Application Summary Group Information

Helen Rahbarinejad (V400498979) Protected B
Application Summary
Group information
Do you want to apply for more than 1 person at the same time? Yes
Group type Family
Group name Stars
Application for a visitor visa
I want to apply for a: visitor visa or supervisa
To visit my grandparent, grandchild, sibling, half-sibling, step-

sibling or non-dependent child who is a Canadian citizen,
Why do you need a visa?
person registered under Canada's Indian Act or permanent
resident of Canada
I have been to Canada many times with my family, and there

have been specific occasions several times. This time
around, we will have my niece's wedding in Montreal to
Tell us more about what you'll do in Canada. Include dates. attend. Also, I will be visiting family members and friends
both in Montreal (where I will be staying with my sister) and
in Toronto where I have another sister, and many friends and
family too.
When will you enter Canada? 2022-08-18
When will you leave Canada? 2022-09-28
UCI (unique client identifier), if known 58037747
Representative
Are you applying on behalf of someone else? No
Date modified: 2022-05-14 20:35:01 UTCZ Page 1 of 12

Travel document information of the applicant
Surname/last name Rahbarinejad
Given name/first name Helen
Date of birth 1963-06-30
Gender Female
What document are you travelling with? Passport
What kind of passport? Regular
Select the country code that matches the one on your passport IRN (Iran)
What's the nationality on your passport? Iran
What's your passport or travel document number? R53764028
Confirm your passport or travel document number R53764028
When was the passport issued? 2021-05-06
Date of expiry of the passport 2026-05-06
Are you a lawful permanent resident of the United States with a valid Green Card (alien
No
registration card)?
Have you held a Canadian visitor visa in the past 10 years? Yes
Do you currently hold a valid U.S. nonimmigrant visa? No
Are you travelling to Canada by air? Yes
Citizenship and places where the applicant has lived
Country or territory where you were born Iran
City or town where you were born Khorramabad
Are you a citizen of more than one country or territory ? No
Which country or territory are you a citizen of?
Country/territory of issue Iran
I am a citizen of this country or territory since birth
From 1963-06-30
National identity document of the applicant
Do you have a valid national identity document? Yes
Document number 4072173101
Confirm your document number 4072173101
Date of issue 2017-08-23
Select the country or territory that issued this document Iran

Names used in the past
Have you used another name in the past? No
Contact information of the applicant
Apt. 5 West, No.1 Kamran Alley, Niavaran Ave.

Address Tehran 1935633834
Iran
Is your mailing address the same as your residential address? Yes
List your current country or territory of residence, then add all other countries or territories where you've lived for the past five
years, for more than 6 months.
Country/territory Iran
Status Citizen
From 1963-06-30
This is where I currently live.
Biometrics (fingerprints and photo) of the applicant
Do we already have your fingerprints and photo (biometrics), and are they still valid? Yes
Do you want to give your biometrics again? No
Invitation
Who is inviting you?
Surname/last name Rahbari Nejad
Given name/first name Hoshai
Relationship to you Family member
Manually input address
# 404 Greenwood Drive

Mailing address Beaconsfield, Montreal Quebec H9W 4Z8
Canada
Telephone number
Telephone type Cellular
Select telephone number country or territory Canada/US
Telephone number 5143002187
Email address hoshai_rn@yahoo.com
Has someone else also invited you? No

Finances
How much money do you have for your stay in Canada? (In Canadian dollars - CAD) 10000
Is someone else giving you money for your stay in Canada? No

Information about education, work and other activities
Post-secondary education history
Have you ever studied at a post-secondary school (university, college or vocational school)?
Yes
You don't need to have completed a degree or diploma.
Give details of each program you have studied and are

Payamnour University
currently studying.
From 1996-09
Level of study University - Bachelor's Deg.
Field of study Arts/Humanities/Social Science
To 2002-07
Artesh Blvd., Oshan Sq.

Address Tehran
Iran
Work/activities history
Military/police history
Did you serve in any military, militia, civil defence unit, security organization or police force
No
(including non-obligatory service, reserve or voluntary units)?
Give details of all your employment and activities for the past 10 years.
From 2009-12
To 2015-10
Work/Activity Business, finance and administration occupations
Job title Administrative and regulatory occupations
Company/employer Ravanasay Clinic
Main duties of the job All secretarial duties at the office.
Valiasr, Pezeshkpour St., No. 20

Address Tehran
Iran
From 2015-10
Ongoing
Work/Activity Retired
Apt.5 West, No. 1 Kamran Alley

Address Tehran
Iran
Travel history

During the past 5 years have you travelled to a country or territory other than the one where
Yes
you're a citizen or where you live now?
From 2022-03
To 2022-03
Country/territory United Arab Emirates
Location/place where stationed Dubai
Purpose of travel Visiting my brother (family gathering)
From 2020-11
To 2020-11
Country/territory Canada
Location/place where stationed Montreal
Purpose of travel Visiting my sister and her family
From 2019-06
To 2019-08
Location/place where stationed Montreal
Purpose of travel Visiting my sister and family
From 2019-08
To 2019-08
Country/territory Turkey
Location/place where stationed Ankara
Accompanying my daughter to the Canada VAC office for

Purpose of travel
her biometrics.
From 2018-07
To 2018-08
Location/place where stationed Montreal and Toronto
Visiting family and attending my niece's wedding

Purpose of travel
ceremony
From 2017-07
To 2017-08
Location/place where stationed Montreal and Toronto
Purpose of travel Visiting Family

From 2017-08
To 2017-08
Country/territory Finland
Location/place where stationed Espoo and Helsinky
Visiting family and attending my husband's niece's

Purpose of travel
wedding.
From 2016-11
To 2016-11
Country/territory United Arab Emirates
Location/place where stationed Dubai
Purpose of travel Family gathering
From 2016-06
To 2016-06
Country/territory Cyprus
Location/place where stationed Limassol
Purpose of travel Vacation
From 2015-08
To 2015-09
Country/territory Spain
Location/place where stationed Madrid
Purpose of travel Tourism
From 2015-09
To 2015-09
Country/territory France
Location/place where stationed Paris
Purpose of travel Tourism
Have you ever stayed in Canada beyond the validity of your status, attended school in Canada
No
without authorization, or worked without authorization in Canada?
Have you ever been refused a visa or permit, denied entry to, or ordered to leave any country or
No
territory?

Criminality and security
Have you ever committed any crime in any country or territory (this includes driving under the
No
influence of alcohol or drugs)?
Have you ever been arrested for any criminal offence in any country or territory (this includes
No
driving under the influence of alcohol or drugs)?
Have you ever been charged for any criminal offence in any country or territory (this includes
No
Have you ever been convicted for any criminal offence in any country or territory (this includes
No
Criminality and security questions
Are you or have you ever been a member associated with any political party, or other group or
organization which has engaged in or advanced violence as a means to achieving a political or No
religious objective, or which has been associated with criminal activity at any time?
Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or
No
desecration of religious buildings?
Medical background questions
Have you had a medical exam performed by an IRCC authorized panel physician (doctor) within
No
the last 12 months?
Do you want to work in one of the following jobs?
health sciences worker

clinical laboratory worker
patient attendant in nursing or geriatric homes
medical student admitted to Canada to attend university
No
medical elective and physician on short term assignment
teacher of primary or secondary schools or other teachers of small children
domestics worker, someone who gives in-home care to children, the elderly and the
disabled
day nursery worker
Medical background questions- Tuberculosis
In the last 2 years, were you diagnosed with tuberculosis? No
In the last 5 years, have you been in close contact with a person with tuberculosis? No

Medical background questions
Are you currently receiving dialysis treatment? No
Have you had a drug or alcohol addiction causing you to be a threat to yourself or others, or to
No
be hospitalized?
Have you had a mental health condition causing you to be a threat to yourself or others, or to
No
be hospitalized?
Have you ever been diagnosed with syphilis? No
Family information
What is your current marital status? Married
Date of marriage or start of common-law relationship 1993-09-23
Name of spouse/common-law partner
Surname/last name Mirfakhraei
Given name/first name Farhang
Country or territory of birth Iran
Present occupation Retired
Is their address the same as yours? Yes
Will your spouse/common-law partner accompany you to

Yes
Canada?
Children
Do you have any biological, adopted or step-children? Yes
Surname/last name Mirfakhraei
Given name/first name Kiana
Relationship Daughter
Does this child have the same address as you? Yes
If the child is not in Canada, will they accompany you to

Yes
Canada?

Tell us about your parents
Surname/last name Shamlou
Given name/first name Ezzatbanou
Relationship Mother
Present occupation Retired
Does this parent have the same address as you? No
Apt. 1 East, No. 1 Kamran Alley, Niavaran

Address Tehran 1935633811
Iran
Will this parent come with you to Canada? Yes
Given name/first name Fathollah
Relationship Father
This parent is deceased.
Date of death 2001-03-07
Language of the applicant
What is your native language or mother tongue? Persian
Can you communicate in English and/or French? English
What language do you want us to use to contact you? English
Email address of applicant
Email address helenr63@gmail.com
Confirm your email address helenr63@gmail.com

Telephone number of the applicant
Telephone type Cellular
Select telephone number country or territory Other
Telephone number +98 9121571322
Telephone type Residence
Select telephone number country or territory Other
Telephone number +98 2122749123
Documents to support your application
Document name National identity document
File name National ID Helen.PDF
Size of the Document 700.00 KB
Date/time uploaded 2022-05-13 20:35:01 UTCZ
Document name Passport/travel document
File name Passport Helen.PDF
Size of the Document 1,710.00 KB
Document name Marriage certificate
File name Marriage Certificate reduced size.pdf
Document name Additional documents
File name Old Passport Helen-compressed.pdf
Fees
Fee Quantity Price Total
Visitor visa 1 CAN$100 CAN$100
Total CAN$100
Consent and declaration

Citizenship and Immigration Canada (CIC), or an organization at CIC's request, may want to contact you in the future to ask you
about any services you received from CIC prior to the application process (such as participation in an information forum), during
the application process (including the application process itself as well as orientation or accreditation services), and services
received after arriving in Canada (including settlement, integration and citizenship). CIC will use this information, along with the
information provided by other individuals, for research, performance measurement or evaluation purposes. CIC will not use this
information to make any decisions about you personally.
Do you consent to be contacted by CIC, or an organization at CIC's request, in the future? Yes
I consent to the release to Citizenship and Immigration Canada (CIC) and Canada Border Services Agency (CBSA) of all records
and information for the purpose of processing my request that any government authority, including police, judicial and state
authorities in all countries in which I have lived may possess about me. This information will be used to evaluate my suitability
for admission to Canada or to remain in Canada pursuant to Canadian legislation.
I declare that I have answered all questions in this application fully and truthfully.
Signature of Applicant or Parent/Legal Guardian's for a person under 18 years of age.
Given name/first name Helen
Privacy Notice
Personal information provided on this form is collected and will be used, disclosed, and retained by Immigration, Refugees and
Citizenship Canada (IRCC) under the authority of the Immigration and Refugee Protection Act (IRPA). The personal information
provided will be used for the purpose of processing applications. The personal information provided may be disclosed to other
federal government institutions and third parties including law enforcement bodies, provincial/territorial governments and/or
foreign governments for the purpose of validating identity, eligibility and admissibility.
The personal information collected on an application, and other information collected in support of an application, may be used
for computer analytics to support processing of applications and decision making, including your application. Personal
information, including from computer analytics, may also be used for purposes including research, statistics, program and policy
evaluation, internal audit, compliance, risk management, strategy development and reporting.
Where biometrics are provided in support of an application, the fingerprints collected will be stored and shared with the RCMP.
The fingerprint record may also be disclosed to law enforcement agencies in Canada in accordance with subsection 13.11(1) of
the Immigration and Refugee Protection Regulations. The information may be used to establish or verify the identity of a person
in order to prevent, investigate, or prosecute an offence under any law of Canada or a Province. This information may also be
used to establish or verify the identity of an individual whose identity cannot reasonably be otherwise established or verified
because of physical or mental condition. Canada may also share immigration information related to biometric records with
foreign governments with whom Canada has an agreement or arrangement.
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. Further details are available in Info Source. 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 068.

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Helen Rahbarinejad (V400498979) Protected B

Group type Family

Group name Stars

Application for a visitor visa

I want to apply for a: visitor visa or supervisa

To visit my grandparent, grandchild, sibling, half-sibling, step-

I have been to Canada many times with my family, and there

When will you enter Canada? 2022-08-18

When will you leave Canada? 2022-09-28

UCI (unique client identifier), if known 58037747

Are you applying on behalf of someone else? No

Date modified: 2022-05-14 20:35:01 UTCZ Page 1 of 12

Travel document information of the applicant

Surname/last name Rahbarinejad

Given name/first name Helen

Date of birth 1963-06-30

What document are you travelling with? Passport

What kind of passport? Regular

What's the nationality on your passport? Iran

What's your passport or travel document number? R53764028

Confirm your passport or travel document number R53764028

When was the passport issued? 2021-05-06

Date of expiry of the passport 2026-05-06

Do you currently hold a valid U.S. nonimmigrant visa? No

Are you travelling to Canada by air? Yes

Citizenship and places where the applicant has lived

Country or territory where you were born Iran

City or town where you were born Khorramabad

Are you a citizen of more than one country or territory ? No

Which country or territory are you a citizen of?

Country/territory of issue Iran

I am a citizen of this country or territory since birth

National identity document of the applicant

Do you have a valid national identity document? Yes

Document number 4072173101

Confirm your document number 4072173101

Date of issue 2017-08-23

Select the country or territory that issued this document Iran

Date modified: 2022-05-14 20:35:01 UTCZ Page 2 of 12

Names used in the past

Have you used another name in the past? No

Contact information of the applicant

Apt. 5 West, No.1 Kamran Alley, Niavaran Ave.

Is your mailing address the same as your residential address? Yes

This is where I currently live.

Biometrics (fingerprints and photo) of the applicant

Do you want to give your biometrics again? No

Who is inviting you?

Surname/last name Rahbari Nejad

Given name/first name Hoshai

Relationship to you Family member

Manually input address

# 404 Greenwood Drive

Select telephone number country or territory Canada/US

Telephone number 5143002187

Email address hoshai_rn@yahoo.com

Has someone else also invited you? No

Date modified: 2022-05-14 20:35:01 UTCZ Page 3 of 12

Is someone else giving you money for your stay in Canada? No

Date modified: 2022-05-14 20:35:01 UTCZ Page 4 of 12

Information about education, work and other activities

Post-secondary education history