Fillable (PERMANENT RESIDENT ABROAD) APPLICATION FOR A TRAVEL DOCUMENT

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(PERMANENT RESIDENT ABROAD) APPLICATION FOR A TRAVEL DOCUMENT

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Country of origin: CANADA
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PART I - PERSONAL INFORMATION
PAGE 1 OF 3
Citizenship and
Immigration Canada
Citoyenneté et
Immigration Canada
APPLICATION FOR A TRAVEL DOCUMENT
(PERMANENT RESIDENT ABROAD)
Space reserved for
applicant's photo
Date of receipt stamp at post
Family name
1. Your full name (as it appears on your Record of Landing (IMM 1000) or
Confirmation of Permanent Residence (IMM 5292) or Permanent Resident
Card)
Given name(s)
2. Your sex Female Male
4. Your place of birth
Town/City
State/province
5. Country of
citizenship
This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants.
(DISPONIBLE EN FRANÇAIS - IMM 5524 F)
I want service in:
English French
Your telephone number
Country code Area code Number
( ) ( )
All individuals, regardless of age, must complete their own
application form. Parents or legal guardians must complete and
sign application forms for children under the age of 14.
Use an extra sheet of paper if you need more space to answer a
question. Print your name at the top of the sheet and indicate the
question number.
Other names
(for example,
maiden name,
son/daughter of,
other family name,
other given name)
Country
6. Passport
number
7. Your marital status (choose one)
Single Widowed Engaged Separated
Married Divorced Common-law partner
12c. Your mailing address outside Canada
(if different from above)
12a. Your permanent address in Canada
Street and no.
City Province
Country Postal code
Telephone Area code Number
number
12b. Your current address outside of Canada
()
9. The number on your Record of Landing, Confirmation of
Permanent Residence or Permanent Resident Card
City
Province
10. When were you last physically present in Canada?
Date
8. Date and place you became a permanent resident of Canada
Date
11. When do you intend to return to Canada?
Date
a.
NoYes
13. Answer Yes or No:
Were there any terms and conditions applied to you
at the time you were granted permanent residence
or landed in Canada?
Have you ever lost your status as a permanent
resident of Canada?
b.
Have you ever submitted an appeal to the
Immigration Appeal Division of the Immigration and
Refugee Board against a decision on the residency
obligation?
c.
Have you ever been issued a Returning Resident
Permit or a Travel Document?
d.
If you answered "YES" to any of the questions above, provide details
below. Use an extra sheet of paper if you need more space.
Your e-mail address
(if available)
IMM 5524 (11-2009) E
Expiry date
3. Your date of birth
Year Month Day
Year Month Day
Year Month Day
Year Month Day
Year Month Day
IMM 5524 (11-2009) E
Your activities and employment
14.
Give details of what you have been doing during the past five years. Include jobs held, periods of unemployment, time spent studying, etc. If you became a
permanent resident less than five years ago: list your activities and employment from the time you became a permanent resident to present.
PART II - RESIDENCY OBLIGATION
Refer to the guide for more information on meeting the residency obligation and on acceptable supporting documents.
If the total number of days is equal to or greater than 730 days, skip to the Declaration.
If the total number of days is less than 730 days, answer the following questions.
PAGE 2 OF 3
15. Time spent in Canada
When were you physically present in Canada? List all periods you spent in Canada during the past five years. If you became a permanent resident less than
five years ago: list time spent in Canada from the time you became a permanent resident to present.
Y Y
M M
City/Town, Province
Total number
of days
From To
TOTAL
Y YM M
Name of company,
school, etc.
City/Town, Province/State, Country
From To
Activity/Employment
Address
16. Absence while accompanying a Canadian citizen or a permanent resident outside Canada
Have you accompanied a Canadian citizen or permanent resident while outside Canada?
No
Yes
Name of person you accompanied
Family name Given name(s)
Relationship to you
Spouse
Canadian citizen. (Provide proof of his or her Canadian citizenship)
Common-law partner Parent
Permanent resident of Canada who is employed outside of Canada on a full-time basis by a Canadian business, or by
the federal or provincial public service in Canada.
(Provide proof of the person's status in Canada and proof of employment)
He or she is a
List the periods when you were outside of Canada and accompanying the person above during the past five years.
If you became a permanent resident less than five years ago: list the periods from the time you became a permanent resident to present.
Y Y
M M
City/Town, Country
Total number
of days
From
To
TOTAL
Address
(Provide proof of the person's relationship to you)
IMM 5524 (11-2009) E
Declaration
PAGE 3 OF 3
17. Absences while employed by a Canadian business
Have you been employed outside of Canada on a full-time basis by a Canadian business or by the public service of Canada or of a province of Canada?
No
Yes
(provide proof of this employment)
List the periods when you have been outside of Canada and employed on a full-time basis by a Canadian business or by the public service of Canada or of a
province of Canada during the past five years. If you became a permanent resident less than five years ago: list the periods from the time you became a
permanent resident to present.
Y YM
M
City/Town, Province
Total number
of days
From To
TOTAL
Total number of days from question 15
Calculation
Total number of days from question 16
Total number of days from question 17
GRAND TOTAL
If your grand total is equal to or greater than 730 days, skip to the Declaration.
If your grand total is less than 730 days and you have been a permanent resident for five years or more, answer question 18.
Note: If your grand total is less than 730 days and you have been a permanent resident for less than five years, you may wish to answer question 18. The visa
office will consider your answer to this question if it is apparent that you will not meet the residency obligation.
If the visa office determines that you do not meet the residency obligation, are there humanitarian and compassionate considerations that would justify the
retention of your permanent resident status? If applicable, also include humanitarian and compassionate considerations relating to the best interests of a child who
may be directly affected by this residency determination. Use an extra sheet of paper if you need more space.
The information you provide on this form is collected under the authority of the Immigration and Refugee Protection Act and will be used in determining
whether you meet the terms and conditions of your permanent residency according to the requirements of the Act. It will be retained in a Personal
Information Bank CIC PPU 068 Determination of Permanent Resident Status 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 and through the Citizenship and
Immigration Call Centre. Infosource is also available in Canadian public libraries.
• I certify that the information given on this form and in any documents attached is correct, complete and accurate.
• If this form pertains to a child under the age of 14, I certify that I am one of the child's parents or guardians.
• I understand the foregoing statements, having asked for and obtained an explanation on every point that was not clear to me.
• I further understand that the information provided by me may be verified and hereby consent to such verification activities.
• I also understand that it is a serious offence to provide false or misleading information and that the provision of false or misleading information may result in
loss of my permanent resident status and may be grounds for my prosecution or removal from Canada.
Signature
Date
Signature of
parent or guardian
(if applicant is under
the age of 14)
Date
Address
18. Humanitarian and Compassionate Grounds
Year Month Day
Year Month Day
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(PERMANENT RESIDENT ABROAD) APPLICATION FOR A TRAVEL DOCUMENT

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Completed 19 May 2021

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