Statutory declaration attesting to the relationship between the Canadian citizen or permanent resident and Ukrainian foreign national (IMM 0191)
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Statutory declaration attesting to the relationship between the Canadian citizen or permanent resident and the Ukrainian foreign national (IMM 0191)
This form must be completed by a Canadian relative who:
- is a Canadian citizen or permanent resident;
- is at least 18 years of age;
- who was not granted permanent residence under this public policy;
- resides in Canada;
and - wishes their Ukrainian family members (listed below) to remain in Canada permanently:
- a spouse or common-law partner
- a child
- a grandchild
- a parent
- a grandparent
- a sibling (half-sibling);
or - in-Canada spouse or common-law partner of a Ukrainian national who is a child (18 years or older), grandchild (18 years or older), parent, grandparent, sibling of a Canadian citizen or permanent resident and is unable to leave Ukraine
- in-Canada spouse or common-law partner of a Ukrainian national who is a child (18 years or older), grandparent (18 years or older), parent, grandparent, sibling of a Canadian citizen or permanent resident and is missing, presumed deceased; and the spouse or common-law partner has not remarried and is not in a common-law relationship with another person since leaving Ukraine.
Section 1
- Enter your full family name (surname or last name) exactly as it is shown on your passport, travel or identity document.
- Enter your given name(s) (first, second or more) exactly as it is shown on your passport, travel or identity document. Do not use initials.
- Enter your Unique Client Identifier (UCI)
- Enter your date of birth. If you do not know your complete date of birth, please use an “*” (asterisk) to fill in the spaces for the unknown year, month or day. For example, if the day and month of your date of birth is unknown you could enter 1964/*/*.
- Enter your country of citizenship
- Enter your current residential address
- Enter your e-mail address
- Enter your phone number
Section 2
- Enter the Ukrainian relative’s full family name (surname or last name) exactly as it is shown on their passport, travel or identity document.
- Enter the Ukrainian relative’s given name(s) (first, second or more) exactly as it is shown on your passport, travel or identity document. Do not use initials.
- Enter their UCI, if applicable
- Enter their place of birth
- Enter their country of citizenship
- Enter their date of birth. If you do not know their complete date of birth, please use an “*” (asterisk) to fill in the spaces for the unknown year, month or day. For example, if the day and month of their date of birth is unknown you could enter 1964/*/*.
Note: Fill out Section 3 only if your child, grandchild, parent, grandparent, sibling is unable to leave Ukraine, or is missing or presumed dead, and their spouse or common-law partner is the principal applicant in Canada. If the form doesn’t let you leave the space blank, type “N/A” or “NA”
Section 3
- If Ukrainian relative’s spouse or common-law partner are the principal applicant in-Canada, enter their full family name (surname or last name) exactly as it is shown on their passport, travel or identity document.
- Enter their given name(s) (first, second or more) exactly as it is shown on your passport, travel or identity document. Do not use initials.
- Enter their UCI, if applicable
- Enter their place of birth
- Enter their country of citizenship
- Enter their date of birth. If you do not know their complete date of birth, please use an “*” (asterisk) to fill in the spaces for the unknown year, month or day. For example, if the day and month of their date of birth is unknown you could enter 1964/*/*.
- Select their relationship to the Ukrainian national
Section 4
- Enter your family and given name confirming that you have read and understood the content of the form
- Enter the given and family name of your Ukrainian family member
- Select your family relationship
- Type your family and given name, sign and date the document
- Signature and declaration must be completed by the Canadian citizen or permanent resident in front of the notary public, lawyer, commissioner of oaths or a justice of the peace in Canada
Section 5
- Should be completed and signed by the notary public, lawyer, commissioner of oaths or a justice of the peace in Canada.