This area to be completed by IAD
IAD File No:
Date of birth: (yyyy/mm/dd)
Notice of Appeal - Removal Order Appeal
Section 63(2) or 63(3) of the Immigration and Refugee Protection Act
TIME LIMIT:
If you received your removal order at an admissibility hearing, you may provide this Notice of Appeal by hand to the
Immigration Division member at the end of your hearing.
If you did not do this at the end of your hearing, or if your removal order was not made at a hearing but was made at an
examination by an officer of the Minister, then you must provide to the Immigration Appeal Division (IAD) this Notice of Appeal and
a copy of the removal order. The IAD Registry Office must receive these documents no later than THIRTY (30) DAYS after you
received the removal order from the Immigration Division member or from the officer.
TO BE COMPLETED BY THE APPELLANT:
Immigration and Refugee Board of Canada
http://www.irb-cisr.gc.ca
Notice of Appeal - Removal Order Appeal
Page 1
This appeal also applies to the following persons who are included in this removal order:
Family name First name and middle names Relationship to me Date of birth (yyyy/mm/dd)
Check the appropriate box:
I choose the language of my appeal to be: English French I need an interpreter at the proceeding:
Language or dialect, if applicable
Address, number and street Apt. # City Province Postal code
Home telephone
(
Area code
)
(
Area code
)
)
)
Cellphone
Area code
(
Fax
My contact information is:
I ,
Family name
First and middle names
(appellant)
appeal a removal order made against me at
City
on
Date (yyyy/mm/dd)
If you are not living at the above address because you are serving a term of imprisonment, state where you are imprisoned:
Where
and the earliest date when it is possible for you to be released:
Date (yyyy/mm/dd)
Email Address:
UCI
IRB / CISR 666A (2020.01)
Disponible en français
using the email address below. I understand the IRB and CBSA cannot guarantee the security of email messages I send to them or I receive from them.
I authorize the Immigration and Refugee Board (IRB) and Canada Border Services Agency (CBSA) to correspond with me by email for the purposes of this
appeal
Area
code
(
Work telephone
For IAD office use only
IAD File No:
COUNSEL:
You have the right to be represented by counsel, at your own expense. If you choose to retain counsel who charges a fee or other
consideration, the counsel must be a member in good standing of either a provincial law society (including a lawyer or paralegal), the
Chambre des notaires du Québec, or the Immigration Consultants of Canada Regulatory Council (ICCRC). If you have retained counsel,
please complete the section below. If you will be retaining counsel later, you must provide to the IAD, in writing and without delay, the
contact information for your counsel (name, address, telephone and fax numbers, any e-mail address, their membership identification
number and the name of their organization).
No
Given Name and Surname (Mr., Mrs., Ms., Miss, Me)
Occupation Organization or Company
Number and Street Apt. # City Province Postal Code
IMPORTANT: If you fail to appear for a hearing, or fail to communicate with the IAD when requested, or fail to
provide information required by the IAD (such as your most recent address), the IAD may declare your appeal
abandoned in accordance with subsection 168(1) of the Immigration and Refugee Protection Act without any further
notice to you. If your appeal is abandoned, this means that your appeal has ended.
For Office Use Only
Received on:
I have attached a copy of the removal order, which I received on:
(not necessary if you are providing this notice of appeal at the end of
your admissibility hearing)
Date (yyyy/mm/dd)
Appellant's signature
signed at
City
on
Date (yyyy/mm/dd)
Immigration and Refugee Board of Canada
http://www.irb-cisr.gc.ca
Notice of Appeal - Removal Order Appeal
Page 2
IRB / CISR 666A (2020.01)
Disponible en français
I authorize the following person to be my counsel (to be completed by your counsel):
Is your counsel receiving a fee or other consideration to represent you in this appeal?
Yes
Telephone: (416) 954-1000 Fax: (416) 954-1165 Email: IRB.IAD-C-SAI.CISR@IRB-CISR.GC.CA
74 Victoria Street, Suite 400, Toronto, Ontario M5C 3C7
Immigration Appeal Division
Immigration and Refugee Board
where
you
are
residing
(see
attached
instructions
for
addresses).
Please
direct
all
communication
to
the
IAD
Registry
Office
that
serves
the
province
or
territory
without delay, if the contact information for you or your counsel changes.
IMPORTANT:
You must notify the Immigration Appeal Division ( IAD), in writing and
Telephone Number
(
Area code
)
Fax Number
(
Area code
)
Email Address:
Membership Identification No.:
Lawyer / Paralegal / Notary:
Immigration Consultants of Canada Regulatory Council (ICCRC)
Province
using the email address below. I understand the IRB and CBSA cannot guarantee the security of email messages I send to them or I receive from them.
I authorize the Immigration and Refugee Board (IRB) and Canada Border Services Agency (CBSA) to correspond with me by email for the purposes of this
appeal
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