Applicant Information
What travel document do you plan to use to travel to Canada?
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What is the nationality noted on this passport?
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Select the code that matches the one on your passport.
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Passport Information
Passport number
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Birthday
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Given name(s) / first name(s)
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Surname(s) / last name(s)
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Gender
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Country/territory of birth
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City/town of birth
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Date of issue of passport
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Date of expiry of passport
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Personal Information
Indicate which countries/territories you are a citizen of
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Marital status
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Current Employment Status
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Contact Details
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Preferred language to contact you
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Residential address
Country/Region
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Address
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Address - line 2
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City
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Zip / Postal code
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Trip Details
Do you know when you will travel to Canada?
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Background Questions
Have you ever been refused a visa or permit, denied entry to, or ordered to leave Canada or any other country/territory?
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Have you ever committed, been arrested for, been charged with or convicted of any criminal oence in any country/territory?
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In the past two years, were you diagnosed with tuberculosis or have you been in close contact with a person with tuberculosis?
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Do you have one of these conditions?
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Please briefly indicate if there are additional details pertinent to your application.
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