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Get Canada IMM 5744 2016

PROTECTED WHEN COMPLETED - B PAGE 1 OF 1 CONSENT FOR AN ACCESS TO INFORMATION AND PERSONAL INFORMATION REQUEST Complete this form if you authorize the Access to Information and Privacy ATIP Division at Immigration Refugees and Citizenship Canada IRCC to release your personal information to someone other than yourself. Please be advised that you must submit a separate consent form for each individual in your file over the age of 18 if you wish to receive their information as well. SECTION A - You must clearly write your name and date of birth 1 Your full name Family name surname Given name s Date of birth YYYY-MM-DD Signature Date YYYY-MM-DD SECTION B - If you are also seeking the information of your spouse or common-law partner in your ATIP request you must indicate their name and signature 2 Your spouse or common-law partner s full name if applicable Telephone number Business or Organization Name if applicable Immigration Consultants of Canada Regulatory Council ICCRC number if applicable E-mail address I authorize IRCC to release my personal information to the individual named above by Mail Email Signature of representative SECTION D - If the applicant is under 18 years of age the parent or guardian must complete this section Name of parent or guardian please print Relationship NOTE This consent is only valid for one time use. A new consent form must be filled out for every request that you submit. The information you provided on this form is collected under the authority of the Access to Information Act and the Privacy Act and will be used to administer these acts as well as to process and respond to requests. This information may also be used during consultations with other government institutions during investigations by the Office of the Information Commissioner and the Office of the Privacy Commissioner and during court reviews. It will be retained in Personal Information Bank CIC PSU 901 Access to Information and Privacy Requests. It may also be shared with other organizations in accordance with the consistent use of information as per paragraph 8 2 of the Privacy Act. Pursuant to the Access to Information Act and the Privacy Act individuals have the right to the protection of and access to their personal information* Details of these matters are available at infosource. gc*ca and through the Immigration Refugees and Citizenship Canada web site. IMM 5744 07-2016 E DISPONIBLE EN FRAN AIS - IMM 5744 F. A new consent form must be filled out for every request that you submit. The information you provided on this form is collected under the authority of the Access to Information Act and the Privacy Act and will be used to administer these acts as well as to process and respond to requests. This information may also be used during consultations with other government institutions during investigations by the Office of the Information Commissioner and the Office of the Privacy Commissioner and during court reviews. This information may also be used during consultations with other government institutions during investigations by the Office of the Information Commissioner and the Office of the Privacy Commissioner and during court reviews. It will be retained in Personal Information Bank CIC PSU 901 Access to Information and Privacy Requests. .

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