Employment and Emploi et PROTECTED WHEN COMPLETED - B

Social Development Canada Développement social Canada

Request to Add or Remove a name on an Labour Market Impact Assessment (LMIA)

LMIA Number: Request must be received 15 business days prior to LMIA

validity expiry date.
LMIA Validity Expiry Date (yyyy-mm-dd):
Business Legal Name:
CRA Business Number:

Foreign National name(s) to be Added or Removed from LMIA

Date of Birth Country of Residence

Add/Remove First Name(s) Last Name(s)
(yyyy-mm-dd) outside of Canada

**To replace a worker, provide information for the worker to be removed and then provide the information for the new worker
being added directly below.

Name of Employer (or employer representative):

Employer’s Phone Number: Fax Number:

Signature of Employer (or employer representative): Date (yyyy-mm-dd):

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