Will accompany
you to Canada?
Full name
APPLICANT
Full name
(DISPONIBLE EN FRANÇAIS - IMM 5645 F)
FAMILY INFORMATION IMM 5645 (09-2010) E Citizenship and
Immigration Canada Citoyenneté et
Immigration Canada
BEFORE YOU START, READ THE INSTRUCTION GUIDE, TYPE OR PRINT IN BLACK INK.SECTION A PROTECTED WHEN COMPLETED - B
PAGE 1 OF 2
Date of birth Complete ALL names in English. Include ALL family members even if they are not accompanying you. If you need more space for any ction, print out an additional page containing the appropriate ction, complete and submit it with your application.
SPOUSE OR
COMMON-LAW PARTNER MOTHER FATHER Relationship
SEE NOTE 1Country of birth
Prent occupation
Prent address
(If decead give city and date)Marital status
Y M D NOTE 1: If no spou or common-law partner is listed in Section A, read and sign below.
I certify that I do not have a spou or a common-law partner.
SECTION B
CHILDREN (Include ALL sons and daughters, including ALL adopted and step-children, regardless of age or place of residence)
Date of birth Relationship
SEE NOTE 2Prent occupation
Prent address (If decead give city and date)Marital status
NOTE 2: If no children are listed in Section B, read and sign below.
I certify that I do not have any children, either natural or adopted.
Type of application:
Visitor
Worker
Student
Other
YES NO Date:
Day
Year Month Signature of applicant or parent/legal guardian's for a person under 18 years of age.
Signature:Ｂ部分 申请人之子女（包括所有子女及收养、继养之子女，无论年龄大小或居住地在何处均须填写）
咸萝卜的腌制方法Ａ部分
填表前请阅读此指南，并用黑色墨水填写并打印请用英文和您本国语言填写表中姓名（例如：阿拉伯文，西里尔文，中文，中文商用代码／中文电码，韩文或日文）。其中包括不陪同的家庭成员在内的
所有家庭成员姓名。如果任何栏目填写的空间不足够，请另附纸张打印出相对应的栏目来填写，与您的申请一并提交。
申请类别
访问
工作
学生
家属信息表
比喻论证
姓名
请查看提示１
亲属关系年 月 日出生国家
出生日期
婚姻状况
现行住址
如去世请注明城市和日期
带刺的植物图片现行职业
是否陪同你去加拿大？是 否
申请人
配偶或普通法伴侣
母亲父亲
提示１：在Ａ部分中如无配偶或普通法伴侣，请阅读以下内容并在横线上签名。
谨此声明，本人无配偶或普通法伴侣。
签名申请人签名，１８周岁以下申请人由父母或法定监护人签名。
日期
年月日姓名
亲属关系
请查看提示２
Country of birth
M D 年 月 日
出生国家
出生日期
婚姻状况
如去世请注明城市和日期现行职业
现行住址
Will accompany
you to Canada?
YES NO 是否陪同你去加拿大？
女符号
是 否
提示２：在Ｂ部分中如无子女，请阅读以下内容并在横线上签名。谨此声明，本人无任何子女，无论是亲生子女或收养子女。
Signature of applicant or parent/legal guardian's for a person under 18 years of age.
Signature:
签名
申请人签名，１８周岁以下申请人由父母或法定监护人签名。
Date:
Day Year Month 日期
年日月
其他
S
A M P
L E 样
本
IMM 5645 (09-2010) E
The information you provide on this form is collected under the authority of the Immigration and Refugee Protection Act to determine if you may be admitted to Canada as a temporary
resident. It will be stored in Personal Information Bank CIC PPU 055, Visitor Ca File. It is protected and accessible under the Privacy Act and the Access to Information Act .
花瓣怎么折I certify that the information contained on this document is complete, accurate and factual. I also realize that once this document has been completed and signed that it will form part of my Immigration Record and will be ud to verify my family details on future applications.
SECTION D
CERTIFICATION
PAGE 2 OF 2
Full name
SECTION C BROTHERS AND SISTERS (Include ALL brothers and sisters, ALL half-brother and sister and stepbrother and sister.)
Relationship
Marital status
Signature of applicant or parent/legal guardian's for a person under 18 years of age.
Signature:
姓名
亲属关系
Date of birth
Country of birth
Y M D 年 月 日
出生国家
出生日期
婚姻状况
Prent occupation
初三数学压轴题Prent address
女人那些话(If decead give city and date)如去世请注明城市和日期
现行职业
现行住址
Will accompany
you to Canada?
YES NO 是否陪同你去加拿大？是 否
Ｄ部分 声明
你不必太在意
谨此声明，本表所含信息是完整，准确和真实的。我明白一旦完整填写并签署此表，它将会成为我的入境申请记录的一部分，并会在未来的申请中被用于核实我的家庭信息。
申请人签名，１８周岁以下申请人由父母或法定监护人签名。
签名
Date:
Day
Year
Month 日期
年月日S
A M P
L E 样
本
