Supplementary Information: Humanitarian and Compassionate Considerations (IMM 5283)

This form must be completed in:

• English or French only and
• Typed or printed clearly in black or blue ink.

You must answer all questions that apply to you. If a section does not apply to you, write “Not applicable” or “N/A”.

Question 1

Write in the appropriate box:

• your last name (surname/family name) as it appears on your passport or other valid identity document
• your given name(s) as it appears on your passport or other valid identity document
• your date of birth and
• your country (or countries) of citizenship.

Question 2

Write or check in the appropriate box the information of whom you were living with before coming to Canada:

• the last name (surname/family name)
• given name(s)
• gender (F-Female, M-Male or X-Another gender)
• relationship to you (e.g.friend)
• country of birth
• date of birth and
• address

Question 3

Write or check in the appropriate box the details of your immediate family (parents, non-dependent children, brothers and sisters) living in Canada.

• the last name (surname/family name)
• given name(s)
• gender (F-Female, M-Male or X-Another gender)
• relationship to you (i.e. friend)
• country of birth
• date of birth and
• address.

Question 4

Check “ yes” or “ no” to indicate if you are living with someone in Canada. If “yes” write in the appropriate box the details of the person you are living with:

• the last name (surname/family name)
• given name(s)
• gender (F-Female, M-Male or X-Another gender)
• relationship to you (i.e. friend)
• country of birth
• date of birth and
• address

Question 5

Write or check in the appropriate box, the details of your immediate family members (parents, non-dependent children, brothers and sisters) living outside Canada whether they wish to be considered in your application for permanent residence at this time or not:

• the last name (surname/family name)
• given name(s)
• gender (F-Female, M-Male or X-Another gender)
• relationship to you
• country of birth
• date of birth and
• address

This information will be used to determine if there are sufficient humanitarian and compassionate grounds to:

• grant your request to process your permanent resident application from within Canada, and/or
• exempt you from any criteria or obligations of the Act.

Important information: In questions 7 to 13, you must ensure that you explain in detail your situation and all the reasons you would suffer hardship if the requested exemptions are not granted. Your application will be assessed on all the information you provide. Make sure to include everything you want considered.

Question 6

Are you currently subject to a removal order? If so, please provide details.

Note: A removal order is made against a person who has violated the Immigration and Refugee Protection Act (IRPA) or its Regulations. There are 3 types of removal orders: departure, exclusion and deportation.

Question 7

Explain in detail why you believe you should be granted exemptions from the requirements of IRPA on Humanitarian and Compassionate (H&C) grounds. Include information about the hardships you would experience if the requested exemption is not granted.

Question 8

If you or a family member is inadmissible to Canada:

• provide all relevant documents regarding the inadmissibility such as conviction certificate, rehabilitation or record suspension (formerly a pardon) application,
• clearly indicate the exemption you are requesting, and
• explain why you should receive an exemption.

Question 9

Provide information that you believe may support your request to have an application for permanent residence processed from within Canada about your:

• family, and/or
• relationships.

Question 10

Provide information on any child who would be affected by your application. If applicable, explain the hardships your child or children would experience if you were not granted the requested exemption(s).

You must provide specific information and supporting documentation on how the child or children would be affected.

Question 11

Explain how you have established yourself in Canada.

Note: You may want to show how you are involved or participate in the community. Remember to provide supporting documentation if it is available. e.g. letters from community organizations, religious institutions, etc. If the documentation is not available, explain why.

Question 12

Provide any documentation that would support your statements on how you intend to support yourself and your family while your application is in process. (e.g. a letter from your employer)

Question 13

Indicate any other information you want considered in your application.

Declaration of Applicant

You must provide all documents that support your case for H&C considerations.

Note: By signing, you certify that you fully understand the questions asked, and that the information you have provided is complete, accurate, and factual.