Fillable IMM1000/RECORD OF LANDING - Verification of Status

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IMM1000/RECORD OF LANDING - Verification of Status

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The IMM1000/RECORD OF LANDING - Verification of Status form is 5 pages long and contains:

  • 3 signatures
  • 33 check-boxes
  • 26 other fields

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File type: PDF

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P.O. Box 31037, College Square, Toronto, ON, M6G 4A7
Phone:
1-866-760-2623
Fax:
416-640-2650
Email : info@immigroup.com
$206.90
$342.50
IMM1000/RECORD OF LANDING - Verification of Status
57 Westchester Drive, London, Ontario, N6G 2K6
Phone:
1-866-760-2623
Fax:
416-640-2650
Email : info@immigroup.com
IMMIGROUP ORDER FORM
INSTRUCTIONS
Read all instructions and follow carefully
REGULAR SERVICE
Processing Time: 6 months
(subject to change without notice)
DISCLAIMER
Applicant must sign below
1. Please complete the order form and application forms included herein.
Make sure to include your telephone number and email address where you
can be contacted.
2. Fax or scan and email all forms and documents in the document checklist
to our office for review at
416-640-2650 or
info@immigroup.com.
3. You will be contacted within 1-2 business days regarding your application.
If you have not been contacted after 2 business days, please contact our
office at 1-866-760-2623 to confirm we have received your order.
4. After we have reviewed your forms and documents, we will advise you to
send the original forms and copies of documents to our office at
IMMIGROUP
57 Westchester Drive,
London Ontario, Canada N6G 2K6
Your immigration specialist may ask you to send the documents to a different address
5. You will receive your Verification of Status document by email (or
regular mail if you do not have access to email).
Including:
Immigroup Fee: $130
HST: $16.90
Government Fee: $30
Courier Fee: $30
PLEASE NOTE THAT CIC NO LONGER ISSUES CERTIFIED TRUE COPIES OF
DOCUMEMTS AS OF SEPTEMBER 12, 2012; ONLY AN UNCERTIFIED
DOCUMENT WILL BE ISSUED.
If you have been married since landing in Canada, you must
provide a copy of your marriage certificate.
Total fees:
* By signing below I assert that I have read and agreed to the terms and conditions as listed
on https://www.immigroup.com/terms-conditions and agree to the following conditions:
* Immigroup Inc is not responsible for applications that are rejected.
* All fees are non-refundable once applications are submitted to the government.
* I agree to being charged the total fees corresponding with my required service
* I assert that I am applying for my documents using Immigroup as my representative
* Government fees can be higher than stated on this application
(if applicable)
If applicable, include:
(written proof from Service Canada that your
application will be closed or you benefits will be
lost without your IMM 1000)
ADDITIONAL DOCUMENTATION MAY BE REQUESTED. IF YOU
DO NOT HAVE ALL OF THE DOCUMENTS, SEND WHAT YOU
HAVE AND WE WILL ADVISE YOU.
Including:
Immigroup Fee: $250
HST: $32.50
Government Fee: $30
Courier Fee: $30
Total fees:
URGENT SERVICE
Processing Time: 30 - 45 days
(subject to change without notice)
CREDIT CARD INFORMATION
DOCUMENT CHECKLIST
IMMIGROUP ORDER FORM
APPLICATION FORMS
duly completed and signed, including last page
COPY OF PASSPORT USED AT TIME OF
LANDING
If you do not have this passport, send a copy of your
current valid passport.
COPY OF DRIVER'S LICENSE (or other
photo ID)
COPY OF BIRTH CERTIFICATE
(with translation if document is not in English or French)
COPY OF CANADIAN CITIZENSHIP
CERTIFICATE
COPY OF MARRIAGE CERTIFICATE
Applicant Name
Cardholder Name
Card Number
Expiry Date
CVV Code
PROOF OF URGENCY
Cardholder
Signature
Signature
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signature
click to edit
PROTECTED WHEN COMPLETED - B
PAGE 1 OF 4
(DISPONIBLE EN FRANÇAIS - IMM 5009 F)
This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants.
1
VERIFICATION OF STATUS (VOS) OR REPLACEMENT OF AN IMMIGRATION DOCUMENT
(To be completed and returned with the application checklist)
Client ID number/UCI
PART A - PERSONAL DETAILS
2
Surname (Family name) on entry
3
Given name(s) on entry
4
Current surname (if different from name on entry)
5
Current given name (if different from name on entry)
6
Gender
F
Female
M
Male
X Another
gender
7
Date of birth
YYYY-MM-DD
8
Place of birth (City, state/province and country or territory)
9
Citizenship
10
Passport number Indicate if:
On entry Current
11
Date of
issue
YYYY-MM-DD
12
Expiry
date
YYYY-MM-DD
13
Marital status on entry
Never married Married
Widowed Separated Divorced Common-law partner
If you are married, is your spouse a
Canadian citizen or permanent resident?
Yes No
14
Language of correspondence
English French
15
Current mailing address
P.O. box Apt./Unit Street no. Street name
City/Town Country or territory Province/State Postal code
District
16
Residential address Same as mailing address?
YesNo
Apt./Unit Street no. Street name City/Town
Country or territory Province/State Postal code District
17
Telephone no. Canada/US Other
18
Alternate Telephone no. Canada/US Other
Type
Country Code No. Ext.
Type
Country Code No. Ext.
19
E-mail address: (Indicating an e-mail address will authorize all correspondence, including file and personal information, to be sent to the e-mail address you specify.)
PART B - DOCUMENTS REQUESTED
1
What type of request
are you making?
Verification of Status
Replacement of a valid temporary resident document
2
Immigration document
Date of Issue
YYYY-MM-DD
3
Canadian port of entry - Place of issue
4
Indicate for which of the following you need a replacement copy or a Verification of Status document. If you have more than one valid temporary resident
document, indicate the document ID number or if unknown, the document issue and expiry date of the requested document.
Immigrant Visa and Record of Landing -
Confirmation of Permanent Residence
Exclusion Order Departure Order
Authorization to Return to Canada
Permit to Come Into or Remain in Canada -
Temporary Resident Permit
Protected Person
Work Permit
ID No.:
OR Issue date:
(YYYY-MM-DD)
and Expiry date:
(YYYY-MM-DD)
Study Permit
ID No.:
OR Issue date:
(YYYY-MM-DD)
and Expiry date:
(YYYY-MM-DD)
Visitor Record
ID No.:
OR Issue date:
(YYYY-MM-DD)
and Expiry date:
(YYYY-MM-DD)
PAGE 2 OF 4
PART B - DOCUMENTS REQUESTED (continued)
5
Was your original
immigration document
Lost Stolen Destroyed Other
Provide details. If the document was a valid temporary resident document and was lost or stolen, indicate the police report number. If you do not have a police report
number, please provide a brief explanation in the space provided.
6
If you are requesting a Verification of Status of an Immigrant Visa and Record of Landing/Confirmation of Permanent Residence have you applied for it
before?
No Yes If yes, when did you apply?
YYYY-MM-DD
7
If you are applying for a Verification of Status of an Immigrant Visa and Record of Landing/Confirmation of Permanent Residence and you are not a Canadian
citizen, have you, since your admission to Canada as a permanent resident, been convicted of a crime or offence in Canada or elsewhere?
No Yes
If yes, attach copies of the relevant court documents.
8
Are you a Canadian citizen?
No Yes
9
List all names you have ever used.
Surname (Family name) Given name(s)
Other name(s)
(Middle name, maiden name, alias, initials, etc.)
10
Did you enter Canada as a
Visitor Student Worker Permanent Resident Protected Person
PART C - IF YOU ENTERED CANADA AS A PERMANENT RESIDENT PRIOR TO 1973, COMPLETE THE FOLLOWING SECTION
1
Provide the full names and date of birth of the person(s) who accompanied you on arrival in Canada.
(e.g., middle name, maiden name, English name or alias.)
Surname (Family name) Given name(s)
Other name(s)
(Middle name, maiden name, alias, initials, etc.)
Date of birth
YYYY-MM-DD
2
Were either of your parents born Canadian citizens?
No
Yes
3
What are the names and dates of birth of your parents?
Surname (Family name) Given name(s)
Other name(s)
(Middle name, maiden name, alias, initials, etc.)
Date of birth
YYYY-MM-DD
✔
PAGE 3 OF 4
4
What is/was the occupation of each of your parents?
Mother's occupation
Father's occupation
5
Had you or your parents ever been part of any military at the time you entered Canada?
No
Yes
DECLARATION
I solemnly declare that the information I have provided is, to the best of my knowledge, complete and accurate. I authorize the department of Citizenship and Immigration
Canada to verify the information I have provided. If I am requesting a replacement document and should I ever regain possession of the original document, I promise to
return it immediately to Citizenship and Immigration Canada.
Signature
Date
YYYY-MM-DD
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, law enforcement bodies, provincial/territorial governments and foreign governments for the purpose of validating identity, admissibility and
eligibility.
Personal information may also be used for other purposes including research, statistics, program and policy evaluation, internal audit, 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 068.
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signature
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SECTION D: YOUR DECLARATION
10. Your declaration
• I declare that I have fully and truthfully answered all questions on this form and any attached application (if applicable).
• I also declare that I have read and understood all the statements on this form, having asked and obtained an explanation for every point that was not
clear to me.
Signature of applicant Date (YYYY-MM-DD)
Signature of spouse or common-law partner for sponsorship application Date (YYYY-MM-DD)
Warning! It is a serious offence to give false or misleading information on this form.
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) and of the Citizenship Act. The personal information of the applicant is used for identification and authorization purposes. The
personal information of the immigration representative is used to verify that the representative is authorized to offer representation services according to the
provisions of IRPA and of the Citizenship Act.
The personal information of both the applicant and the representative may be disclosed to other federal government institutions, non-governmental and inter-
governmental organizations, regulatory bodies, investigative bodies, and provincial/territorial governments for the purposes of validating identity, information,
and supporting an investigation.
Personal information of both the applicant and the representative may be used for other purposes including research, statistics, program and policy evaluation,
internal audit, compliance, risk management, strategy development and reporting.
Failure to complete the form in full will result in a delay to processing. 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, 054, 068.
PROTECTED WHEN COMPLETED - B
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IMM1000RECORD OF LANDING - Verification of Status

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Completed 9 November 2021

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