Signature - Immigration, Refugees and Citizenship Canada
Signature - Immigration, Refugees and Citizenship Canada
Signature
Required documents checklist
Privacy notice
Personal information provided on this form is collected and will be used, disclosed, and
retained by Immigration, Refugees and Citizenship Canada (IRCC) under the authority of
the Immigration and Refugee Protection Act (IRPA). The personal information provided will
be used for the purpose of processing applications. The personal information provided may
be disclosed to other federal government institutions and third parties including law
enforcement bodies, provincial/territorial governments and/or foreign governments for the
purpose of validating identity, eligibility and admissibility.
The personal information collected on an application, and other information collected in
support of an application, may be used for advanced analytics, automation, and other
technologies to support processing of applications and decision making, including your
application. Personal information, including from advanced analytics, automation, and
other technologies, may also be used for purposes including research, statistics, program
and policy evaluation, internal audit, compliance, risk management, strategy development
and reporting.
Where biometrics are provided in support of an application, the fingerprints collected will
be stored and shared with the RCMP. The fingerprint record may also be disclosed to law
enforcement agencies in Canada in accordance with subsection 13.11(1) of the Immigration
and Refugee Protection Regulations. The information may be used to establish or verify the
identity of a person in order to prevent, investigate, or prosecute an offence under any law
of Canada or a Province. This information may also be used to establish or verify the
identity of an individual whose identity cannot reasonably be otherwise established or
verified because of physical or mental condition. Canada may also share immigration
information related to biometric records with foreign governments with whom Canada has
an agreement or arrangement.
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. Further details are available in Info Source. 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 068.
Consent and declaration
Declaration of applicant
I have read and understand the above.
I declare that the information I have given in this application is truthful, complete and
correct.
I understand that misrepresentation is an offence under section 127 of the Immigration
and Refugee Protection Act and may result in a finding of inadmissibility to Canada or
removal from Canada.
I agree that by typing my name and clicking sign, I am electronically signing my application.
Signature
I agree that by submitting this application, I am electronically signing the application.
I, SAMUEL GACHARA NDUNGU, solemnly declare that the information I have provided is
true and that the documents I am submitting in support of my application are genuine and
have not been altered in any way.
Your application has not yet been submitted. Your application will be submitted once your
payment is processed.
Make sure you have your payment information ready. If you don't have your payment
information, save your application, and continue when you have it. You will have 2 hours to
pay and submit your application. You will see a fee summary before paying your fees.
Your account will sign you out after 20 minutes. If your session times out while you are
paying your client's fees, your client's application will still be submitted. Sign back in to your
account to see your client's acknowledgement of receipt letter. It may take a few hours for the
letter to be sent to your account.
Exit questionnaire
Important: This information is for reference only and no immigration decision will be made
based on your answers. If you choose to apply, your application will be considered by an
immigration officer in accordance with the Immigration and Refugee Protection Act, without
regard to any outcome you attain through this questionnaire. Read the full notice
Date modified:
2024-03-20