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PROTECTED WHEN COMPLETED - B

IMM 5257 (06-2019) E

This form is made available by Immigration, Refugees and Citizenship Can ada and is not to be sold to applicants. (DISPONIBLE EN FRANÇAIS - IMM 5257 F)PAGE 1 OF 5 APPLICATION FOR VISITOR VISA (TEMPORARY RESIDENT VISA) APPLICATION FOR VISITOR VISA (TEMPORARY RESIDENT VISA) If you need more space for any section, print out an additional page con taining the appropriate section, complete and submit it with your application.

UCI* I want service in2* Visa requested3

PERSONAL DETAILS

1Full name

*Family name (as shown on your passport or travel document)

Given name(s)

(as shown on your passport or travel document) 2

Family name

Given name(s)Have you ever used any other name (e.g. Nickname, maiden name, alias, e tc.) ? * No* Yes *Sex3* Date of birth YYYY

MM DDPlace of birth

* City/Town * Country or Territory *Citizenship 6

Current country or territory of residence:

Country or TerritoryStatusOtherFromTo

Previous countries or territory of residence:

During the past five years have you lived in any country or territory o ther than your country of citizenship or your current country or territory of residence (indicate d above) for more than six months? * No* Yes

Country or TerritoryStatusOtherFromTo

Country or Territory where applying:

* No* Yes

Country or TerritoryStatusOtherFromTo

Same as current country or territory of residence?

YYYY-MM-DDYYYY-MM-DD

YYYY-MM-DD YYYY-MM-DD

YYYY-MM-DD YYYY-MM-DD

YYYY-MM-DD

YYYY-MM-DD

45
7 8 9

Validated

OFFICE USE ONLY

1 b) (If you are married or in a common-law relationship)

Provide the date

on which you were married or entered into the common-law relationship

10* a) Your current marital statusDate

Family name

Given name(s)

c) Provide the name of your current Spouse/Common-law partner

YYYY-MM-DD

FOR OFFICE USE ONLY - DO NOT WRITE IN THIS SPACE

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