadian business or in the Canadian federal or provincial public service
►
Provide proof of full-time Canadian employment
From
(YYYY-MM-DD)
To
(YYYY-MM-DD)
No. and street City/Town, country
Total number
of days
Total number of days
D. RESIDENCY OBLIGATION (continued)
Option 3 - Absence while accompanying a family member who is a permanent resident of Canada and who is employed by a Canadian business or in the Canadian
federal or provincial public service
Name of family member
►
Provide proof of this person's permanent resident status and proof of this
person's full time employment.
Relationship to you
►
Provide proof of your relationship.
From
(YYYY-MM-DD)
To
(YYYY-MM-DD)
No. and street City/Town, country
Total number
of days
Total number of days
E. CONSENT TO DISCLOSE INFORMATION
23. History of entries to Canada
Request for authorization
By selecting "YES" in the box below, and by signing this form, I hereby give my consent to the Canada Border Services Agency (CBSA) to disclose the details of my history of
entries into Canada to Citizenship and Immigration Canada (CIC) in order to assist CIC in determining my eligibility for a permanent resident card.
I also hereby authorize CIC to collect the history of my entries into Canada from the CBSA.
Yes No
Note that if you do not provide consent, you may be asked to request your history of entries directly from the CBSA and send it to CIC which could result in delays in the
processing of your application.
F. DECLARATION OF APPLICANT
24. This declaration covers the information that I have provided on this form and all the information submitted in my application for a Permanent Resident Card as well as
in the attached accompanying documents.
•
I declare that the information I have given is truthful, complete and correct.
• I understand that any false statements or concealment of a material fact may be grounds for my prosecution or removal.
• The photographs enclosed are a true likeness of me.
• I am a permanent resident of Canada.
•
I am not a Canadian citizen.
•
I understand all the foregoing statements, having asked for and obtained an explanation on every point that was not clear to me.
•
I realize that once this document has been completed and signed, it will form part of my Immigration Record and will be used to verify my family details on future applications.
•
I will immediately inform Citizenship and Immigration Canada if any of the information or the answers provided in my application forms change.
•
I have included the SUPPLEMENTARY IDENTIFICATION FORM (IMM5455).
Signature
of declarant
Date
(YYYY-MM-DD)
City
Province
Signature of parent
or legal guardian,
if applicable
Date
(YYYY-MM-DD)
I am the applicant's:
(check appropriate box)
Mother Father Legal guardian
SIGN SECTION F BEFORE PROCEEDING TO SECTION G.
PAGE 4 OF 5
IMM 5444 (02-2015) E
G. SOLEMN DECLARATION CONCERNING A LOST, STOLEN, DESTROYED OR NEVER RECEIVED PERMANENT RESIDENT CARD
25. Complete this section only if you are applying to replace a lost, stolen, destroyed or never received PR Card.
Permanent Resident Card number
Date of issue
(YYYY-MM-DD)
My Permanent Resident Card was
Lost
Destroyed
Stolen
Never received
►
on or about
(YYYY-MM-DD)
at
Under the following circumstances (full information must be provided below):
I have made the following efforts to locate this document
(if applicable, indicate police authorities notified and attach a copy of police report or incident report number):
Should I ever regain possession of my original PR Card, I promise to destroy it immediately.
I solemnly declare that the information I have provided is true, that is of the same force and effect as if made under oath, and that it was freely given. I authorize the department of
Citizenship and Immigration Canada to verify the information I have provided. I also understand that the provision of any false or misleading information may lead to prosecution in
accordance with Section 127 of the Immigration and Refugee Protection Act.
Signature
of declarant
Date
(YYYY-MM-DD)
Signature of parent
or legal guardian,
if applicable
Date
(YYYY-MM-DD)
DO NOT SIGN HERE UNLESS YOU ARE DECLARING A LOST, STOLEN, DESTROYED OR NEVER RECEIVED PERMANENT RESIDENT CARD.
The information you provide on this form is collected under the authority of the Immigration and Refugee Protection Act and will be used to determine whether the term and conditions
of your permanent residency were maintained and whether you should be granted a Permanent Resident Card. It will be retained in the Personal Information Bank CIC PPU 067
entitled Permanent Resident Card as identified in infosource. It may be shared with other organizations in accordance with the consistent use of information under the Privacy Act.
Under the Privacy Act and the Access to Information Act individuals have the right to protection of and access to their personal information. Details on these matters are available at
infosource.gc.ca and through the Citizenship and Immigration Call Centre. Infosource is also available at Public Libraries in Canada.
PAGE 5 OF 5
IMM 5444 (02-2015) E
DOCUMENT CHECKLIST
APPLICATION FOR A PERMANENT RESIDENT CARD
Send the following documents with your application. Check each box once you enclose the item.
Failure to provide a fully completed application form or the necessary documents will result in the return of your
application.
Note: Any document that is not in English or French must be accompanied by the English or French translation, an affidavit from
the person who completed the translation and a certified copy of the original document.
I have enclosed the following items:
Application for a Permanent Resident Card (IMM 5444), fully completed and signed.
Supplementary Identification Form (IMM 5455).
Do not forget to download the Supplementary Identification form.
Photocopy of one (1) primary identity document.
Photocopy of one (1) secondary identity document.
Photocopy of additional documents of proof of residence in Canada.
Two (2) photos placed in a small envelope (no staples or paper clips). Photos must follow the Photograph Specifications
for Permanent Resident Cards.
Fees. Copy 2 of the Receipt form showing the amount paid.
If this applies to you:
You are under the age of 18: a photocopy of your birth certificate, adoption order or legal guardianship document issued
by a Canadian court.
You are under the age of 18: a photocopy of your school records (report cards, transcripts, attendance records).
Proof of residency requirements: if you were outside Canada for 1095 days or more in the past five (5) years.
Legal change of name: photocopy of supporting legal documentation as proof of your name change.
Mail your fully completed application form and all required documents to:
Regular Mail: By courier:
Case Processing Centre - PR Card Case Processing Centre - PR Card
P.O. Box 10020 49 Dorchester Street
Sydney, NS Sydney, NS
B1P 7C1 B1P 5Z2
(Include this completed Document Checklist with your application package.)
✔
