Application Form and Document Checklist: Verification of Status or Replacement of an Immigration Document Application Form and Document Checklist (IMM 5009)

Question 1

Indicate your Client Identification number (Client ID) or Unique Client Identifier (UCI), if known. Otherwise leave it blank.

If you have not dealt with IRCC since 1973, you will not have a UCI or a Client ID.

Question 2

Indicate your surname (family name) on entry to Canada.

Question 3

Indicate your given name(s) on entry to Canada.

Question 4

Indicate your current surname (family name) if it is different than your surname upon entry to Canada.

Question 5

Indicate your current given name if it is different than your given name upon entry to Canada.

Question 6

Indicate your date of birth in the following format: YYYY-MM-DD (Year-Month-Day).

Question 7

Indicate your place of birth including the city, state/province and country.

Question 8

Indicate your current citizenship. To be a citizen of a country means that you were either born in that country (in most cases) or you were granted citizenship in that country. If you have dual citizenship, select the country that issued the passport or travel document that you used to enter Canada.

Question 9

Indicate the passport number of the document you used upon entry to Canada.

If you do not have a copy of this passport, indicate your current passport number.

Check the box to indicate if the passport number was used at the time of entry or if it is your current passport number.

If you did not have a passport upon entry, provide your travel document number.

Question 10

Indicate the date of issue of the passport you used in box 10 in the following format: YYYY-MM-DD (Year-Month-Day).

Question 11

Indicate the expiry date of the passport you used in box 10 in the following format: YYYY-MM-DD (Year-Month-Day).

Question 12

Marital Status on your first entry to Canada: (check the box that applies to you)

• Never married
• Married: This means that you and your spouse have had a ceremony that legally binds you to each other. Your marriage must be legally recognized in the country where it was performed and in Canada (if you were married upon your first entry to Canada, check yes or no to indicate if your spouse is a Canadian citizen or permanent resident).
• Widowed: This means that your spouse has died and you have not re-married or entered into a common-law relationship.
• Separated: This means that you are married but officially no longer living with your spouse.
• Divorced: This means that you are officially separated and have legally ended your marriage.
• Common-law partner: This means that you have lived with your partner in a common-law relationship for a minimum of one year.

Question 13

Indicate the language of correspondence (English or French) you wish to use.

Question 14

Indicate your current mailing address:

• Post Office (P.O.) Box number
• Apartment or unit number
• Street number
• Street name
• City or town
• Country
• Province/state
• Postal code
• District

If the country in which you reside does not use any of these values, please ensure a complete address for the country in which you reside is included.

If you are requesting a replacement of a valid temporary resident document, a Canadian mailing address MUST be provided.

Question 15

Indicate your current residential address (where you live) if it is different from your mailing address.

• Apartment or unit number
• Street number
• Street name
• City or town
• Country
• Province/state
• Postal code
• District

If the country in which you live does not use any of these values, please ensure a complete address for the country in which you reside is included.

Question 16

Check the box to indicate whether your telephone number is from Canada or the United States (US) or any other country.

Indicate if your telephone number belongs to your residence, cell or business.

Indicate your country code.

Indicate your telephone number including your area code and extension, if applicable.

Question 17

Check the box to indicate whether your alternate telephone (cell, mobile, business, etc.) number is from Canada or the (US) or another country.

Indicate if your telephone number belongs to your residence, cell or business.

Indicate your country code.

Indicate your alternate phone number including the area code and extension, if applicable.

Question 18

Indicate your e-mail address using this format (if applicable): name@provider.com

Note: By indicating your e-mail address, you are hereby authorizing transmission of correspondence including file and personal information to be sent to you via e-mail to the address provided.

Ensure your e-mail address will be valid for the entire processing period.

Question 1

Check the appropriate box to indicate the type of request you are making:

• Verification of Status
• Replacement of a valid temporary resident document

Question 2

If you entered Canada for the first time as a permanent resident (landed immigrant) indicate the date of issue in the following format: YYYY-MM-DD (Year-Month-Day).

If you entered Canada for the first time as a temporary resident (worker, visitor, or student) or refugee claimant, indicate the date of issue on your immigration document in the following format: YYYY-MM-DD (Year-Month-Day).

Question 3

Indicate the name of the Canadian port of entry or the place of issue. If are a permanent resident, enter the location at which your status was granted.

Note: A port of entry is an airport, land border, or sea border, where you entered through a customs and immigration checkpoint prior to entering the country.

Question 4

Check the appropriate box to indicate for which document you need a replacement copy or a Verification of Status document. If requesting a valid temporary resident document, indicate the document number. If unknown, indicate the document issue and expiry date.

Note: If you are requesting a replacement of a temporary resident document, you may only apply for a valid Work Permit, Study Permit, or a Permit to Come Into or Remain in Canada. A replacement document can only be issued for temporary resident documents that have not yet expired.

Note: If you do not indicate which valid temporary resident document you are requesting by providing the document number or the document issue and expiry date, IRCC will issue the temporary resident document that was last issued. Any requests for other valid temporary resident documents must be submitted with a new application form and fee.

Question 5

Check the appropriate box to indicate what happened to your original immigration document. If applicable, provide details in the space provided.

If you are applying for a replacement of a valid temporary resident document, and it was lost or stolen, indicate the police report number. If you do not have a police report number, provide a brief explanation in the space provided.

Question 6

Check the appropriate box to indicate if you previously applied for Verification of Status of an Immigrant Visa and Record of Landing/Confirmation of Permanent Residence.

If you check “yes”, provide the date on which you applied in the following format: YYYY-MM-DD (Year-Month-Day).

Question 7

Check the appropriate box to indicate if, since your admission to Canada as a permanent resident, you have been convicted of a crime or offence in Canada or elsewhere. If you check “yes”, attach any copies of your relevant court documents.

Question 8

Indicate whether you are a Canadian citizen by checking the appropriate box.

Question 9

List all of the names you have ever used at the time of landing or entry to Canada, including given names, middle names, maiden names, foreign names, nicknames, aliases, or other names or initials.

Question 10

Check the appropriate box to indicate your immigration status when you first entered Canada.

Question 1

List the complete names and dates of birth of all the persons that entered Canada with you. This may include your parents, children, spouse, or other relatives.

Question 2

Check the appropriate box to indicate if either of your parents was born a Canadian citizen.

Question 3

Indicate the names and dates of birth of your parents in the following format: YYYY-MM-DD (Year-Month-Day).

Question 4

List the occupation of each of your parents at the time you entered Canada.
Write N/A if not applicable, do not leave blank.

Question 5

Check the appropriate box to indicate if you or your parents were ever part of the military at the time you entered Canada.

Important information:

Read the declaration. Sign and date the application form.

If you are less than 18 years of age: your application must be signed by you and one of your parents or a legal guardian.

By signing, you certify that you fully understand the questions asked, and that the information you have provided is complete, truthful, and correct. If you do not sign and date the application, it will be returned to you.