Imm5257 2019

PROTECTED WHEN COMPLETED - B PAGE 1 OF 5 APPLICATION FOR VISITOR VISA TEMPORARY RESIDENT VISA If you need more space for any section print out an additional page containing the appropriate section complete and submit it with your application. UCI I want service in Visa requested OFFICE USE ONLY Validated PERSONAL DETAILS 1 Full name Family name as shown on your passport or travel document Given name s as shown on your passport or travel document Have you ever used any other name e.g. Nickname maiden name alias etc. Family name Sex No Yes Given name s Date of birth Place of birth Country or Territory City/Town YYYY Citizenship Current country or territory of residence MM DD Status Other From To YYYY-MM-DD Previous countries or territory of residence During the past five years have you lived in any country or territory other than your country of citizenship or your current country or territory of residence indicated above for more than six months Same as current country or territory of residence 10 a Your current marital status b If you are married or in a common-law relationship Provide the date on which you were married or entered into the common-law relationship Date c Provide the name of your current Spouse/Common-law partner This form is made available by Immigration Refugees and Citizenship Canada and is not to be sold to applicants. IMM 5257 02-2019 E DISPONIBLE EN FRAN AIS - IMM 5257 F Applicant Name 11 a Have you previously been married or in a common-law relationship b Provide the following details for your previous Spouse/Common-law Partner d Type of relationship LANGUAGE S a Native language/Mother Tongue b Are you able to communicate in English and/or French d Have you taken a test from a designated testing agency to assess your proficiency in English or French c In which language are you most at ease PASSPORT Passport number For this trip will you use a passport issued by the Ministry of Foreign Affairs in Taiwan that includes your personal identification number Issue date Expiry date NATIONAL IDENTITY DOCUMENT Do you have a national identity document Document number US PR CARD Are you a lawful Permanent Resident of the United States with a valid alien registration card green card CONTACT INFORMATION If submitting your application by mail - All correspondence will go to this address unless you indicate your e-mail address below. IMM 5257 02-2019 E DISPONIBLE EN FRAN AIS - IMM 5257 F Applicant Name 11 a Have you previously been married or in a common-law relationship b Provide the following details for your previous Spouse/Common-law Partner d Type of relationship LANGUAGE S a Native language/Mother Tongue b Are you able to communicate in English and/or French d Have you taken a test from a designated testing agency to assess your proficiency in English or French c In which language are you most at ease PASSPORT Passport number For this trip will you use a passport issued by the Ministry of Foreign Affairs in Taiwan that includes your personal identification number Issue date Expiry date NATIONAL IDENTITY DOCUMENT Do you have a national identity document Document number US PR CARD Are you a lawful Permanent Resident of the United States with a valid alien registration card green card CONTACT INFORMATION If submitting your application by mail - All correspondence will go to this address unless you indicate your e-mail address below. - Indicating an e-mail address will authorize all correspondence including file and personal information to be sent to the e-mail address you specify. - If you wish to authorize the release of information from your application to a representative indicate their e-mail and mailing address es in this section and on the IMM5476 form. 1 Current mailing address Apt/Unit P.