Humanitarian for Primary Applicant - Get Immigration Forms Canada

Did you make a refugee claim that was rejected by the Refugee Protection Division or the Refugee Appeal Division of the Immigration and Refugee Board of Canada, or did you abandon a refugee claim†

yes
no

Canada

A. Was your refugee claim rejected or abandoned within the last 12 months

Yes
No

Name

First

Middle

Last

Have you ever used any other name

Yes
No

Name

First

Last

Name

First

Last

Email

Confirm Email

Birth Date

Gender

Female
Male
Other

Please briefly explain

Citizenship ( List all your Citizenships )

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What is your status in Canada

Date Status Start

Date Status End

With Whom Did You Live Before Coming to Canada

Please provide your relationship to the person you lved with before coming to Canada

Name

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date of Birth

Name - 2nd Person You Lived With

First

Middle

Last

Date of Birth

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country