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SCHEDULE 1
Application for Permanent Residence under the Temporary Public Policy for
Extended Families of Former Language and Cultural Advisors
This form must be completed by:
• you, the principal applicant.
Provide as much detail as possible when answering the following questions.
• If you need more space, attach a separate sheet of paper. Make sure you indicate the form's title and the number or letter of the question you are
answering. Print your name at the top and number each additional sheet.

For details and definitions, consult the instruction guide IMM 0188.

Note: False statements or concealment of material fact may result in the refusal of the application.

SECTION A - APPLICANT INFORMATION

a) Family name(s) (as shown on your passport) b) Given name(s) (as shown on your passport)

c) Passport number (if applicable) d) Date of birth (YYYY-MM-DD) e) Country or Territory of birth (as shown on your passport)

f) Citizenship (as shown on your passport) g) Country of Residence h) Telephone number Extension i) Marital status

j) Email address

k) Residential address:

Street name and Number

City Province/Territory/State Country Postal code

SECTION B - REQUIREMENTS OF THE PUBLIC POLICY - APPLICATION FOR PERMANENT RESIDENCE FOR EXTENDED FAMILY
MEMBERS OF FORMER LANGUAGE AND CULTURAL ADVISORS

1. Are you a national of Afghanistan?

Yes

No ► You are not eligible for the temporary public policy

2. Are you currently outside of Canada?

Yes

No ► You are not eligible for the temporary public policy

3. Were you in Afghanistan on or after July 22, 2021?

Yes ► If applicable, please provide details of how and when you left Afghanistan:

No ► You are not eligible for the temporary public policy

This form is made available by Immigration, Refugees and Citizenship Canada and is not to be sold to applicants.

IMM 0185 (03-2023) E (DISPONIBLE EN FRANÇAIS - IMM 0185 F)

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4. Are you related to a Canadian citizen or permanent resident whose employment as a Language and Cultural Advisor in Afghanistan for the Department of National Defence of
Canada between 2001 and 2021 can be confirmed by the Department of National Defence?

Yes ► If so, is that person your:

Sibling-in-law (if the sibling is missing or deceased, and you were married or in a
Parent Grandparent Child Grandchild Sibling common-law relationship with the sibling at the time of disappearance or death,
and you are not a spouse or common-law partner of another person)
Please provide details below:

No ► You are not eligible for the temporary public policy

5. In which province or territory in Canada do you intend to reside?

Province of Quebec

Any other Canadian province or territory

SECTION C - DECLARATION
I declare that the information I have given is truthful, complete and correct

Signature of applicant Date (YYYY-MM-DD)

WARNING: It is an offence under Section 127 of the Immigration and Refugee Protection Act to knowingly make a false statement on this form.

Personal information provided on this form is collected by Immigration, Refugees, and Citizenship Canada (IRCC) under the authority of the Immigration and Refugee Protection
Act (IRPA). The personal information will be used for the purpose of processing an application. The personal information provided may be disclosed to other federal government
institutions, non-governmental organizations for the purpose of validating information and eligibility. The personal information may also be disclosed to law enforcement bodies
for the purpose of validating identity, eligibility and admissibility. The personal information may also be disclosed to provincial/territorial governments and foreign governments for
the purpose of validating eligibility and admissibility.

Personal information may also be used for other purposes including research, statistics, program and policy evaluation, internal audit, compliance, program integrity, risk
management, subsequent program eligibility, strategy development and reporting.

Failure to complete the form in full may result in a delay or the application not being processed. The Privacy Act gives individuals the right of access to, protection, and correction
of their personal information. If you are not satisfied with the manner in which IRCC handles your personal information, you may exercise your right to file a complaint to the
Office of the Privacy Commissioner of Canada. The collection, use, disclosure and retention of your personal information is further described in IRCC's Personal Information
Bank IRCC PPU 013, 042.

IMM 0185 (03-2023) E