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ACCESS TO INFORMATION AND PERSONAL INFORMATION REQUEST - INSTRUCTIONS

IMPORTANT - PLEASE READ THE FOLLOWING
Please note that only the information requested on this form will be provided. Additional information requested through a letter, e-mail or the Treasury Board
Secretariat (TBS) request form will be disregarded if using this form. You must only submit one form, along with the necessary consent(s) and application fee, if
applicable.
NOTE: To request a certified copy of a landing record, please visit the following link: http://www.cic.gc.ca/english/information/applications/certcopy.asp.

WHAT YOU WILL NEED TO SUBMIT A REQUEST

1. Formal request
It must be signed and dated, and indicate which records you would like to receive.
2. Proof that you have the right to make a request
To be eligible, you must be a Canadian citizen, a permanent resident of Canada or an individual or corporation currently present in Canada.
Proof may include a copy of your Canadian passport, your permanent resident card, or an official document that proves you are currently living in
Canada (i.e. driver's license, bill with proof of address, work/study permits or visitor record).
3. Consent(s), if applicable
If you are making a request on behalf of someone else, you must include consent to release their information. The consent must be signed and dated by
the person authorizing the disclosure of his/her information.
Please use the following consent form when submitting an ATIP request: Consent for an Access to Information and Personal Information Request IMM 5744.
You must include consent for each individual listed in your file over the age of 18.
4. Application fee, if submitting your request under the Access to Information Act
There is a $5.00 application fee for requests made under the Access to Information Act. (There are no fees under the Privacy Act).
You must pay your fee by cheque or money order (made payable to the Receiver General for Canada).

SECTION A - DETAILS OF REQUEST

Check off the appropriate boxes to indicate:
1. The Act under which you are making a request;
2. The language of the records (the information recorded by the officer will not be translated; only the system interface will be in the language of your choice);
3. The format for record delivery;
4. Whether you are requesting your own information. If you are requesting information on behalf of another individual, you must include his/her consent (see
number 3 above).
NOTE: We cannot disclose personal information about an individual who has been dead for less than 20 years. In some cases, an exception will be made if
the executor of the estate or one having Power of Attorney requires the deceased's personal information to administer his/her estate. In these cases,
you must provide proof of death, which may include a copy of an obituary notice, a death certificate or a photograph of the person's tombstone, as
well as proof of executorship or Power of Attorney.

SECTION B - REQUESTER'S INFORMATION

1. Check off the box to indicate that you are a Canadian citizen, permanent resident of Canada or a person or corporation currently present in Canada and
thus eligible to make a request.
2. Select the category that best describes you. Please note that the business category includes all professions within the private sector, such as consultants,
lawyers, legal assistants, etc.
3. Write the name of your business or organization (if applicable).
4. Write your family name (surname).
5. Write your given name.
6. Fill in all applicable fields of your mailing address.
7. Make sure to include your telephone number, so that we can contact you should additional information be needed.
8. By filling in your e-mail address, you are authorizing correspondence, including documents and personal information, to be sent by e-mail.

SECTION C - INFORMATION REQUESTED

If you are requesting information on your own behalf, you do not need to re-write your family name and given name in questions 1 and 2. Simply proceed to
question 3.
1. Clearly write the family name (surname) of the individual whose information you are requesting.
2. Clearly write the given name, including any applicable aliases, of the individual whose information you are requesting. (If you are requesting a file with
multiple family members, you are only required to write the name of the principal applicant. You must, however, include a separate consent form for each
individual in your file over the age of 18 if you wish to receive their information as well.)
3. Include the date of birth of the individual whose information you are requesting.
4. Include the client ID number of the individual whose information you are requesting.
5. Select the information you would like to receive by checking off one of the two boxes: 5a or 5b.
5a) Notes in electronic file: You will receive the requested immigration or citizenship file as is found in CIC's computer systems.
5b) Physical file: You will receive the entire physical file of your choosing (select one of the seven options).
Note:

1) If you are requesting a Physical file that could have originated overseas, note that CIC may experience delays in the receipt of documents. This
could result in a delayed response to your request. However, by selecting Notes in electronic file, your request will be processed within the
legislated deadline. If you want a case status update and/or reason for refusal, it can be obtained by selecting Notes in electronic file.
2) If you select Sponsorship File, you will receive the sponsor's information. If you want the sponsored person's information, select Immigration file:
permanent residence.
3) X-rays will not be provided even when selecting medical file.

SECTION D - SIGNATURE AND DATE

You are required to sign and date your request form.
*If your request is incomplete, it will be returned and you will be required to submit a new request.

For more information about access to information and privacy, you can visit the Citizenship and Immigration Canada's web site at
http://www.cic.gc.ca/english/department/atip/index.asp.
IMM 5563 (10-2014) E

(DISPONIBLE EN FRANAIS - IMM 5563 F)

Citizenship and
Immigration Canada

Citoyennet et
Immigration Canada

PROTECTED WHEN COMPLETED - B

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Print Form

ACCESS TO INFORMATION AND PERSONAL INFORMATION REQUEST

SECTION A - DETAILS OF REQUEST
1

Please select the Act under which you are submitting this request:
Access to Information Act

FOR OFFICE USE ONLY

Privacy Act

Note: If you are submitting a request under the Access to Information Act, you must include the $5.00 application fee.
2

In which language do you wish to receive the requested records?

English

French

As is

Note: The information recorded by the officer will not be translated, only the system interface will be in the language
of your choice.
3

How do you wish to receive the records?

E-mail

CD

Are you requesting information on your own behalf?

Yes

No

Note: If no, you must include a consent to release the information.

Consent included

SECTION B - REQUESTER'S INFORMATION

1
2

I am a Canadian citizen, a permanent resident of Canada and/or a person or corporation currently present in Canada.
Select the category that best describes you:
Academia

Family name (surname)

Mailing Address

Apt/Unit
7

Street no.

Business (private sector)

Media

Organization

Public
5

Street name

Telephone number (including area code)

Proof included
Business or Organization Name (if applicable)

Decline to identity

Given name(s)

City/Town
8

Province

Postal code

E-mail address

SECTION C - INFORMATION REQUESTED

If your name is the same as provided in section B, skip to question number 3.
1

Family name (surname)

Select the information you would like to receive by checking off one of the two boxes: 5a or 5b (Please refer to instructions).
a)

Given name(s)

Notes in electronic file

b)

Date of birth (YYYY-MM-DD)

Client ID number / UCI

Physical file

Immigration file: temporary residence

Immigration file: temporary residence

File number

File number

Immigration file: permanent residence

Immigration file: permanent residence

File number

File number

Sponsorship file

Medical file (x-rays not included)

File number

Application for Permanent Resident Card

Application for Permanent Resident Card

Sponsorship file

Citizenship file

File number

CIC's information pertaining to refugee file

Citizenship/naturalization file
Landing record (non-certified copy only)
CIC's information pertaining to refugee file

Use the space below to provide any additional information to help clarify your request.

SECTION D: SIGNATURE AND DATE

1

Requester's signature

Date (YYYY-MM-DD)

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 or during investigations by the Office of the
Information Commissioner and the Office of the Privacy Commissioner and/or 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 Citizenship and Immigration Canada's web site.

Completed forms must be sent to the following address:

Access to Information and Privacy Division
Citizenship and Immigration Canada
Ottawa, Ontario K1A 1L1
IMM 5563 (10-2014) E

(DISPONIBLE EN FRANAIS - IMM 5563 F)