Name
Date of birth
(DISPONIBLE EN FRANÇAIS - IMM 5406 F)
ADDITIONAL FAMILY INFORMATION
IMM 5406 (06-2002) E
Citizenship and
Immigration Canada
Citoyenneté et
Immigration Canada
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 an
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 Access
to Information Act.
NOTE 2: If no children are listed in Section B, read and sign below.
NOTE 1: If no spouse or common-law partner is listed in Section A, read and sign below.
I certify that I do not have a spouse or a common-law partner, ex-spouse, or former common-law partner.
I certify that the information contained on this document is complete, accurate and factual. I also realize that once this document has been completed and signed
that it will form part of my Immigration Record and will be used to verify my family details on future applications.
Signature
I certify that I do not have any children, either natural or adopted.
SECTION B CHILDREN (Include ALL sons and daughters, including ALL adopted and step-children, regardless of age or place of residence)
Complete ALL names in English and in your native language (for example, Arabic, Cyrillic, Chinese, Chinese commercial/telegraphic code,
Korean, or Japanese characters). If additional space is required attach a separate sheet.
SECTION A
SECTION C BROTHERS AND SISTERS (Including half - and step-brothers and sisters)
SECTION D CERTIFICATION
Signature
Signature
Day Month Year
Day Month Year
Name Relationship Present addressDate of birth Place of birth
Marital
status
Date
Day Month Year
Date
Day Month Year
Day Month Year
Place of birth
Marital
status
Present address
Relationship
Applicant
Mother
Father
Relationship
SEE NOTE 2
Present addressDate of birth Place of birth
Marital
status
Name
Spouse or
common-law
partner
SEE NOTE 1
Date
Day Month Year
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