Indicate whether you are
The principal applicant
The spouse, common-law partner or dependent child aged 18 years or older of the principal applicant
The principal applicant, his or her spouse or common-law
partner, if applicable, and all dependent children aged
18 years or older listed in the application for permanent
residence must complete their own copy of this form.
PROTECTED WHEN COMPLETED - B
PAGE 1 OF 4
SCHEDULE 1
BACKGROUND / DECLARATION
Citizenship and
Immigration Canada
Citoyenneté et
Immigration Canada
Family name
1. Your full name
Given name(s)
9. Have you, or, if you are the principal applicant, any of your family
members listed in your application for permanent residence in Canada,
ever:
This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants.
(DISPONIBLE EN FRANÇAIS - IMM 0008 F ANNEXE 1)
If there is not enough space to provide all the necessary information,
attach to this form a separate sheet of paper with further details. Print
your name at the top of each additional sheet and indicate the form's
title and the number of the question you are answering.
• been convicted of, or are you currently charged
with, on trial for, or party to a crime or offence,
or subject of any criminal proceedings in any
country?
NOYES
• previously sought refugee status in Canada or
applied for a Canadian immigrant or permanent
resident visa or visitor or temporary resident
visa?
• been refused refugee status in, or an immigrant
or permanent resident visa or visitor or temporary
resident visa to, Canada or any other country, or
have been refused a Certificat de sélection du
Québec (CSQ) to Quebec?
• been refused admission to, or ordered to leave,
Canada or any other country?
• been involved in an act of genocide, a war crime
or in the commission of a crime against humanity?
• used, planned or advocated the use of armed
struggle or violence to reach political, religious
or social objectives?
• been associated with a group that used, uses,
advocated or advocates the use of armed struggle
or violence to reach political, religious or social
objectives?
• been detained or put in jail?
• had any serious disease or physical or mental
disorder?
If your answer to any of these questions is YES, provide details below.
IMM 0008 (06-2002) E
SCHEDULE 1
2. Your full name written in your native language or script
(e.g., Arabic, Cyrillic, Chinese, Korean, Japanese characters or
Chinese commercial/telegraphic code)
3. Other names you are or have been using
(including name at birth, previous married names, aliases)
8. Personal details of your mother
Family name
at birth
Given name(s)
YearMonthDay
Date of birth
Town/City
of birth
Country
of birth
Date of death,
if deceased
YearMonthDay
• been member of an organization that is or was
engaged in an activity that is part of a pattern of
criminal activity?
5. Current country
of residence
4. Your date of birth
YearMonthDay
6. Your status
in that country
7. Personal details of your father
Family name
Given name(s)
YearMonthDay
Date of birth
Town/City
of birth
Country
of birth
Date of death,
if deceased
YearMonthDay
Before you start completing this form, make enough photocopies for your needs.
You can also print all or part of this form from our Web site at www.cic.gc.ca.