Get Imm 5475

IMM 5475 12-2004 E This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants DISPONIBLE EN FRAN AIS - IMM 5475 F. Fillable Form Citizenship and Immigration Canada Citoyennet et IMM PROTECTED WHEN COMPLETED - B AUTHORITY TO RELEASE PERSONAL INFORMATION TO A DESIGNATED INDIVIDUAL 12-2004 E Complete this form if you authorize Citizenship and Immigration Canada CIC and Canada Border Services Agency CBSA to release information from your case file to someone other than yourself. If your spouse or common-law partner wishes to release personal information to the same designated individual he or she should sign in the space provided. Your dependent children who are 18 years of age or older must complete their own copy of this form if they wish to authorize CIC and CBSA to release their information to a designated individual. The individual you designate will be able to obtain information such as the status of your application and will be able to change your address if you move. However he or she will not be a representative who can conduct business with CIC and CBSA on your behalf. If you wish to be represented you must complete and submit form Use of a Representative IMM 5476. Choose one Your designated individual s full name Family name Surname I authorize Citizenship and Immigration Canada and Canada Border Services Agency to release information from my case file to the following individual. Given name s I withdraw my authorization to release information from my case file to the following individual. Your full name Name of firm or organization if applicable Mailing address Day Month Year Your date of birth If you have already submitted your application City Province/State/Territory Country Postal code/Zip Name of office where the application was submitted Telephone number Location of office Fax Type of application permanent residence extension of study permit etc. Country code Area code E-mail address if applicable Your Client Identification ID or Unique Client Identifier UCI number identification number if known Your declaration I understand the following statements having asked for and obtained an explanation for every point that was not clear to me. Choose one Your designated individual s full name Family name Surname I authorize Citizenship and Immigration Canada and Canada Border Services Agency to release information from my case file to the following individual. Given name s I withdraw my authorization to release information from my case file to the following individual. Your full name Name of firm or organization if applicable Mailing address Day Month Year Your date of birth If you have already submitted your application City Province/State/Territory Country Postal code/Zip Name of office where the application was submitted Telephone number Location of office Fax Type of application permanent residence extension of study permit etc. Country code Area code E-mail address if applicable Your Client Identification ID or Unique Client Identifier UCI number identification number if known Your declaration I understand the following statements having asked for and obtained an explanation for every point that was not clear to me. If you are giving your authorization above. I am aware that some information may not be released if it is subject to exemption under the Privacy Act or the Access to Information Act. I further authorize the designated individual to update the address listed in my file as required. If you are withdrawing your authorization Signature of spouse or common-law partner if applicable Signature of applicant Date If you have not yet submitted your application Send this form along with your application to the office listed in your respective application kit.