Immigration. Refugees Immigration.

Refugies If PROTECTED WHEN COMPLETED - B

7
and Citizenship Canada et Citoyennete Canada
u )2 ' Page 1 of 7

SCHEDULE2
REFUGEES OUTSIDE CANADA
The principal applicant AND each family member 18 years of age and older must complete their own copy of this form.

1AM
D The principal applicant
A family member

GIVEN DATE (YYYv-MM-DD)

Yh,~l :,:!.:. Na<=::il • OF BIRTH (; I~ - : 1 - (, ~;
NAME NAMES

Provide as much detail as poSSlble when answering the foHowing questions.

If you need more space. attach a separate sheet of paper. Make sure you 1nd1cate 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.

Famrly member: A famtlymember ts a spouse or commori-law partner, a biological or legally adopted child or a grandchild (providing that the parent of your grandchild is also
accompanying on the apphcation).

NOTE TO FAMILY MEMBERS 18 YEARS OF AGE AND OLDER:

If your answers are the same as the principal applicant's answers. write "same as principal apphcant" tn the space provided after each question

To be eltglble for resettlement tt> Canada as a refugee, at least one member of the family must demonstrate the following:
• Tha11hey:

o have a well-founded fear of persecution for reasons of race-. religion, nationality. political op,mon or membership in a particular soc,al group and are outside all
of their countries of nationality and that they are unable or, by reason of that fear. unwtlhng to avail themselves of the protection of each of those countries:

OR

o have been. and continue to be. seriously and personally affected by civil war. armed conflict or masS1ve VTolatJon of human rights in each of the1r coulltnes of
nationality and habitual residence.

ANO
-· .
• That they are a person with no reasonable prospect withrn a reasonable penod. of a durable solution in the CQuntry of natJonahty (VQluntary repatnatJon). 1n the country of
asylum (local integration) or in any country other than Canada (permanent resettlemer.t).

PART A
C-ASE 'NARRATIVE:
All of the information you provide mu~t be complete. accurate and true. It is your responsibility to ensure the reliability of any other person that helps you to
translate or write this information. If you are found to have provided incomplete. inaccurate. or untruthful information in answer to any question. your
aoofication mav be refused

Please descrice in·a-s much detairas possible t~ spectfic events which red you to ftco your homo country. You·should include ony actions taken
against you. your family members. or any others in a similar situation. If the events were generalized. please describe how they affected you
personally or what led to you fearing for your safety. You should also indicate whether you sought protection from the authorities of your country and if
not. why not. For each incident. specify the date (month/ year) the event(s) occurred.
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..!.J A)· Please describe 1n chronological order when exactly you ond your family members left your home and what route you took. 'Explain the mode of
transportation taken, the types of vehicles or air1ines used, flrght numbers. the date of travel. how you paid for travel. etc. If you did not leave
together. please explain the route each family member took ond .the reason(s) why you did not travel together: Please include a copy of your
passport stamp of when you entered the country (if available). Please indicate whether someone planned your travel or helped you leave or enter
a country and how much you paid.
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IMM 0008 (10-2022) E (DISPONIBLE EN FRANCAIS • IMM 0008 F)

Canada
 Page 2 of 7
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B) Are you able to return to your home country? If not. why?

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C) Since arriving in the country where you are living now. have you returned to your country of origin, even briefly? If yes. how many times and under
what circumstances? Do you maintain property, a business or are you currently employed in your country of origin?
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A) In the country where you are living now. do you have the right to work, go to school or move freely? Are these rights available to you? Are you
residing in a refugee camp or in an urban area? Please explain.
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B) Since arriving in the country where you currently live, how have you supported yourself and (if applicable) your family?
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lf there is any other information that you think might be relevant to your case. please attach a separate page.

PART B: IMMIGRATION STATUS &SETTLEMENT ABILITIES

[!] A) Have you ever previously applied for resettlement under Canada's Refugee and
0Yes ({] No
1t •ves•. answer (B) and (C)
Humanitarian Resettlement program? below. lf ·No·. proceed to
question 6.

B) When and where did you apply? What was the result?

C) Have your circumstances changed since you applied previously? If so. please describe how.

A) Have you ever been refused refugee status by any country including the country 0Yes ({]No
where you are currently living?

B) Other than this application, do you currently have a refugee status application in
proceH in any other country including the country where you are currently living?
0 Yes @No

If y~ answered •vES" to either question. pl~ase _prov~de as muc~ detail as possible. includ\ng da!es, places a_n~ d~~crip~~n of circumstances.

IMM 0006 (10-2022) E

I -
Page 3 or 7
I
I

I - -

C) Have you ever applied for refugee status with

the United Nations High 0Yes [ZJ No
Refuge es (UNHC R) in any country ?
Commissioner for
d from the UNHCR and/ or country regarding
if possible. include a copy of all documentation receive
If you answered "YES·. what was the result and letter.
include a copy of the refusal
any refugee claim. If applicable and available. please

ation in process to any country

D) Do you currently have an application for immigr 0Yes [ZJNo
(e.g. family reunification or economic categories)?

If yes. please ~xplain.

t. visitor.
you and your family members in your current country of residence (e.g .. citizen. permanent residen
l2.J A) What ts the immigration status of Please provide documentation as proof of this status if availab
le.
refugee. no legal status. other)?

or French?
8) Do you speak. react write or understand English
French
English
High Moderate Low None
High Moderate Low None

Speak 0 Speak 0
Read 0 Read 0
0 Write
·- . - ----· :D - - 0
Write
-- --- Understand 0 I
Understand 0
to speak moderately well or better.
C) Please indicate all languages that you are able
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in successfully settling in Canada.

and/ or personal qualities that would assist you
D) Give examples of any work experience. skills
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?ART C: ADDITIONAL FAMIL Y INFORMATIO
e commercial/telegraphic code. Korean. or
ge (for example. Arabic, Cyrillic. Chinese. Chines
Enter ALL names in English and in your native langua sectio n does not apply to you, write •Not applic able•.
d attach a separate sheet. If this
Japanese characters). If additional space is require

• Write the personal details in the boxes below for:

• yourself:

• your spouse or common-law partner;

• your mother; and

• your father.
Applic able.
n does not apply to you, answe r "NIA" for Not
You must answe r all questi ons. ff this sectio

iAM 0008 /10-2022) E

 J__. {.,'pl Pag-,4or7

Date of death. ,t
Date of birth City I Town and deceased Present Address Email Address
Name Relationship Mantal status
{YYYY-MM-DD) Country of Birth (YYYY-MM-OD)

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: .H yd)·.,
f,].)- - ) I Yourself ;"- i I/~
,1tgl1<111 i:.1'..dll
I:·l;:1;:::sj
~L,
J:•aki ., t ~n

Your spouse or
common-law
partner
-~ r 1 ":--c-t- _ l ,
:.., ·1.:(" 1:j,
r;ryab, :::-- : 1/:
Mother M,HL i.::,. J
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f'.1r:i,-.,:1

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Father MarL·i-=:·:1 1r;,.;, _ l .
an i~·tr..i, I.:; l -i~l-.,..,:- ,,,:t

f·:,i<i:.r: an

CHILDREN

Write the personal details in the boxes below for all the following persons. including:

• -all children (adult and minor)-regardless·of their marital·status (married.-singte. widowed:divorced). regardless of their current location and
regardless of their status in Canada (permanent resident or citizen);

• adopted children:

• children of your spouse or common-law partner for whom you are not the biological parent (step-children):

• any of your children who have been adopted by others:

• any of your children who are in the custody of an ex-spouse. former common-law partner or other guardian:

• any children who are missing. deceased or presumed deceased.

You must answer all questions. If this section does not apply to you, answer "NIA" for Not Applicable. If you require more space, please
either add lines to the form by clicking the +
button to the right or attach a separate sheet with the additional family members.
Date or death. ,f
Date of birth City/ Town and Marital status deceased Present Address Email Addr~ss
Name Relationship (YYYY-MM-DD) Country of Birth (YYYY -MM-DD I

IJ i P..

. -- - - -- - - - - - -- - . - - - -· - -~

BROTHERS AND SISTERS

Write the personal details in the boxes below for:
• brothers. sisters. half-brothers. half-sisters. step-brothers, step-sisters. ·adopted brothers and sisters. brothers and sisters who have been
adopted by others. regardless of marital·status (married. ·single. widowed. divorced) and regardless·of their current whereabouts

• any brothers and sisters who are missing / deceased or presumed deceased.

You must answer all questions. If this section does not apply to you, answer "NIA" for Not Applicable. If you require more space, please
•ither add line.s to thtt form by clicking the + button to the right or attach a separate shHt with the additional hlmily members.

IMM 0008 ( 10-2022) E

 Date of death. ,f
JJJ-2 1 Pag•5ol7

Date of brrth City / Town and Marital status deceased Present Address Email Address
Name Relationship
(YYYY-MM-DO) Country of Birth (YYYY -MM-OD)
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RELATIVES IN CANADA

Write the personal details of all relatives living in Canada.

If you require more space, please either add lines to the form by clicking the + button to the right or attach a separate sheet with the
additional relatives in Canada.

Name Relat1on6hip Telephone No Ct.1rrent City and Province of Residence Email Address

1) Ev-1c,,n [ 11 i V-:- MlE

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IMM 0008 (10-2022) E

I PARTD
Co ns en t an d De cla
rat ion
Page 6 of 7

All personal inform

ation provided on this
Immigration and Re application Is collec
fugee Protection ted by Immigration.
residence in Canada Ac t and will be use
d for the purpose of Refugees and ?itlzen
according to the req assessing and makin shi_p_Canada (IRCC
uirements of the Ac )_un~er the au thori
t and to facilitate you g a de a~ on you tyn~f the
r settlem ent in Canada if you r application for pe
Information related rmane
to: are selected.
• your identity. inc
luding any personal
• your resettlemen information from you
t needs related to you r immigrant case file
• information you r immediate health :
have provided in inte and safety; and
rviews to a migration
officer. including cop
o the UNHCR ·or an ies of supporting do .
other referral organ cuments. may be sha
iza tion with wh red wtth:
the purpose of referr ich the Minister of IRC
ing refugees: C has entered into
a Memorandum of
o the Internation Understanding for
al Organization for
Migration:
o any organiza
tion under contract
or that has an inform
Canada (IRCC) to ation-sharing arran
provide refugee pro gement with Immig
cessing services; ration. Refugees an
o any service provid d Citizenship
ing organization tha
t wilt be providing you
with settlement ser
o provincial public vices upon your arr
health authorities in ivat in Canada:
conditions -placed on Canada. if based up
your -admissibility to on the results of your Jmmig
Canada: "ration Medical Exam
o potential sponso ination you have
rship groups in Cana
da who may be inte
rested in sponsoring
o the sponsor in Ca you (and your famity.
nada who signed a if applicable): and
sponsorship for you
(and your family. if
13 appficable).
Assistance in comple
ting your applicatio
n
a) Did you receive
assistance in comple
application forms? ting the
0 No 0 Yes What is the name of
the individua l or organization tha
t assisted you?
b) Did you pay the
pe rso n/ organization
?
0 No D Yes
H ·Declaration of Applic
ant
I declare that the info
rmation I have given
is truthful, complete
and correct.

Signature of applic
ant
I Date (YY YY -M M- 00
)\

Personal informatio
n provided on this
Refugee Protection form is collected by
Act (IRPA). The pe Immigration, Refug
be disclosed to oth rsonal information ees. and Citizensh
er federal governm will be used for the ip Canada (IRCC)
ent institu.tions for purpose of proces under the authority
to law enforcement the purpose of val sing an application. of the tmmigration
bodies for the purpo ida ting info Th e personal inform an d
territorial governm se of validating identity. rm ation and eliQibility. ation provided ma
ents and foreign go eligibility and admis The personal inform y
medical practitioners vernments for the sibility. The perso ation may als o be
for the purpos-e of purpose of validating nal information ma disclosed
companies for the validating admissib eligibility and admis y als o be disclose
purpose of travel arr ility: to medical pro sibility. Th e perso d to provincial/
angement. viders for the purpo nal information ma
se of validating ide y also be disclose
ntity an d eligibility; d to
In accordance with an d to transportatio
the Immigration an n
processing of applic d Refugee Protection
ations and decision Act. lRCC may us
documents may als ma kin g. including on you e ele ctr on ic means such as co
o be used to suppo r application. Th e
personal informati
mputer analytics an
risk management, rt electronic proces on collected on an d automation to su
de vel op ing com sing, such as for res application an d on pp ort the
IRCC's Transparency puter analytics. str earch, statistics. pro supporting
webpage: ategy development gram and policy ev
• and reporting. To aluation. internal au
team more about dit. compliance.
ho w IRCC us es ele
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:::>erso_nal i~formatio
n may also be use
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gement. subseque including research
nt program eligibility. . statistics, progra
quality assurance. m an d policy evalua
strategy de ve lop me tion. internal au dit
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