Immigration and Refugee Board of Canada
http://www.irb-cisr.gc.ca
Notice of Appeal - Residency Obligation
Page 1
Family name
First name and middle names
Relationship to me
Date of birth
(yyyy/mm/dd)
In Canada, I may be contacted through:
Name
Apt. #
City
Province
Postal code
Telephone number
( )
Area code
My last physical residence in Canada was in:
City / District Province
Date of birth (yyyy/mm/dd)
Visa Office:
This area to be completed by IAD
IAD File No:
I ,
, (appellant)
UCI No:
I
choose
the
language
of
my
appeal
to
be:
English
French
I need an interpreter at the
proceeding:
Check the appropriate box:
appeal the Immigration, Refugees and Citizenship (IRCC) decision made outside Canada on my residency obligation
.
Family
name
First
and
middle
names
I do not intend to return to Canada for the hearing of my appeal.
I would like to participate in my hearing by telephone or some other manner
hearing.)
60 days after the IAD receives this Notice of Appeal. The IAD will decide your application based upon whether it is necessary for you to be present at your
your written application for a travel document to return to Canada must be received by the IAD Registry Office and the Minister's counsel no later than
(Note: If you need a travel document to return, and you cannot get one from IRCC, then you must make an application to the IAD. Under the IAD Rules,
I wish to return to Canada to appear at my hearing in person.
Language, including any dialect, if applicable
IRB / CISR 665 (2020.01)
Disponible en français
individual Notice of Appeal using a separate copy of this
form
.
obligation. Use an additional sheet if necessary.
This is for cross-referencing of your family's appeals ONLY. Each family member must submit their
own
Please list your family members (spouse
or
partner, dependent children) who are also submitting Notices
of
Appeal
about IRCC's decision
on
their residency
TO
BE COMPLETED
BY
THE
APPELLANT:
after you received the IRCC written decision.
must be received by the IAD Registry Office for the region in Canada where you last resided no later than SIXTY (60) DAYS
Immigration, Refugees and Citizenship (IRCC) decision made outside Canada on your residency obligation. These documents
TIME
LIMIT:
You must provide to the Immigration Appeal Division (IAD) this Notice of Appeal and a copy of the
Section 63(4) of the
Immigration and Refugee Protection Act
Notice of Appeal - Residency Obligation Appeal
Immigration and Refugee Board of Canada
http://www.irb-cisr.gc.ca
Notice of Appeal - Residency Obligation
Page 2
This area to be completed by IAD
IAD File No:
My current address is:
Number and street
Apt. #
City
Postal code
Given Name and Surname (Mr., Mrs., Ms., Miss, Me)
Occupation
Organization or Company
Number and Street
Apt. #
City
Province
Postal Code
Telephone Number
( )
Area code
Fax Number
(
)
Area code
Province / State
Telephone Number (Home)
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
No
and
fax
numbers, any e-mail address, their membership identification number and the name
of
their organization).
retaining counsel later, you must provide
to
the IAD,
in
writing and without delay, the contact information for your counsel (name, address, telephone
or
the Immigration Consultants
of
Canada Regulatory Council (ICCRC).
If
you have retained counsel, please complete the section below.
If
you will
be
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,
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:
IRB / CISR 665 (2020.01)
Disponible en français
(
)
(
)
Country code
Area
code
Country
Email Address:
Membership Identification No.:
Lawyer / Paralegal / Notary:
Immigration Consultants of Canada Regulatory Council (ICCRC)
Province
Country code
Area code
(
)
(
)
Telephone Number
(Cell)
Email Address:
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
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
IMPORTANT - CHANGE IN CONTACT INFORMATION FOR YOU OR YOUR COUNSEL:
You must notify the IAD, in writing and without delay, if the contact information for you or your
counsel changes. Please direct all communication
to
the IAD Registry Office that serves the province
or
territory where you are residing (see attached instructions for addresses).
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.
I have attached a copy of the officer's written decision, which I received on:
Date (yyyy/mm/dd)
Appellant's signature
signed at
on
City
Date (yyyy/mm/dd)
For Office Use Only
Received on:
IRB / CISR 665 (2020.01)
Disponible en français
Page
3
Notice of Appeal -
Residency Obligation
http://www.irb-cisr.gc.ca
Immigration
and
Refugee Board
of
Canada
click to sign
signature
click to edit
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