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IMM 5444 (08-2016) E
G. DECLARATION OF APPLICANT
25. This declaration covers the information that I have provided on this form and all the information submitted with my application for a Permanent Resident Card as well
as the attached accompanying documents.
• I declare that the information I have given is truthful, complete and correct.
• I understand that any false statements or concealment of a material fact may be grounds for my prosecution or removal.
• The photographs enclosed are a true likeness of me.
• I am a permanent resident of Canada.
• I am not a Canadian citizen.
• I understand all the foregoing statements, having asked for and obtained an explanation on every point that was not clear to me.
• I realize that once this document has been completed and signed, it will form part of my Immigration Record and will be used to verify my family details on future applications.
• I will immediately inform Immigration, Refugees and Citizenship Canada if any of the information or the answers provided in my application forms change.
SIGN SECTION G BEFORE PROCEEDING TO SECTION H.
To avoid processing delays, ensure your application is not postdated or stale dated.
Signature
of declarant
Date
(YYYY-MM-DD)
City
Province
Signature of parent
or legal guardian,
if applicable
Date
(YYYY-MM-DD)
I am the applicant's:
(check appropriate box)
Mother Father Legal guardian
H. SOLEMN DECLARATION CONCERNING A LOST, STOLEN, DESTROYED OR NEVER RECEIVED PERMANENT RESIDENT CARD
26. Complete this section only if you are applying to replace a lost, stolen, destroyed or never received PR Card.
Permanent Resident Card number
Date of issue
(YYYY-MM-DD)
My Permanent Resident Card was
Lost
Destroyed
Stolen
Never received
► on or about
(YYYY-MM-DD)
at
Under the following circumstances (full information must be provided below):
I have made the following efforts to locate this document
(if applicable, indicate police authorities notified and attach a copy of police report or incident report number):
Should I ever regain possession of my original PR Card, I promise to destroy it immediately.
I solemnly declare that the information I have provided is true, that is of the same force and effect as if made under oath, and that it was freely given. I authorize the department of
Immigration, Refugees and Citizenship Canada to verify the information I have provided. I also understand that the provision of any false or misleading information may lead to
prosecution in accordance with Section 127 of the Immigration and Refugee Protection Act.
DO NOT SIGN HERE UNLESS YOU ARE DECLARING A LOST, STOLEN, DESTROYED OR NEVER RECEIVED PERMANENT RESIDENT CARD.
Signature
of declarant
Date
(YYYY-MM-DD)
Signature of parent
or legal guardian,
if applicable
Date
(YYYY-MM-DD)
The information you provide on this form is collected under the authority of the Immigration and Refugee Protection Act and will be used to determine whether the term and conditions
of your permanent residency were maintained and whether you should be granted a Permanent Resident Card. It will be retained in the Personal Information Bank CIC PPU 067
entitled Permanent Resident Card as identified in infosource. It may be shared with other organizations in accordance with the consistent use of information under the Privacy Act.
Under the Privacy Act and the Access to Information Act individuals have the right to protection of and access to their personal information. Details on these matters are available at
infosource.gc.ca. Infosource is also available at Public Libraries in Canada.
