The principal applicant, his or her spouse or common-law partner, if applicable, and all dependent children aged 18 years or older listed in the application for temporary residence must complete their own copy of this form.

*Indicate whether you are

 The principal applicant

 The spouse, common-law partner or dependent child aged 18 years or older of the principal applicant

 

1. Full Name

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

Given name(s) (as shown on your passport or travel document)

2. Date of Birth             YYYY  MM  DD

3.  UCI

Canada places a high value on bringing those who commit acts of genocide, war crimes or crimes against humanity to justice. Canada was the first country to incorporate the obligations of the Rome Statute into its national laws.

4.  Military Service

Did you serve in any military, militia, or civil defence unit or serve in a security organization or police force (including non obligatory national service, reserve or volunteer units)?

  *No     *Yes  - Give the following details:

From
YYYY/MM

To
YYYY/MM

Location/Place where stationed

Province

Country

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or desecration of religious buildings?

  *No     *Yes  - Give the following details:

From
YYYY/MM

To
YYYY/MM

Location

Province

Country

 

 

 

 

 

Details:

 

 

 

 

 

 

 

 

 

 

Details:

 

 

 

 

 

Details: