CPR Form

Canada Permanent Resident Applicant Information
I. Your Personal Information

First Name: Middle Name: Last Name:
Date of Birth: Eye Color: Height (feet/inches):
Marital Status:
Date of marriage:
Have you previously been married or in a common law relationship? (YES/NO)
If YES: Name of spouse:
Type of relationship: (married or common-law)
Duration of Union: From(dd/mm/yyyy)-to (dd/mm/yyyy)
Residential Address:
No. and Street:
Province/State: Country: Postal Code:
Mailing Address if different from residential address:
No. and Street:
Province/State: Country: Postal Code:
Contact Person in the country of Residence:
Name:
Relationship to you:
Address:
Email:
Phone number:
ImmigCanada -Immigration Consulting Firm

4781 Van Horne Avenue Suite 210 Montreal, Quebec Canada H3W 1J1 Tel: 1.514.574.2480 Fax: 1.888.212.2573 email:
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consultant@immigcanada.com
II. Your Educational History
Give full details of all the secondary and post-secondary education (including university, college and apprenticeship,
starting with the most recent).
From To Name of Institution City,Province,Country Type of Certificate Field of Study/Course
(dd,mm,yyy) (dd,mm,yyy) or Diploma Issued
III. Your Personal History

Provide the details of your personal history since the age of 18, or the past 10 years, whichever is most recent. Start with the most
recent information. Under “Activity” write your occupation or job title if you are working. If you were not working, provide
information on what you were doing (e.g. unemployed, studying, travelling, retired, in detention, etc.). If you were outside of your
country of nationality, indicate your status in that country.
NOTE: Please leave no gaps in time.
From To Activity City,Province,Country Name of company, employer, school, facility (as
(dd,mm,yyy) (dd,mm,yyy) applicable)
IV. Address
Lists all address where you have lived since the age of 18. Do not use P.O. Box

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From To Street and number City or Town Province, State or Postal/Zip Country
(dd,mm,yyy) (dd,mm,yyy) District Code
V. Membership or Association with Organization (If any)

What organizations have you supported, been a member or been associated with? Include any political
social, youth or student organization, trade unions and professional associations. Do not use abbreviations. Indicate the city
and country where you were a member.
From To Name of organization Type of Activities and/or position held City and Country
(dd,mm,yyy) (dd,mm,yyy) organization within organization
VI. Government Positions (If any)

List any government positions (such as civil servant, judge, officer, employee in a security organization) you have held.
Include positions you have held before or after your retirement. Do not use abbreviations.
From To Country and level of jurisdiction (e.g. Department/Branch Activities and/or position held
(dd,mm,yyy) (dd,mm,yyy) national, regional, municipal)
VII. Military and/or paramilitary service (If any)

Provide below complete details of military and/or paramilitary service for each countries in whose armed
forces you served.
From To Branch of service, unity Ranks Dates and palces of any Reason for end of Country
(dd,mm,yyy) (dd,mm,yyy) numbers and names of active combat service
your commanding officer
VIII. Personal Details of your Dependents

Spouse Child Child Child

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Last Name
First Name
Sex
Marital Status
Height
Color of Eyes
Current Occupation
Date of Birth (dd,mm,yyy)
Place and Country of

Birth
Country of Citizenship
Other countries with resident

status
Native Language
Can Communicate in English or

French
Total years of formal
education
Level of Education
(Secondary, College, University,
Master’s Degree)
IX. Additional Family Information

The principal applicant, their spouse or common-law (if applicable), and all dependent children under 18 years of age or older must complete their
own copy of this form. Complete all forms in English.
Section A APPLICANT

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Name Relationship Date of Birth Place of Birth Marital Present address
dd,mm,yyyy Status
Applicant
Spouse or
common-
law partner Email address
Mother
Father
Section B CHILDREN (Include all sons and daughters, including all adapted and step-children
regardless of age or place of residence)
Name Relationship Date of Birth Place of Birth Marital Present address and Email address
dd,mm,yyyy Status
Email address
Email address
Email address
Email address
Email address
Section C BROTHERS and SISTERS (including half-and step-brothers and sisters)

Name Relationship Date of Birth Place of Birth Marital Present address
dd,mm,yyyy Status
X. Your Travel
List all trips you and your family members have taken outside your country of origin or of residence in the last ten years (or since
your 18th birthday if this was less than ten years ago). Include all trips: tourism, business, training, etc.

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From To Length Destination Purpose
(mm,yyy) (mm,yyy) (City and Country)
Your Spouse or common-law partner

Your dependent child 18 years old or older

Given Name:
XI. Your Background Declaration

Have you or, if you are the principal applicant, any of your family members YES NO

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listed in your application for permanent residence in Canada, ever:
A.) Been convicted of a crime or offence in Canada for which a pardon has not been granted
under the Criminal Records Act of Canada?
B.) Been convicted of, or are you currently charged with, on trial for, or party to a crime or
offence, or subject of any criminal proceedings in any other country?
C.) Made a previous claims for refugee protection in Canada or at a Canadian visa office
abroad. In any other country or countries, or with the
United Nations High Commissioner for Refugees (UNHCR)?
D.) Been refused refugee status, an immigrant or permanent resident visa (Including a
Certificat de selection du Quebec (CSQ) or visitor or temporary resident visa, to Canada or
any other country?
E.) Been refused admission to, or ordered to leave, Canada or any other
country?
F.) Been involved in an act of genocide, a war crime or in the commission of a crime against
humanity?
G.) Used, planned or advocated the use of armed struggled or violence to
reach political, religious or social objectives?
H.) Been associated with a group that used, uses, advocated or advocates
the use of armed struggle or violence to reach political, religious or social objectives?
I.) Been member of an organization that is or was engaged in an activity that

is part of a pattern of criminal activity?
J.) Been detained, incarcerated or put in jail?
K.) Had any serious disease or physical or mental disorder?
If your answer is YES to any questions, please provide explanation on a separate sheet.
XII. Your Previous Visa Application (if applicable)

YES NO
Have you or a dependent accompanying you previously applied for admission to Canada as a
Permanent Resident
If YES, Please answer questions below
Immigration Office where you sent your
application
Year of submission
Who is the main applicant?
What is the Category of application?
XIII. Relatives in Canada (if applicable)

YES NO
Do you (or your spouse) have any Blood Relatives in Canada
If YES, Please answer questions below

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Relation to you (or your spouse)
Which Province in Canada

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Canada Permanent Resident Applicant Information

I. Your Personal Information

Date of Birth: Eye Color: Height (feet/inches):

Have you previously been married or in a common law relationship? (YES/NO)

If YES: Name of spouse:

Type of relationship: (married or common-law)

Duration of Union: From(dd/mm/yyyy)-to (dd/mm/yyyy)

No. and Street:

Province/State: Country: Postal Code:

Mailing Address if different from residential address:

No. and Street:

Province/State: Country: Postal Code:

Contact Person in the country of Residence:

ImmigCanada -Immigration Consulting Firm

III. Your Personal History

ImmigCanada -Immigration Consulting Firm

V. Membership or Association with Organization (If any)

VI. Government Positions (If any)

VII. Military and/or paramilitary service (If any)

VIII. Personal Details of your Dependents

ImmigCanada -Immigration Consulting Firm

Date of Birth (dd,mm,yyy)

Place and Country of

Other countries with resident

Can Communicate in English or

IX. Additional Family Information

ImmigCanada -Immigration Consulting Firm

Section C BROTHERS and SISTERS (including half-and step-brothers and sisters)

ImmigCanada -Immigration Consulting Firm

Your Spouse or common-law partner

Your dependent child 18 years old or older

XI. Your Background Declaration

ImmigCanada -Immigration Consulting Firm

I.) Been member of an organization that is or was engaged in an activity that

XII. Your Previous Visa Application (if applicable)

XIII. Relatives in Canada (if applicable)

ImmigCanada -Immigration Consulting Firm

ImmigCanada -Immigration Consulting Firm

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