PROTECTED WHEN COMPLETED - B

Save Reset Form Print Form

Page 1 of 3

SCHEDULE 1
APPLICATION FOR PERMANENT RESIDENCE UNDER THE TEMPORARY PUBLIC
POLICY TO FACILITATE THE ISSUANCE OF PERMANENT RESIDENCE VISAS TO
CERTAIN COLOMBIAN, HAITIAN, AND VENEZUELAN NATIONALS WITH FAMILY IN
CANADA
This form must be completed by:
• you, the principal applicant.
Provide as much detail as possible when answering the following questions.
• If you need more space, attach a separate sheet of paper. Make sure you indicate the form's title and the number or letter of the question you are
answering. Print your name at the top and number each additional sheet.
For details and definitions, consult the instruction guide IMM 5991.

SECTION A - APPLICANT INFORMATION

a) Family name(s) (as shown on your passport/travel document) b) Given name(s) (as shown on your passport/travel document)

c) Passport/travel document number (if

d) Date of birth (YYYY-MM-DD) e) Country or Territory of birth (as shown on your passport/travel document)
applicable)

f) Citizenship (as shown on your passport/

g) Country of Residence h) Telephone number i) Marital status
travel document)

j) Personal email address

k) Residential address:

Apartment Number Street Number Street Name

City Province/Territory/State Country Postal code

SECTION B - REQUIREMENTS OF THE PUBLIC POLICY

1. Are you a citizen of one of the following countries? If ‘Yes’ please check one of the boxes.

Colombia Haiti Venezuela

No ► You are not eligible for the temporary public policy

2. Are you currently living in Central or South America, the Caribbean or Mexico?
Yes

No ► You are not eligible for the temporary public policy

3. Have you identified a Canadian citizen or permanent resident who will support your application (as an Anchor relative) and who meets the requirements of the temporary public
policy?

►
If yes please provide details (complete name of your Anchor and relationship to you) and demonstrate the relationship (documentation to confirm the
Yes
relationship)

No ► You are not eligible for the temporary public policy

This form is made available by Immigration, Refugees and Citizenship Canada and is not to be sold to applicants.

IMM 5989 (11-2023) E (DISPONIBLE EN FRANÇAIS - IMM 5989 F)

 Save Reset Form Print Form
Page 2 of 3

4. In which province or territory in Canada do you plan to live?

Province of Quebec ► You are not eligible for the temporary public policy
Any other Canadian province or territory

SECTION C - PRE-ARRIVAL FACILITATION

If you are eligible for this program, you will have access to some facilitation services, including coverage for the cost of the Immigration Medical Exam and other limited medical
services and products under the Interim Federal Health Program Pre-Departure Medical Services.

Please use the checkbox below to let us know if you and your accompanying family members will require the facilitation service available.
Immigration Loans Program Transportation Loan and International Organization for Migration (IOM) Travel Booking Assistance:

Yes No
• If you are selected for this program, you are responsible for paying for the costs of your travel to Canada. To cover these costs, you may access a Government of Canada
transportation loan by using IOM’s travel booking assistance.
• The IOM charges an assistance fee of CAD $300 per person for their travel booking assistance. The assistance fee and the cost of your flight tickets will be added to your
transportation loan.
• IOM’s travel booking assistance includes:
- facilitating application for exit permits (and, in some cases, application for waiving of exit fees)
- arranging transportation and accommodations when required to appear at a government office for exit permit processing
- assembling travel documents, including documents for transit countries and entry into Canada
- finalizing transportation loans for clients
- arranging transportation, accommodation and meal allowances during travel
o Note:
• If your travel itinerary includes long transit times, it is your responsibility to arrange and pay for overnight accommodations and meals, if required.
- ensuring the most direct route is taken (as far as operationally feasible), using a Canadian carrier or reliable non-Canadian carrier that has signed an agreement to provide
reduced migrant fares
- arranging an operational escort for travel when needed (when pre-approved by IRCC)
- assisting during travel when unforeseen circumstances are encountered in transit

Pre-arrival and in Canada Settlement Services

If your application is approved, you will be eligible to receive free assistance from a third party organization that provides settlement supports to immigrants coming to Canada. This
assistance includes information about living and working in Canada, an employment skills assessment and referrals to settlement services in Canada. You will be eligible to access
these services prior to your departure for Canada, as well as within your community to support your settlement once you arrive in Canada. These are available at no cost to you. IRCC
will contact you via e-mail after your application is processed to provide you with information on how to access these services.

Once in Canada, you will also be eligible for a one-time payment of financial assistance to help support your immediate settlement and integration needs. You will need a Canadian
bank account in order to access these funds. Your anchor relative is required to assist you with setting this up. If your application is approved, IRCC will contact you to provide you
with more information on accessing these funds.

SECTION D – CONSENT AND DECLARATION

All personal information provided on this application:
• is collected by Immigration, Refugees and Citizenship Canada (IRCC) under the authority of the Immigration and Refugee Protection Act,
• will be used to assess and make a decision on your application for permanent residence in Canada according to the requirements of the Act
• will be used to facilitate your settlement in Canada if you are selected.

Information related to:

• your identity, including any personal information from your immigrant case file;
• your resettlement needs related to your immediate health and safety; and
• information you have provided to IRCC, including copies of supporting documents, may be shared with:
○ the International Organization for Migration (IOM);
○ any organization under contract or that has an information-sharing arrangement with Immigration, Refugees and Citizenship Canada (IRCC) to provide services;
○ any service providing organization that will be providing you with settlement services upon your arrival, and;
○ provincial or territorial public health authorities in Canada, if based on the results of your Immigration Medical Exam, a condition is imposed on your admissibility to
Canada.

SECTION E – DECLARATION OF APPLICANT

I confirm that I have read and understood the contents of the form, and I declare that the information I have given is truthful, complete and correct

Signature of applicant Date (YYYY-MM-DD)

WARNING: It is an offence under Section 127 of the Immigration and Refugee Protection Act to knowingly make a false statement on this form.

IMM 5989 (11-2023) E

 Save Reset Form Print Form
Page 3 of 3

Personal information provided on this form is collected by Immigration, Refugees, and Citizenship Canada (IRCC) under the authority of the Immigration and Refugee Protection Act
(IRPA). The personal information will be used for the purpose of processing an application. The personal information provided may be disclosed to other federal government
institutions, non-governmental organizations for the purpose of validating information and eligibility. The personal information may also be disclosed to law enforcement bodies for the
purpose of validating identity, eligibility and admissibility. The personal information may also be disclosed to provincial/territorial governments and foreign governments for the purpose
of validating eligibility and admissibility.

Personal information may also be used for other purposes including research, statistics, program and policy evaluation, internal audit, compliance, program integrity, risk management,
subsequent program eligibility, strategy development and reporting.

Failure to complete the form in full may result in a delay or the application not being processed. The Privacy Act gives individuals the right of access to, protection, and correction of
their personal information. If you are not satisfied with the manner in which IRCC handles your personal information, you may exercise your right to file a complaint to the Office of the
Privacy Commissioner of Canada. The collection, use, disclosure and retention of your personal information is further described in IRCC's Personal Information Bank IRCC PPU 013,
042.

IMM 5989 (11-2023) E