Application EN – Autorisation de voyage éléctronique

Contact information

Last name * Enter the last name on your passport

Name (s) * Enter your first and last name (s) as indicated on your passport

City of birth *

Native country *

Date of Birth *

Sex * MaleFemale

Civil status *

Nationality *

Passport details

Please provide details of the passport you will use to enter Canada. Enter this information exactly as it appears on your passport.

Passport country *

Passport number *

Passport issue date *

Passport expiration date *

If you are also a citizen of other countries than the one listed in your passport, please indicate this

Unique Client Identifier (UIC), Old Canadian Visa or Permit Number (optional)

Contact details

e-mail Adress *

Mobile phone number *

Residential address

Enter the address where you live. A PO Box will not be accepted.

Street Name *

Street Number *

Postal code *

City *

Country *

Consentement et déclaration

Information provided to CIC is collected in accordance with the Immigration and Refugee Protection Act (IRPA) to determine admissibility to Canada. The information provided may be shared with other institutions of the Canadian government such as, but not limited to, the Canada Border Services Agency (CBSA), the Royal Canadian Mounted Police (RCMP), the Canadian Intelligence Service of Security (CSIS), Global Affairs Canada (CMA), Employment and Social Development Canada (ESDS), Canada Revenue Agency (CRA), provincial and territorial governments under subsection 8 (2) of the Privacy Act.

Applicant's statement

I have read and understood the general conditions and the privacy policy. I declare that the information I have provided in this request is true, complete and correct.

1. Have you ever been refused a Visa or permit, prohibited from entering Canada or any other country or territory or asked to leave Canada or any other country or territory? * YesNo

2. Have you ever committed a criminal offense in any country or territory, or have you ever been arrested for such an offense, charged with or convicted of such an offense? * YesNo

3. In the past two years, have you been diagnosed with tuberculosis or have you been in contact with someone with tuberculosis? * YesNo

4. Do you have any of these medical conditions? *