Authorization to Return to Canada Letter

CREDIT CARD INFORMATION

By signing below I agree that I will be charged the appropriate fee for the initial application. I agree that this fee will be deducted upon receipt of order from the credit card I have provided.

Cardholder Name:

Card Number:

Expiration Date: Security Code:

*For Visa & MasterCard, the last 3 digits on the back of your card. *For Amex, the last 4 digits on the front of your card.

Cardholder Signature:

DISCLAIMER

By signing below the applicant agrees to the following items:

- I have read and accept the terms and conditions as listed at the following link http://www.immigroup.com/Disclaimer.php

- Immigroup is not responsible for applications lost in the mail or for failures in fax or email

- Immigroup is not responsible for applications that are denied. All fees are non-refundable once applications are submitted to the government.

- I assert that I understand I am using Immigroup to apply for my ARC.

SIGN HERE:

Your Email:

Date of Birth: Place of Birth: Citizenship:

Passport #: Expiry Date: Country of Issue:

Sex: Male Female

Marital Status:

Present Occupation:

Name and Address of Employer:

Current Mailing Address:

Permanent Address:

Telephone Number: Email:

Immigration Status in your actual country of residence: Citizen Permanent Resident Visitor Worker Student

Valid until:

I received: Exclusion Order Deportation Order

Family Name / First Name / Relationship / Date of Birth / Place of Birth / Citizenship / Passport Number / Expiry Date / Country of Residence

During the past five years have you lived in any country other than your country of citizenship or permanent residence for more than six months?

Yes No

If yes, list countries and length of stay:

Explain your purpose for travelling to Canada:

Full address in Canada and name of host (if applicable):

Intended dates of travel: From To

Have you ever been treated for any serious physical or mental disorders or any communicable or chronic diseases?

Yes No

Committed any criminal offence in any country?

Yes No

Been refused admission to or ordered to leave Canada?

Yes No

Been refused a visa to travel to Canada?

Yes No

Been involved in the commission of a war crime or crime against humanity?

Yes No

If you answered yes to any of the above, please provide details below:

1. Your full name

Family name (Surname):

Given name(s):

2. Your date of birth:

3. If you have already submitted your application:

Name of office where the application was submitted:

Location of office:

Type of application:

4. Client Identification (ID) or Unique Client Identifier (UCI) number:

5. Your representative's full name

Family name (Surname):

Given name(s):

6. Your representative: family member or friend member of a non-governmental or religious organization member of ICCRC/law society/notaire 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? Membership ID number:

the Chambre des notaires du Québec

Membership ID number:

Name of firm or organization:

Mailing address:

Postal code/ZIP:

Telephone number:

Fax number:

E-mail address (if applicable):

9. Your representative's full name

Family name (Surname):

Given name(s):

Name of firm or organization (if applicable):

10. I declare that the information I have given is truthful, complete and correct.

Signature of applicant:

Date:

Signature of spouse or common-law partner (if applicable):

Date:

Application for Authorization to Return to Canada;

Processing fees in the amount of $400 Canadian by bank draft made payable to the Receiver General for Canada.

Use of a Representative (IMM 5476), if applicable;

Recently issued Police Certificate from all the countries where you have resided for more than 6 months since the age of 17 years;

Proof that you appeared before an immigration officer at a port of entry to verify your departure from Canada;

If you incurred a criminal conviction in Canada, you must apply for a National Pardon in Canada and submit it with your application;

Detailed explanation of why you want to return to Canada;

Proof of funds and employment letter indicating the type and duration of employment;

Two passport-sized photographs;

A copy of your current passport bio-data page;

A copy of this checklist.