Fillable SETTLEMENT PLAN AND FINANCIAL ASSESSMENT Group of Five (Government of Canada)

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SETTLEMENT PLAN AND FINANCIAL ASSESSMENT Group of Five (Government of Canada)

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PAGE 1 OF 3
IMM 5373A (02-2018) E
PROTECTED WHEN COMPLETED -
B
(DISPONIBLE EN FRANÇAIS - IMM 5373A F)
SETTLEMENT PLAN AND FINANCIAL ASSESSMENT
Group of Five
A - GENERAL INFORMATION
Name of principal applicant
Surname (family name)
Given names Date of birth (YYYY-MM-DD)
Name of Sponsoring Group
B - SETTLEMENT NEEDS CHECKLIST
* Settlement Needs: For each settlement need, specify if your group can provide monetary or in-kind support and give the corresponding dollar figure.
Settlement Needs
Monetary Support Annual Amount In-Kind In-Kind Deduction
START-UP COSTS
Clothing
$ $
Furniture
$ $
Household start-up costs
$ $
Food staples
$ $
Hook-up costs
$
n/a n/a
School start-up costs (if applicable)
$ $
TOTAL START UP COSTS Total:
$
Total:
$
ONGOING EXPENDITURES
Shelter (monthly rent X 12 months)
$ $
Transportation (public transit) (monthly costs X 12 months)
$
n/a n/a
Living allowance (food, incidentals, etc.) (monthly costs X 12 months)
$
n/a n/a
TOTAL ONGOING EXPENDITURES Total:
$
Total:
$
GRAND TOTAL:
$ $
C - SETTLEMENT CHECKLIST
Confirm, by checking the appropriate boxes, which settlement needs your group will provide to the refugees. If one or more of the settlement needs indicated below is not applicable
to your group or if your group is not willing to provide one or more of the settlement needs, please provide an explanation in the box at the end of this section.
Meet refugees upon arrival and provide transportation to the final destination
Arrange transportation for the refugees to and from appointments and activities
Arrange for interpreter services (if applicable)
Provide orientation (public transportation, banking services, etc.)
Enroll adult refugees in language training (if applicable)
Provide assistance in finding employment
Provide assistance in linking the refugees with community activities
Plan for refugees to see a health care worker shortly after arrival
Assist refugees in selecting a family physician, a dentist, etc.
Assist refugees in applying for provincial and Interim Federal Health plans
Enroll children in school (if applicable)
Make child care arrangements (if applicable)
Apply for child tax benefit (if applicable)
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PAGE 2 OF 3
IMM 5373A (02-2018) E
Provide further details if your group will not provide a settlement need indicated above or explain why a settlement need is not applicable.
D - SETTLEMENT PLAN - DETAILS
Please give details that your group has made or intends to make to help the refugees settle. All of these questions must be answered in full for this application to be processed.
As sponsors, you must arrange for proper accommodations for the refugees. Indicate where the refugees will reside by providing, if known, the complete address (or
addresses if refugees will first reside in temporary accommodations) and provide details of the accommodations:
As sponsors, you must register the refugees for settlement activities (language training, finding a job, etc.). Indicate which immigrant settlement agencies are available
and accessible to the refugees and what services they offer:
As sponsors, you must plan, if applicable, to refer refugees to support or service centres for persons dealing with a trauma or crisis. Explain if any special
accommodations are required for the refugees. If accommodations are required, provide details regarding your group's plan to accommodate:
E - FINANCIAL ASSESSMENT
* This section will allow the group to predetermine if it has committed sufficient funds to the sponsorship.
* Use the dollar amounts indicated on the Group's financial documents and/or individual member's Financial Profile (IMM 5373B, Section F) and the
dollar amounts listed in the two cost tables below to fill out this section
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PAGE 3 OF 3
IMM 5373A (02-2018) E
Financial Commitment
Funds held in trust
$
Member 1 Financial Commitment
+ $
Member 2 Financial Commitment
+ $
Member 3 Financial Commitment
+ $
Member 4 Financial Commitment
+ $
Member 5 Financial Commitment
+ $
Total Financial Commitment : = $
FOR IRCC USE ONLY
Financial Requirement
Final Cost of Sponsorship : = $
Total Cost of Sponsorship: (column C below)
$
Total In-Kind Deduction: (from page 1)
- $
Family Size
12 Months of Income
Support
Start-up Costs
Estimated Total Annual
Settlement Cost ($)
1 10,700 2,800 13,500
2 18,000 4,400 22,400
3 18,900 5,300 24,200
4 21,200 7,000 28,200
5 23,700 7,200 30,900
6 25,700 8,000 33,700
Additional member 1,550 1,000 2,550
Sponsorship Cost Table ($)
In-Kind Deduction Table ($)
Family Size Shelter Clothing Furniture
Start-up Costs
(household needs)
School
Start-up Costs
Food Staples
1 6,900 500 1,500 325 175
2 8,300 1,000 2,000 350 250
3 9,000 1,375 2,500 375 325
4 9,600 1,750 3,000 400 400
5 10,800 2,125 3,500 425 475
6 10,800 2,500 4,000 450 550
For each additional member, add 900 375 500 25 150 per child
between ages
4 - 21
75
F - DECLARATION
Signature
Date (YYYY-MM-DD)
SIGNATURE OF
GROUP REPRESENTATIVE
I declare that the information given on this form and any attached documents are true, complete and accurate.
The information you provided on this form is collected under the authority of the Immigration and Refugee Protection Act and will be used to maintain a record of application and
sponsorship undertakings by local Groups of Five or more individuals according to the requirements of the Act. It will be retained in the Personal Information Bank CIC PPU 008
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. Infosource is also
available at Public Libraries in Canada.
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SETTLEMENT PLAN AND FINANCIAL ASSESSMENT Group of Five (Government of Canada)

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Completed 18 April 2022

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