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Get Canada IMM 5646 2019

Year. OFFICIAL SEAL OF NOTARY PUBLIC AUSSI DISPONIBLE EN FRAN AIS - IMM 5646 F ALSO AVAILABLE ON CIC WEB SITE AT http //www. Year Signature of custodian Sworn before me at This month Signature of notary IMM 5646 01-2015 E Day Date city in the province of day of Month province/territory country if applicable. Citizenship and Immigration Canada PROTECTED WHEN COMPLETED - B Citoyennet et PAGE 1 OF 2 CUSTODIANSHIP DECLARATION CUSTODIAN FOR MINORS STUDYING IN CANADA STUDENT INFORMATION Family name Given name s Date of birth Y Sex M D Male Female Name and address of school in Canada Address where student will reside in Canada PARENTS/GUARDIANS INFORMATION Preferably from both parents/guardians Parent/Guardian 1 Full name Home address Telephone number CUSTODIAN INFORMATION Status in Canada Canadian citizen or Permanent resident Telephone no. The application of the official seal below confirms that the notary public has received evidence that the custodian is a Canadian citizen or a permanent resident is over 19 years of age and currently resides at the home address stated above. I name of custodian hereby solemnly declare that I will undertake the full custodianship for the said student name of student during his/her stay in Canada while under the age of majority in the province in which he/she resides. As a custodian I have made the necessary arrangements for the care and support of the said student in place of the parents as appropriate. By signing this custodian agreement I certify that I reside within a reasonable distance of the student s intended residence and school and will be able to fulfil my obligations as a custodian in the event of an emergency. cic*gc*ca Current residential address My/Our child will reside with the appointed custodian in the school dormitory or with another person please provide name and indicate relationship. I/We and names of parents/guardians the parents/guardians of the said student province in which he/she resides. I have made the necessary arrangements for the care and support of the said student such that the custodian should act in the place of me/us the parents. By signing this custodian agreement I/We affirm that I am/we are satisfied the above appointed custodian resides within a reasonable distance of my/our child s intended residence and school and will be able to fulfil his/her obligations as a custodian in the event of an emergency. Citizenship and Immigration Canada PROTECTED WHEN COMPLETED - B Citoyennet et PAGE 1 OF 2 CUSTODIANSHIP DECLARATION CUSTODIAN FOR MINORS STUDYING IN CANADA STUDENT INFORMATION Family name Given name s Date of birth Y Sex M D Male Female Name and address of school in Canada Address where student will reside in Canada PARENTS/GUARDIANS INFORMATION Preferably from both parents/guardians Parent/Guardian 1 Full name Home address Telephone number CUSTODIAN INFORMATION Status in Canada Canadian citizen or Permanent resident Telephone no. The application of the official seal below confirms that the notary public has received evidence that the custodian is a Canadian citizen or a permanent resident is over 19 years of age and currently resides at the home address stated above. .

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