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STATUTORY DECLARATION TO CONFIRM THE RELATIONSHIP TO EXTENDED

FAMILY MEMBER AND RESIDENCY IN CANADA
This declaration must be completed and signed by the former Language and Cultural Advisor employed by the Department of National Defence of Canada in
Afghanistan between 2001 and 2021 who wishes to have their extended family member join them in Canada. The former advisor must complete and sign
this form by solemn declaration in the presence of a person who, by law, is authorized to receive a solemn declaration.

SECTION 1 - PERSONAL INFORMATION (FORMER LANGUAGE AND CULTURAL ADVISOR)

The information provided in this section may be shared with the Department of National Defence of Canada for verification purposes.
Family name (as shown on valid Canadian Government ID) Given name(s) (as shown on valid Canadian Government ID)

UCI (if applicable) Place of birth Date of birth (YYYY-MM-DD) Citizenship

RESIDENTIAL ADDRESS (Note: Former Language and Cultural Advisor must reside in Canada)

P.O. Box Apartment or Unit number Street number Street name

City Province or Territory Postal code

E-mail address Telephone number

SECTION 2 – EMPLOYMENT INFORMATION OF FORMER LANGUAGE AND CULTURAL ADVISOR FOR THE DEPARTMENT OF
NATIONAL DEFENCE OF CANADA

Note: The information provided in this section may be shared with the Department of National Defence of Canada for verification purposes. If you do not have
some of the information requested in this section, please indicate “not known” in the specific box.

Personal Record Indicator (PRI) Position Number

Dates and Location of Service

Please provide below complete details of employment history as Language and Cultural Advisor for the Department of National Defence between 2001 and 2021 in Afghanistan.

From To Location in Afghanistan Commanding Officer

(YYYY-MM) (YYYY-MM) (Province/District)

Employment Documents
Check all that apply. Note that all checked items must be included with the application. Refer to the Document Checklist IMM 0187.

Letter of Employment or Offer Terms of Reference Pay Stubs Personal Evaluation Other

IMM 0186 (03-2023) E (DISPONIBLE EN FRANÇAIS - IMM 0186 F)

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SECTION 3 - PERSONAL INFORMATION OF PRINCIPAL APPLICANT (FOREIGN NATIONAL / EXTENDED FAMILY MEMBER)

Family name (as shown on passport/travel document) Given name(s) (as shown on passport/travel document)

UCI (if applicable and known) Place of birth Country of Citizenship (as shown on passport/travel document) Date of birth (YYYY-MM-DD)

Identity/Travel Document (if applicable)

Passport Tazkira Permit to re-enter the U.S. (I-327)

U.S. Refugee travel document (I-571) Other refugee travel document for non-citizens Other

Travel Document Number (if known)

SECTION 4 - DECLARATION
I confirm that I have read and understood the contents of the form and I make this solemn declaration conscientiously, believing it to be true and knowing that it is of the same force
and effect as a declaration made under oath.
I, a former Language and Cultural Advisor (LCA) employed by the Department of National Defence of Canada in Afghanistan
between 2001 and 2021 solemnly declare that I reside in Canada at the residential address indicated above in Section 1 and that

is my extended family member as they are:

my child my grandchild my sibling (i.e.- brother or sister, including half-siblings)

my sibling-in-law (only applies if the sibling is missing or deceased, and the individual was married or in a
my parent my grandparent common-law relationship with the sibling at the time of disappearance or death, and is not a spouse or
common-law partner of another person)

Former Language and Cultural Advisor

TYPE NAME Signature Date (YYYY-MM-DD)

SECTION 5 - DECLARATION OF CANADIAN AUTHORIZED OFFICIAL

Family name Given name

Occupation

Commissioner for Oaths Justice of the peace Lawyer Notary public Consular officer of the Government of Canada

BUSINESS ADDRESS

Apartment or Unit number Street number Street name

City Province or Territory Postal code

E-mail address Telephone number

DECLARATION - declared before me

Solemn declaration

Signed at - City and Province/Territory Signature Date (YYYY-MM-DD)

IMM 0186 (03-2023) E

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(blank space for officiant seal)

PRIVACY NOTICE

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 and financial institutions 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. Select information may be disclosed to external parties to verify an individual's claims.

In accordance with the Immigration and Refugee Protection Act, IRCC may use electronic means such as computer analytics and automation to support the processing of
applications and decision making, including on your application. The personal information collected on an application and on supporting documents may also be used to support
electronic processing, such as for research, statistics, program and policy evaluation, internal audit, compliance, risk management, developing computer analytics, strategy
development and reporting. To learn more about how IRCC uses electronic systems, please visit IRCC's Transparency webpage: https://www.canada.ca/en/immigration-
refugees- citizenship/corporate/transparency/digital-transparency-advanced-data-analytics.html

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, quality assurance, 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 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.

IMM 0186 (03-2023) E