ip Date of birth Place of birth Present addressР statusР Day Month YearРSECTION D CERTIFICATIONР I certify that the information contained on this document plete, accurate and factual. I also realize that once this document has pleted and signed Р that it will form part of my Immigration Record and will be used to verify my family details on future applications.Р Day Month YearР Signature DateР The information you provide is collected under the authority of the Immigration and Refugee Protection Act to determine if you may be admitted to Canada as anР immigrant. It will be stored in Personal Information Bank number EIC PPU 015. It is protected and accessible under the provisions of the Privacy Act and the AccessР to Information Act.РIMM 5406 (04-2008) E (DISPONIBLE EN FRANÇAIS - IMM 5406 F)
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