Fillable SUPPLEMENTARY IDENTIFICATION FORM (Government of Canada)

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SUPPLEMENTARY IDENTIFICATION FORM (Government of Canada)

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Country of origin: CANADA
File type: PDF

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PAGE 1 OF 1
IMM 5455 (01-2012) E
PROTECTED WHEN COMPLETED -
B
(DISPONIBLE EN FRANÇAIS - IMM 5455 F)
SUPPLEMENTARY IDENTIFICATION FORM
FOR OFFICIAL USE ONLY
Client ID
IMMIGRANT IDENTIFICATION
1. Full name
Surname
Given name(s)
2. Date of birth
Date (YYYY-MM-DD)
3. Height
cm
OR
ft in
4. Eye colour
Blue Green Grey Black Brown Hazel (yellowish brown)
Other
Date of permanent residence
►
(YYYY-MM-DD)
Please read these instructions carefully. If the instructions are not followed correctly, your application will be returned to you.
• DO NOT glue the picture in the box (square) below as it may damage the picture. This box is reserved for office use only.
Place the photos in a small envelope and write the name of the applicant on the envelope.
For office use only
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SUPPLEMENTARY IDENTIFICATION FORM (Government of Canada)

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Completed 11 September 2021

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