1、Canad;IMM5257(10-2006)BI亠由亠C|zenshipandCitoyenneteetI“igrationCanadaImmigrationCanadaApplicationforatemporaryresidentvisam加拿大境外临时居民签证申请表Pleasekindlynote:hiscompletedformisforyourinformationonly.敬请注意：此申请表格填与样本仅供您参考使用。TSIDEOFCANADAIwantservicein:EnglishFrench所选服务语言种类：口英语法语ThisformmustbecompletedinEngl
2、ishorFrench此表格必须用英语或者法语填写File-文件号P|Sngle、enryyisa(s)requestedMultip門多、“入tntryvisa(s)requestedTransitvisa(s)requested过境签证-2.APPLICANT申请人SPOUSEORC配偶或普通法伴侣AF以及子女NDCHILDRENFamilyname姓ZHANGZHAOZHANGZHANGFirstname名WUJIMINZHIRUOLQINGSHUSecondname中间名N/AN/AN/AN/AVRelationship关系SELFLUI-MEMESPOUSEDAUGHTERSONSe
3、x性别MALEFEMALEFEMALEMALEh,Dateofbirth出生日期0-8日IM月19Y-年61210-6日-0M月*6年5严0-8日0M月19石1年310-630月199年4Placeofbirth出生地点ZHEJIANG1VwSHANGHAISHANGHAIZHIEJIANG1厂/Citizenship国籍CHINACHINACHINACHINAyPassportno.护照号码G2001XXXXG2002XXXXiN/A,G2003XXXXPassportexpirydate护照有效期至/0-|日I01月2旷1年2|0-|日10月20-1年2ID一日-M月Y-年11111110
5、6IMycurrentmailingaddress.Allcorrespondencewillgotothisaddressunlessyouindicateyoure-mailaddressbelow,therebyauthorizingcorrespondence,includingfileandpersonalinformation,beprovidedtothespecifiede-mailaddress.Ifyouwishtoauthorizethereleaseofinformationfromyourcasefiletoarepresentative,indicatetheira
11、s是Citizen公民a)Withinthepasttwoyears,haveyouorafamilymemberhadtuberculosisofthelungorbee.在过去的两年中，您或您的家人是否曾患过肺结核或者曾与患过肺结核的人员有过密切接触？2Do日g)Inperiodsofeitherpeaceorwar,haveyoueverbeeninvolvedinthecommissionofawarcrimeorcrimeagainsthumanity,suchas:willfulkillingtorture,attacksupon,enslavement,starvationoro
12、therinhumaneactscommittedagainstciviliansorprisonersofwar:ordeportationofcivilians在和平或战争时期，您曾经参与过战争罪行或反人类罪行，例如：故意杀人、拷打、攻击、奴役、饥饿或其它针对平民或者战俘的非人道的行为？a)Immigrationstatusofapplicant(s)incountrywhereapplying申请人在申请所在国家的移民身份SonPermanentresident永久居民person(s)orinstitutionIwillvisitare肚止及我与其关系AddressinCanada-
15、rwhichthatpersonwillrequiresocialthanmedication,durinathestay您或者您随行的家庭成员在赴力加旅行期间是否有除药物治疗外，需要社保或医保提供服务的身体或精神方面的疾病？land/orhealthservices,other|1yesNO是否.厂、11Havevouoranymemberofyourfamilyever:您或是您的家庭成员是否曾经:Committed,beenarrestedorchargedwithanycriminaloffenceinany在任何国家犯罪，被逮捕或者因任何刑事犯罪被指控？一1,Beenrefused
16、admissionto,ororderedtoleaveCanada被拒绝进入，或被勒令离开加拿大？4vcountry、w一11YES口NO是否YES口NO是否_V1e)AppliedforanyCanadianImmigrationvisas(e.g.PermanentResident,Student,Worker,TemporaryResident(visitor),TemporaryResidentPermit)申请过任何加拿大移民签证？(例如：永久居民、学生、工作、临时居民(访问)、临时居留许可签证)？1亠冈YES口NO是否f)Beenrefusedavisatotravelto
17、Canada被加拿大拒签过？因YES口NO是否YESmNO是否ThisformhasbeenestablishedbytheMinisterofCitizenshipandImmigrationFormulaireetabliparleministredelaCitoyenneteetdelImmigrationTheinformationyouprovideonthisformiscollectedundertheauthorityoftheImmigrationandRefugeeProtectionActtodetermineifyoumaybeadmittedtoCanadaasat
18、emporaryresident.ItwillbestoredinPersonalInformationBankCICPPU051,ForeignTemporaryResidentRecordsandCaseFile.ItisprotectedandaccessibleunderthePrivacyActandtheAccesstoInformationAct.LesrenseignementsfournissurceformulairesontrecueillisenvertudelaLoisurimmigrationetlaprotectiondesrefugiespouretablirs
19、ivousetesadmissibleauCanadaatitrederesidenttemporaireIlsserontversesaufichierderenseignementspersonnelsCICPPU051,Dossieretfichierderesidenttemporaire.IlssontprotegesetaccessiblesenvertudelaLoisurlaprotectiondesrenseignementspersonnelsetdelaLoisur1accesaIinformation.APPLICANTFAMILYCOMPOSITIONINFORMAT
20、ION家属表PLEASECOMPLETEALLITEMSINBOTHENGLISHORFRENCHANDCHINESECHARACTERS所有内容请用中文及英文，或中文及法文填写RELATIONSHIP关系NAME姓名DATE&PLACEOFBIRTH出生日期及地点PRESENTADDRESS现行地址PRESENTOCCUPATION现行职业VisaApplicant签证申请人ZhangWuji张无忌dd08mm08yyyy1962Zhejiang浙江Spouse申请人配偶ZhaoMin赵敏dd06mm06yyyy1965Shanghai上海Mother申请人之母亲YinSusu殷素素Xmm0
21、9194Zhejiang浙江Father申请人之父ZhangCuishan张翠山dd09mmyyyy091939Zhejiang浙江退休N/A不适用RoomXXX,No.XX,LaneXXXLubanRoadLuwanDistrict,Shanghai上海市卢湾区鲁班路XXX弄XX号XXX室Passedaway去世GeneralManager总经理上海市卢湾区鲁班路XXX弄XX号XXX室RoomXXX,No.XX,LaneXXXLubanRoad亠*,LuwanDistrict,ShanghaiRoomXXX,No.XXJiefangRoad,YuyaoCounty,NingboCity,Zh
22、engjiang浙江省宁波市余姚县解放路XX号XXXAccountant会计NAME姓名CRELATION&关系及性别jMARITAL一STATUS婚姻状况DATE&PLACEOFBIRTH出生日期及地点dd/mm/yyyyPRESENTADDRESS现行地址PRESENTOCCUPATION现行职业ZhangZhiruoDaughter/FemaleSingle08/06/1993RoomXXX,No.XX,LaneXXXLubanRoadStudent张芷若女儿/女未婚Shanghai上海LuwanDistrict,Shanghai上海市卢湾区鲁班路XXX弄XX号XXX室学生yZhangQ
23、ingshuSon/MaleSingle06/08/1994No.XXXLondonRoad,Winnipeg,Manitoba,CanadaStudent张青书儿子/男JM未婚厂、力3Zhejiang浙江4/D学生CHILDREN:（INCLUDINGALLSONSANDDAUGHTERSPLUSADOPTEDANDSTEPCHILDRENREGARDLESSOFAGEORPLACEOFRESIDENCE）申请人之子女（包括所有子女及收养、继养之子女，无论年龄大小或居住地在何处均须填写）ANDSISTERS)NAME姓名RELATION&SEX关系及性别MARITALSTATUS婚姻状况DA
24、TE&PLACEOFBIRTH出生日期及地点dd/mm/yyyyPRESENTADDRESS现行地址PRESENTOCCUPATION现行职业ZhangYuanqiaoBrother/MaleMarried07/07/1960RoomXXX,No.XXJiefangRoadEngineer张远桥兄弟/男已婚Zhejiang浙江YuyaoCounty,NingboCity,Zhengjiang浙江省宁波市余姚县解放路XX号XXX室工程师ZhangBuhui张不悔Sister/FemaleDivorced05/05/1965RoomXXX,No.XXJiefangRoadTeacher兄妹/女离婚
25、Zhejiang浙江YuyaoCounty,NingboCity,Zhengjiang浙江省宁波市余姚县解放路XX号XXX室教师BROTHERSANDSISTERS:（INCLUDILFANDSTEPBROT申请人之兄弟姊妹（包括同父异母及同母异父之兄弟姊妹）DETAILSOFEDUCATIONANDEMPLOYMENT教育和就业细节表APPLICANTPLEASECOMPLETEALLITEMSINBOTHENGLISHORFRENCHANDCHINESECHARACTERS所有内容请用中文及英文，或中文及法文填写IsthisyourfirsttimetravellingoutsideofC
26、hinaIfno,pleaseprovideasummaryofyourtravelhistoryforthepastfiveyearsincludingcountriestravelledtoanddatesoftravel.此次是否是你的第一次出境旅行？若不是，请提供过去五年中所有出境旅行概况、包括目的地国家及旅行起始日期。No.不是01/0S/2006-07/0S/2006Ja日本；14/02/2007-28/02/2007Can%加拿大01/10/2008-07/10/2008UnitedKingdomIfyouareamemberofabusinessdelegation,cany
27、ouconfirmtheidentityandstatedprofessionofwithyouIfno,pleaseprovideanexplanation:如果你是某商务团组之成员，你是否能确认与你同行人士的身份及职业？若不能，请提供解释：DATE日期NAME&ADDRESSOFSCHOOL学校的名称及地址DIPLOMA/DEGREE学历/学位TYPEOFCOURSE课程类别FROM从TO到09/196806/1974NingboBBBPrimarySchool（AddressNoDetails）宁波BBB小学（地址不详）PrimarySchoolDiploma小学毕业BasicCour
28、se基础课程09/197406/1977NingboCCCJuniorHighSchool（Moved）宁波CCC初级中学（已搬迁）.、JuniorHighSchoolDiploma初中毕业BasicCourse基础课程09/197706/1980ShanghaiDDDSeniorHighSchoolNo.XXXXietuRoad,LuwanDistrict,Shanghai上海DDD高级中学上海市卢湾区斜土路XXX号SeniorHighSchoolDiploma高中毕业BasicCourse基础课程09/198006/1984ShanghaiEEEUniversityNo.XXXHandanRoad,YangpuDistrict,Shanghai上海EEE大学上海市杨