PAGE 1 OF 1
IMM 5455 (01-2012) E
PROTECTED WHEN COMPLETED -
(DISPONIBLE EN FRANÇAIS - IMM 5455 F)
SUPPLEMENTARY IDENTIFICATION FORM
FOR OFFICIAL USE ONLY
1. Full name
2. Date of birth
4. Eye colour
Blue Green Grey Black Brown Hazel (yellowish brown)
Date of permanent residence
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