PROTECTED WHEN COMPLETED - B

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SCHEDULE 4
ECONOMIC CLASSES - PROVINCIAL NOMINEES

All Provincial Nominee Class principal applicants must complete this form.

Provincial Nominees nominated under a business, entrepreneur, or self-employed stream/category must also complete Schedule 4A.

1. Your full name

3. Which provincial government has nominated you?

Family name

Given name(s) Provincial stream/category:

Given name(s)

4. Funds
2. Your date of birth

Date
Amount of unencumbered transferable and $
available funds you have, in Canadian dollars
(YYYY-MM-DD)

Declaration

I declare that my family members and I intend to live in the Province that nominated me.

I understand that my participation in an immigration-linked passive investment scheme (as defined in the Immigration and Refugee Protection Regulations) could exclude me
from consideration as a member of the Provincial Nominee Class.

I authorize the Government of Canada to share all necessary information respecting my application for permanent residence in Canada, including the status to the application
decision, with officials of the provincial government that nominated me.

Signature

Date
(YYYY-MM-DD)

This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants.
IMM 0008 (10-2015) E
SCHEDULE 4 (DISPONIBLE EN FRANÇAIS - IMM 0008 F ANNEXE 4)