Authority to Release Personal Information to a Designated Individual (IMM 5475)

Download the form

How to download, save and open this form

  1. Use your computer. The form may not open on tablets or mobile phones.
  2. Save the form on your computer in a place you can remember.
    • For most Internet browsers, clicking on the link above will automatically download the form.
    • If the form doesn’t automatically download, right-click on the link and select “Save as.”
  3. After you download the form, open it using Adobe Acrobat Reader.

 Open this form in Acrobat Reader

  1. Open Acrobat Reader.
  2. Select “File” from the top menu.
  3. Click “Open.
  4. Find the location where you saved the form, click on the file, and click “Open.

When to use this form

Use this form if you want to allow us to give your personal information, such as the status of your application, to someone who will not act as your representative.

Paper applications

Online applications

Page details

Date modified: