- Jul 1, 2018
- 2,162
Part 1 - Parent/Guardian or Representative Details |
Question: | Answer: |
---|---|
1. Are you applying on behalf of someone? | [] Yes [X] No -> Proceed to Part 2 |
2. Are you applying on behalf of a minor? | [] Yes [] No |
3. I am | [] A family member or friend [] A member of a non-governmental or religious organisation [] A member of the Immigration Consultants Regulatory Council [] A Canadian provincial or territorial law society [] A travel agent |
4. Are you being paid to represent the applicant and complete the form on their behalf? | [] Yes [] No |
5. Parent/Guardian or Representative Surname(s) | X |
6. Parent/Guardian or Representative Given Name(s) | X |
7. Name of firm/organisation (if applicable) | X |
8. Mailing address | X |
9. Telephone number | X |
10. Fax number (if applicable) | X |
11. Email address | X |
Part 2 - Travel Documents |
Question: | Answer: |
---|---|
12. What travel document do you plan to use to travel to Canada? | [] Passport - ordinary/regular [] Passport - diplomatic [X] Passport - official [] Passport - service [] Emergency/temporary travel document [] Refugee travel document [] Permit to re-enter the United States (I-327) [] United States refugee travel document (I-571) |
13. Which country issued your passport/document? | Spain |
14. What is the nationality noted on your passport/document? | Spanish |
Part 2(A) - Permanent Residents of the United States |
Question: | Answer: |
---|---|
15. Are you a lawful permanent resident of the United States with a valid alien registration card (Green Card)? | [] Yes [X] No -> Proceed to Part 2(B) |
16. United States lawful permanent resident alien registration card (Green Card) number | X |
17. United States lawful permanent resident alien registration card (Green Card) number (re-enter) | X |
18. Date of expiry | [][][][] Year [][] Month [][] Day |
Part 2(B) - Passport Details |
Question: | Answer: |
---|---|
19. Passport number | CAB934216 |
20. Passport number (re-enter) | CAB934216 |
21. Surname(s) | Puigdemont |
22. Given name(s) | Carles |
23. Date of birth | [1][9][6][2] Year [1][2] Month [2][9] Day |
24. Gender | [X] Male [] Female [] Other |
25. Country/territory of birth | Catalonia, Spain |
26. City/town of birth | Amer |
27. Date of issue of passport | [2][0][1][1] Year [0][4] Month [0][1] Day |
28. Date of expiry of passport | [2][0][2][1] Year [0][4] Month [0][1] Day |
Part 2(C) - Personal Details |
Question: | Answer: |
---|---|
29. Additional nationalities (Indicate which countries/territories you are a citizen of) | X |
30. Marital status | [X] Married [] Legally Seperated [] Divorced [] Annulled Marriage [] Widowed [] Common-law [] Never Married/Single |
31. Have you ever applied for or obtained a visa, an eTA or a permit to visit, live, work or study in Canada? | [] Yes [X] No -> Proceed to Part 2(D) |
32. Unique client identifier (UCI)/Previous Canadian visa, eTA or permit number | X |
33. Unique client identifier (UCI)/Previous Canadian visa, eTA or permit number (re-enter) | X |
Part 2(D) - Employment Information |
Question: | Answer: |
---|---|
34. Occupation | [] Art, culture, recreation and sport occupation [] Finance and administration occupations [X] Education, law and social community and government services occupation [] Health occupations [] Homemaker [] Management occupations [] Manufacturing and utilities occupations [] Military/armed forces [] Natural and applied sciences and related occupations [] Natural resources, agriculture and related production occupations [] Retired [] Sales and service occupations [] Student [] Trades, transport and equipment operators and related occupations [] Unemployed |
35. Job title (if applicable) | President of the Government of Catalonia |
36. Name of company, employer, school or facility (if applicable) | Government of Catalonia |
37. Country/territory (if applicable) | Catalonia, Spain |
38. City/town (if applicable) | Barcelonia |
39. Since what year (if applicable) | 2011 |
Part 2(E) - Contact Information |
Question: | Answer: |
---|---|
40. Preferred language to contact you | [X] English [] French |
41. Email address | cpuigdemont@cat.es |
42. Email address (re-enter) | cpuigdemont@cat.es |
43. Apartment/unit number or Street number or house name | 23 |
44. Street address/name | Carrer de Pamplona |
45. City/town | Barcelona |
46. Country/territory | Catalonia, Spain |
47. District/region (if applicable) | Subdistrict El Parc i la Llacuna del Poblenou |
Part 2(F) - Travel Information |
Question: | Answer: |
---|---|
48. Do you know when you will travel to Canada? | [X] Yes [] No -> Proceed to Part 2(G) |
49. When do you plan to travel to Canada? | [2][0][1][3] Year [1][2] Month [0][5] Day |
50. Please enter the time your flight to Canada will depart (24-hour format) | [1][2] Hour [5][5] Minute [+][0][1]:[0][0] Time Zone |
Part 2(G) - Background Information |
Question: | Answer: |
---|---|
51. Have you ever been refused a visa or permit, denied entry to, or ordered to leave Canada or any other country/territory? | [] Yes [X] No |
52. Have you ever committed, been arrested for, been charged with or convicted of any criminal offence in any country/territory? | [] Yes [X] No |
53. Have you or a family member ever had or been in close contact with a person with tuberculosis? | [] Yes [X] No -> Proceed to Question 55 |
54. Have you ever been diagnosed with tuberculosis? | [] Yes [X] No |
55. Do you have a serious health condition for which you are receiving regular medical treatment? | [] Yes [X] No |
56. Do you have any of the following? | [] Untreated syphillis [] Untreated drug or alcohol addiction [] Untreated mental health condition with psychosis [X] None of the above |
Part 2(H) - Consent and Declaration |
Question: | Answer: |
---|---|
57. I declare that the information I have given in this application is truthful, complete and correct. I understand that misrepresentation is an offence under section 127 of the Immigration and Refugee Protection Act and may result in a finding of inadmissibility to Canada or removal from Canada. I agree that by typing my name, I am electronically signing my declaration. | [x] I agree |
58. Signature of applicant | C. PUIGDEMONT |
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