Get Canada IMM 5476 E 2011

I authorize Citizenship and Immigration Canada and Canada Border Services Agency to release information from my case file and that of my dependent children under 18 years of age to my representative. This authorization is in accordance with the Privacy Act. I am aware that any information which would be subject to exemption if I had the right of access under the Privacy Act or the Access to Information Act will likely not be released. Your representative s full name is UNPAID and is a family member or friend member of a non-governmental or religious organization member of the Immigration Consultants of Canada Regulatory Council ICCRC a Canadian provincial or territorial law society or the Chambre des notaires du Qu bec. other is or will be PAID and is a member in good standing of the Immigration Consultants of Canada Regulatory Council ICCRC Membership ID number a Canadian provincial or territorial law society Which province or territory the Chambre des notaires du Qu bec IMM 5476 07-2011 E This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants DISPONIBLE EN FRAN AIS - IMM 5476 F Name of firm or organization if applicable Canada Turismo Mailing address Av dos Esportes 1065 - Jardim Planalto Postal code/ZIP 13270-210 Telephone number Country code Fax number Area code Number E-mail address if applicable vistos canadaturismo. com.br By indicating your representative s e-mail address you are hereby authorizing Citizenship and Immigration Canada to transmit your file and personal I declare that the information in Section B is truthful complete and correct. Com.br By indicating your representative s e-mail address you are hereby authorizing Citizenship and Immigration Canada to transmit your file and personal I declare that the information in Section B is truthful complete and correct. I understand and accept that I am the person appointed by the applicant to conduct business on the applicant or sponsor s behalf with Citizenship and Signature of representative Date SECTION C CANCEL THE APPOINTMENT OF A REPRESENTATIVE I withdraw my authorization for this person to serve as my representative to receive information on my case file and to conduct business on my behalf with if applicable SECTION D YOUR DECLARATION I understand all the foregoing statements having asked for and obtained an explanation for every point that was not clear to me. Signature of applicant Signature of spouse or common-law partner Warning It is a serious offence to give false or misleading information on this form. The information you provide on this form is collected under the authority of the Immigration and Refugee Protection Act and will be used in assessing your application according to the requirements of the Act. Complete Section A C and D. SECTION A APPLICANT INFORMATION Your full name Family name Surname Given name s Day Your date of birth Month Year If you have already submitted your application Name of office where the application was submitted Location of office Type of application permanent residence extension of study permit etc. Your Citizenship and Immigration Canada Identification number if known Client Identification ID or Unique Client Identifier UCI number SECTION B APPOINTMENT OF REPRESENTATIVE I authorize the following individual to serve as my representative and to conduct business on my behalf with Citizenship and Immigration Canada and Canada Border Services Agency. I authorize Citizenship and Immigration Canada and Canada Border Services Agency to release information from my case file and that of my dependent children under 18 years of age to my representative. This authorization is in accordance with the Privacy Act. I am aware that any information which would be subject to exemption if I had the right of access under the Privacy Act or the Access to Information Act will likely not be released. Your representative s full name is UNPAID and is a family member or friend member of a non-governmental or religious organization member of the Immigration Consultants of Canada Regulatory Council ICCRC a Canadian provincial or territorial law society or the Chambre des notaires du Qu bec. other is or will be PAID and is a member in good standing of the Immigration Consultants of Canada Regulatory Council ICCRC Membership ID number a Canadian provincial or territorial law society Which province or territory the Chambre des notaires du Qu bec IMM 5476 07-2011 E This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants DISPONIBLE EN FRAN AIS - IMM 5476 F Name of firm or organization if applicable Canada Turismo Mailing address Av dos Esportes 1065 - Jardim Planalto Postal code/ZIP 13270-210 Telephone number Country code Fax number Area code Number E-mail address if applicable vistos canadaturismo. This authorization is in accordance with the Privacy Act. I am aware that any information which would be subject to exemption if I had the right of access under the Privacy Act or the Access to Information Act will likely not be released. Your representative s full name is UNPAID and is a family member or friend member of a non-governmental or religious organization member of the Immigration Consultants of Canada Regulatory Council ICCRC a Canadian provincial or territorial law society or the Chambre des notaires du Qu bec. other is or will be PAID and is a member in good standing of the Immigration Consultants of Canada Regulatory Council ICCRC Membership ID number a Canadian provincial or territorial law society Which province or territory the Chambre des notaires du Qu bec IMM 5476 07-2011 E This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants DISPONIBLE EN FRAN AIS - IMM 5476 F Name of firm or organization if applicable Canada Turismo Mailing address Av dos Esportes 1065 - Jardim Planalto Postal code/ZIP 13270-210 Telephone number Country code Fax number Area code Number E-mail address if applicable vistos canadaturismo. com.br By indicating your representative s e-mail address you are hereby authorizing Citizenship and Immigration Canada to transmit your file and personal I declare that the information in Section B is truthful complete and correct. I understand and accept that I am the person appointed by the applicant to conduct business on the applicant or sponsor s behalf with Citizenship and Signature of representative Date SECTION C CANCEL THE APPOINTMENT OF A REPRESENTATIVE I withdraw my authorization for this person to serve as my representative to receive information on my case file and to conduct business on my behalf with if applicable SECTION D YOUR DECLARATION I understand all the foregoing statements having asked for and obtained an explanation for every point that was not clear to me. .