Stage 1: Provide your personal information

This first stage is when you complete the statutory declaration form and the consent to disclose personal information form. Make sure to give us all the information we need to move forward with your application.

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About the statutory declaration form

The statutory declaration form is a document that is used to confirm the anchor’s intention to provide support to you and the family members who come with you to Canada through these measures. It lists the specific support that is expected from the anchor.

The following information must also be included in the form:

How to complete the statutory declaration form

The anchor must download and complete the statutory declaration form (IMM 5992) below.

The form must be signed in the presence of an authorized official (for example, a lawyer, commissioner of oath or justice of the peace). This can be done in person or remotely.

The anchor must complete a separate statutory declaration for each family unit.

Download and complete the statutory declaration form (IMM 5992) (PDF, 1.77 MB).

About the consent to disclose personal information form

The consent to disclose personal information form must be completed in this first stage and included in stage 3 of your application for us to move forward with your application.

If you wish to exit Gaza, the governments of Israel and Egypt require that the following detailed information for every traveller be provided to them in advance:

This information will also be shared with Canadian federal organizations and service providers in the region who may assist with your departure.

We need your consent to disclose this information. If you don’t consent to sharing this information, Canada won’t be able to seek approval from the local authorities for your departure from Gaza.

About your personal information

Although we will take steps to protect your personal information, the Government of Canada can’t give assurances as to how that information will be protected, used or further disclosed once it is shared. The names of and information related to individuals approved to cross the Rafah border are often published online by the Rafah news authority.

The Government of Canada will put forward your name to the governments of Israel and Egypt for approval, but does not ultimately decide who can leave Gaza.

How to complete the consent to disclose personal information form

You or your representative (someone applying on your behalf, such as your anchor, another family member, a friend or a paid representative) must follow the instructions based on your situation.

Situation A

Complete the form for situation A if

Download and complete the consent to disclose personal information form (IMM 0707) (PDF, 151 KB).

A separate form must be completed for each applicant who is 18 years of age or older.

Situation B

Follow the instructions below for situation B if

Instructions for situation B
Consent text to copy and paste into a text message or email

I, [Insert Name Of Applicant And Date Of Birth], authorize [Insert Name Of Representative], who is my [Indicate Paid Representative / Family / Friend / Or Anchor] to serve as my representative and to submit an application under the Temporary Public Policy to Facilitate Temporary Resident Visas for Certain Extended Family affected by the Crisis in Gaza on my behalf with Immigration, Refugees and Citizenship Canada and the Canada Border Services Agency. I confirm that I have provided all required information pertaining to my application to my representative. I authorize Immigration, Refugees and Citizenship Canada and the Canada Border Services Agency to release information from my case file and that of my family members under 18 years of age to my representative. This authorization is in accordance with the Privacy Act. I am aware that any information that would be subject to exemption, if I had the right of access under the Privacy Act or the Access to Information Act, will likely not be released.

I also solemnly declare that I understand the information my representative has provided in this application, and I confirm that the questions in the application are answered fully and truthfully. I consent for my representative to affix their signature to my application, by typing their name in the application form.

I further give my consent to the disclosure by the Government of Canada of my full name, date of birth, sex (as per ID), passport or national ID details, mobile phone number and current location by district to other Canadian federal departments, the governments of Israel and Egypt, as well as any service providers assisting the Government of Canada. I also consent on behalf of any of my family members who are minors. I understand that my adult family members will be providing their own consent.

[Insert Names Of Children, Relationship, And Date Of Birth]

I understand that the governments of Israel and Egypt, and service providers require my personal information and the personal information of my family members to make the necessary transit arrangements.

I understand that the Government of Canada is not providing any assurances as to how my personal information will be protected, used or further disclosed once it is shared with the governments of Israel and Egypt, as well as service providers. I understand that my information may be shared on a list in a public forum.

I understand that the Government of Canada accepts no responsibility or liability for any further use of my information by the governments of Israel and Egypt, as well as service providers, or disclosure of my information by these organizations to other parties, including other governments or government entities.

I understand that the Government of Canada is not responsible for any losses or injuries I or my family members may suffer in the course of this transit.

I understand that disclosing my personal information will not guarantee that I will be permitted to leave Gaza. I also understand that even if the Government of Canada facilitates my travel from Gaza to Egypt, this does not guarantee onward travel to Canada if I am subsequently deemed not to be eligible or admissible to Canada.

I confirm my consent and the consent of my family members who are minors to the above representation and disclosure by the Government of Canada. I declare that I have read and understood all the statements on this form, and have asked and obtained an explanation for every point that was not clear to me.

By providing the following personal information, I am indicating consent to the disclosure and this information will constitute my official signature.

Situation C

Complete the form for situation C if all of the following apply:

Download and complete the consent to disclose personal information form (IMM 0707) (PDF, 151 KB).

A separate form must be completed for each applicant who is 18 years of age or older.

Stage 1 checklist – Before you go to stage 2

Before moving to the next stage, make sure that

  • your anchor has completed a statutory declaration form for each family unit
  • you’ve completed the consent to disclose personal information form according to your situation (A, B or C), for each applicant who is 18 years of age or older

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