A.
MANDATORY INFORMATION ON PRINCIPAL APPLICANT
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Immigration File # (i.e. B123456789)
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Family Name
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Given Name(s), Middle Name
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Date of birth
(YYYY/MM/DD)
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E-mail address (For future communications)
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B.
ALTERNATE PAYEE INFORMATION, IF REQUIRED
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Payee Family Name
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Payee Given Name(s), Middle Name
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I authorize CIC to issue the fee return to the person designated in section B in accordance with their information in section C (or D where applicable).
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Signature of principal applicant
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C.
MANDATORY PAYEE INFORMATION
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Payment will be made to the principal applicant, unless section B is properly completed. Payments requested in China will take longer to process.
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Mailing address of principal applicant or individual designated in section B cannot be in Iran, Syria, Myanmar (Burma), Sudan, Libya or Cuba |
PO Box or Street Address
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City
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State, province or other
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Postal or ZIP code
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Country Name
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Cheque Currency (i.e. CAD)
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D.
PAYEE BANK ACCOUNT INFORMATION
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To prevent delays in the return of fees, all applicants are encouraged to provide this information, should it be required. EFTs will be payable to the principal applicant, unless sections B is properly completed. Payee name and bank account holder must match.
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Banking information of principal applicant or individual designated in section B cannot be for a bank in Iran, Syria, Myanmar (Burma), Sudan, Libya or Cuba |
Bank Name
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Bank Address
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PO Box or Street Address
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City
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State, province or other
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Postal or ZIP code
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Country Name
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Bank Code (i.e. ABA, Sort Code, BSB, etc.)
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Bank Identifier Code (SWIFT code)
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Bank Account Number
or
International Bank Account Number (IBAN)
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Bank Account Type
| Chequing Savings
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Bank Account Currency
| CAD USD EUR
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If applicable, an electronic funds transfer will be issued in the currency of the bank account where possible.
Due to banking restrictions, an alternate currency may be required.
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Other currencies accepted in this account?
| YES NO
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If yes, which currencies?
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