Fillable Printable Sponsorship Undertaking Form - Canada
Fillable Printable Sponsorship Undertaking Form - Canada
Sponsorship Undertaking Form - Canada
Citizenship and
Immigration Canada
Citoyenneté et
Immigration Canada
PAGE 1 OF 5
IMM 5373PP (12-2012) E
PROTECTED WHEN COMPLETED -
B
This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants.
(AUSSI DISPONIBLE EN FRANÇAIS - IMM 5373PP F)
UNDERTAKING/APPLICATION TO SPONSOR
UNDERTAKING TO SPONSOR UNDER A PUBLIC POLICY
Settlement Organization (SO) Group of Five (G5)
Check the appropriate box below. I am / We are a:
If you require more space to provide all the necessary information, attach a separate sheet with further details. Print the sponsor's name at the top of
each additional sheet and indicate the form's title and the number of the question you are answering.
FOR CIC USE ONLY
CIC File Identification No.
Principal Applicant ID No.
Name of Principal Applicant
Home telephone no.
Name of Sponsorship Group (SO/G5)
Year DayMonth
Date
of birth
Name of representative - Surname Given name(s)
Other names used (include birth name, maiden, previous married name, aliases and nicknames)
Address Apt./Unit City Province Postal code
No.Area code
Work or cell telephone no.
No.Area code Ext.
E-mail address
FOR CIC USE ONLY
Group ID no.
Home telephone no.
Name of corporation (if applicable)
Year DayMonth
Date
of birth
B - THIS SECTION MUST BE COMPLETED BY CO-SPONSORS (INDIVIDUAL OR GROUP) ONLY
Name of representative - Surname Given name(s)
Other names used (include birth name, maiden, previous married name, aliases and nicknames)
Address Apt./Unit City Province Postal code
No.Area code
Work or cell telephone no.
No.Area code Ext.
E-mail address
Relationship to principal applicant (if applicable)
FOR CIC USE ONLY
Group ID no.
A - SPONSORSHIP GROUP - THIS SECTION MUST BE COMPLETED BY ALL SPONSORING GROUPS
PAGE 2 OF 5
IMM 5373PP (12-2012) E
Home telephone no.
FOR CIC USE ONLY
Client ID no.
Year DayMonth
Date
of birth
C - THIS SECTION MUST BE COMPLETED BY GROUPS OF FIVE ONLY
Group member - Surname
Given name(s)
Other names used (include birth name, maiden, previous married name, aliases and nicknames)
Address Apt./Unit City Province Postal code
No.Area code
Work or cell telephone no.
No.Area code Ext.
E-mail address
1
FOR CIC USE ONLY
Group ID no.
Home telephone no.
FOR CIC USE ONLY
Client ID no.
Year DayMonth
Date
of birth
Group member - Surname Given name(s)
Other names used (include birth name, maiden, previous married name, aliases and nicknames)
Address Apt./Unit City Province Postal code
No.Area code
Work or cell telephone no.
No.Area code Ext.
E-mail address
2
Home telephone no.
FOR CIC USE ONLY
Client ID no.
Year DayMonth
Date
of birth
Group member - Surname Given name(s)
Other names used (include birth name, maiden, previous married name, aliases and nicknames)
Address Apt./Unit City Province Postal code
No.Area code
Work or cell telephone no.
No.Area code Ext.
E-mail address
3
Home telephone no.
FOR CIC USE ONLY
Client ID no.
Year DayMonth
Date
of birth
Group member - Surname Given name(s)
Other names used (include birth name, maiden, previous married name, aliases and nicknames)
Address Apt./Unit City Province Postal code
No.Area code
Work or cell telephone no.
No.Area code Ext.
E-mail address
4
Home telephone no.
FOR CIC USE ONLY
Client ID no.
Year DayMonth
Date
of birth
Group member - Surname Given name(s)
Other names used (include birth name, maiden, previous married name, aliases and nicknames)
Address Apt./Unit City Province Postal code
No.Area code
Work or cell telephone no.
No.Area code Ext.
E-mail address
5
PAGE 3 OF 5
IMM 5373PP (12-2012) E
D - APPLICANTS OUTSIDE CANADA - Include both accompanying and non-accompanying family members and dependants.THIS SECTION MUST BE COMPLETED BY
ALL SPONSORING GROUPS.
FOR CIC USE ONLY
Client ID no.
Principal Applicant - Surname Given name(s)
1
Sex
Male Female
Year DayMonth
Date
of birth
Marital status Country of citizenship
Place and country of birth
FOR CIC USE ONLY
Client ID no.
Family member - Surname Given name(s)
4
Sex
Male Female
Year DayMonth
Date
of birth
Marital status
Place and country of birth
Country of citizenship Relationship to principal applicant
Accompanying Non-accompanying
Client ID no.
Family member - Surname Given name(s)
5
Sex
Male Female
Year DayMonth
Date
of birth
Marital status
Place and country of birth
Country of citizenship Relationship to principal applicant
FOR CIC USE ONLY
Client ID no.
Family member - Surname Given name(s)
6
Sex
Male Female
Year DayMonth
Date
of birth
Marital status
Place and country of birth
Country of citizenship Relationship to principal applicant
Accompanying Non-accompanying
Accompanying Non-accompanying
FOR CIC USE ONLY
Client ID no.
Family member - Surname Given name(s)
3
Sex
Male Female
Year DayMonth
Date
of birth
Marital status
Place and country of birth
Country of citizenship Relationship to principal applicant
Accompanying Non-accompanying
FOR CIC USE ONLY
Client ID no.
Family member - Surname Given name(s)
2
Sex
Male Female
Year DayMonth
Date
of birth
Marital status
Place and country of birth
Country of citizenship Relationship to principal applicant
Accompanying Non-accompanying
FOR CIC USE ONLY
Client ID no.
Family member - Surname Given name(s)
7
Sex
Male Female
Year DayMonth
Date
of birth
Marital status
Place and country of birth
Country of citizenship Relationship to principal applicant
Accompanying Non-accompanying
FOR CIC USE ONLY
E - COMPLETE MAILING ADDRESS OF PRINCIPAL APPLICANT OUTSIDE CANADA OR CONTACT PERSON/ORGANIZATION OUTSIDE CANADA - THIS SECTION
MUST BE COMPLETED BY ALL SPONSORING GROUPS
Name of principal applicant or contact person or organization outside Canada, street no., city, village, country, postal code
Telephone no.
Email address
PAGE 4 OF 5
IMM 5373PP (12-2012) E
F - MULTIPLE UNDERTAKINGS - THIS SECTION MUST BE COMPLETED BY ALL SPONSORING GROUPS, IF APPLICABLE
FOR CIC USE ONLY
Client ID no.NAMES OF OTHER PRINCIPAL APPLICANTS LINKED TO THIS UNDERTAKING Date of birth
Y DM
Y DM
Y DM
Y DM
Y DM
G - OBLIGATIONS
This undertaking specifies the obligations of the sponsoring group with respect to the principal applicant and all accompanying or non-accompanying family members:
• Reception - Meet the sponsored person(s) upon arrival in the community;
• Lodging - Provide suitable accommodation, basic furniture and other household essentials;
• Care - Food, clothing, local transportation costs and other basic necessities of life;
• Settlement Assistance and Support - Help for the sponsored person(s) to learn an official language, seek employment, extend ongoing friendship, encourage and assist
them to adjust to life in Canada, teach rights and responsibilities of permanent residents in Canada.
The sponsoring group's obligations commence upon arrival of the sponsored persons in Canada. The sponsored person(s) are supported for 12 months or until they
become self-sufficient.
H - DECLARATION/SIGNATURES - THIS SECTION MUST BE COMPLETED BY ALL SPONSORING GROUPS
We declare that the information provided is to the best of our knowledge true, complete and accurate.
We are not in default of any other sponsorship undertakings.
We are not in default of any immigration loans.
We have made or will make adequate arrangements in the expected community of settlement for the reception and settlement of the person(s) identified in this undertaking,
as evidenced in the Settlement Plan and Financial Assessment.
We have sufficient financial resources and expertise to fulfill this undertaking.
To the best of our ability, we will not knowingly or deliberately allow any individual to participate in the group's settlement activities who may be considered a threat to the
safety and security of the sponsored person(s).
We understand that any false statements or concealment of any material fact may result in, but is not limited to, the following consequences:
• Refusal to approve this or future undertakings;
• Refusal of the sponsored individual's application for permanent residence;
• Exclusion or removal from Canada of the sponsored individuals;
• Suspension or cancellation of the existing sponsorship agreement with CIC (if applicable);
• Prosecution or other enforcement action.
We understand that the sponsorship undertaking constitutes a financial obligation that could result in collection action, should there be a breach of that obligation.
Representative name (print name) Date
(YYYY-MM-DD
)Signature
FOR GROUPS OF FIVE:
Member 1 name (print name) Date
(YYYY-MM-DD
)Signature
Member 2 name (print name) Date
(YYYY-MM-DD
)Signature
Member 3 name (print name) Date
(YYYY-MM-DD
)Signature
Member 4 name (print name) Date
(YYYY-MM-DD
)Signature
Member 5 name (print name) Date
(YYYY-MM-DD
)Signature
FOR SETTLEMENT ORGANIZATIONS:
Signature Date
(YYYY-MM-DD
)Co-sponsor name (print name)
FOR CO-SPONSORS (if applicable):
PAGE 5 OF 5
IMM 5373PP (12-2012) E
J - FOR CIC USE ONLY
Officer name
Signature
Phone number
Visa office and number
Approval date
(YYYY-MM-DD)
Remarks
The information you provided on this form is collected under the authority of the Immigration and Refugee Protection Act and will be used to maintain a record of
application and sponsorship undertakings by private sponsors in Canada according to the requirements of the Act. It will be retained in the Personal Information Bank CIC
PPU 008 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.
I - PERSONAL INFORMATION
Check this box, and read and sign below if you are submitting the application package directly to CIC.
Check this box, and read and sign below if the application package is being submitted by the principal applicant you have agreed to sponsor directly to CIC,
or if you are submitting your sponsorship undertaking form to an organization under contract or that has signed a Memorandum of Understanding with CIC
to provide processing or referral services.
DECLARATION ON SUBSEQUENT USE OF DISCLOSURE OF PERSONAL INFORMATION
I understand that I am prohibited from using or disclosing any personal information provided to me by the principal applicant I have agreed to sponsor for the purpose of
submitting their application for permanent residence. I agree not to further disclose or use any personal information provided to me by the principal applicant I have agreed to
sponsor for the purpose of submitting their application for permanent residence.
CONSENT FOR INDIRECT COLLECTION OF PERSONAL INFORMATION
I authorize CIC to collect the personal information requested in my sponsorship undertaking from the principal applicant I have agreed to sponsor or from an organization
under contract or that has signed a Memorandum of Understanding with CIC to provide processing or referral services. I understand this information is being collected
indirectly for the purposes of processing the sponsorship undertaking and for assisting CIC in assessing and processing the application for permanent residence submitted by
the applicant I have agreed to sponsor. I understand that I am not obliged to provide this authorization. However, failure to do so may mean that CIC will not be able to carry
out the assessment of the sponsorship undertaking.
FOR SETTLEMENT ORGANIZATIONS:
Representative name (print name) Signature Date
(YYYY-MM-DD
)
FOR GROUPS OF FIVE:
Member 1 name (print name) Signature Date
(YYYY-MM-DD
)
Member 2 name (print name) Signature Date
(YYYY-MM-DD
)
Member 3 name (print name) Signature Date
(YYYY-MM-DD
)
Member 4 name (print name) Signature Date
(YYYY-MM-DD
)
Member 5 name (print name) Signature Date
(YYYY-MM-DD
)
FOR CO-SPONSORS (if applicable):
Co-sponsor name (print name) Signature Date
(YYYY-MM-DD
)
OR
