Application – Canada Immigration Document

Step 1 of 7 - Applicant Information

Applicant Information

Full Name*

First Name Last Name

Birth Date*

Gender*

Male

Female

Country of Birth*

Place of Birth*

Marital status*

Country of Citizenship / Nationality*

Passport information

Country Passport*

Passport number*

Repeat Passport number*

Passport Date of Issue*

Expiration date*

Other data

Are you currently a citizen or national of another country?*

Yes

Have you previously applied to enter or stay in Canada?*

Yes

Country of Citizenship / Nationality*

Unique client identifier (UCI), previous Canadian visa or license number (optional)

E-mail Address*

Enter Email Confirm Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Occupation*

Occupation Details

Job Title*

Employer or School Name*

Country*

City*

Start Year (e.g., 2020)*

Background Questions

Have you ever been refused a visa or eTA for Canada, denied entry, or ordered to leave the country?*

Yes

Please provide as many details as possible to assist with processing.*

In the past two years, were you diagnosed with tuberculosis or have you been in close contact with a person with tuberculosis?*

Yes

Please provide as many details as possible to assist with processing.*

Do you have one of these health conditions?*

Have you ever committed, been arrested for, charged with, or convicted of any criminal offense in any country/territory?*

Yes

Please provide as many details as possible to assist with processing.*

If you have committed or been convicted of a crime, you may not be eligible for a Canada eTA. This includes both minor and serious crimes, such as theft, assault, manslaughter, dangerous driving, driving while under the influence of drugs or alcohol, possession of or trafficking in drugs or controlled substances.
Information provided to CIC is collected under the authority of the Immigration and Refugee Protection Act (IRPA) to determine admissibility to Canada. Information provided may be shared with other Canadian government institutions, such as, but not limited to, the Canada Border Services Agency (CBSA), the Royal Canadian Mounted Police (RCMP), the Canadian Security Intelligence Service (CSIS), the Department of Foreign Affairs, Trade and Development (DFATD), Employment and Social Development Canada (ESDC), the Canada Revenue Agency (CRA), provincial and territorial governments and foreign governments in accordance with subsection 8(2) of the Privacy Act.

Billing Details

Billing Full Name*

First Name Last Name

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Payment

Canada Immigration Application

Canada Immigration

Including Canada Government Fees

Credit Card*

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Canada Immigration Application Form

Applicant Information

Passport information

Other data

Occupation Details

Background Questions

Declaration of Applicant

Billing Details

Payment