Statutory Declaration for Extended Family Members Outside Canada of a Canadian Victim of an Air Disaster that may apply for a Permanent Residence Visa (IMM 0171)
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Statutory Declaration [IMM 0171]
This form must be completed by:
- the spouse or common-law partner of the victim of the air disasters, or
- if the victim does not have a surviving spouse or common-law partner, or if they are not in
Canada;
- the child (18 years of age or older), or;
- the guardian of a child (under 18 years of age)
Note: The completed and signed statutory declaration must be provided by the victim’s spouse or common-law partner in Canada, or if the victim does not have a surviving spouse or common-law partner, or if they are not in Canada, by the oldest child (18 years of age or over), or the guardian of the child (under 18 years of age). Surviving family member in Canada may sign a statutory declaration for up to two principal applicants.
Section 1
- Enter your full family name (surname or last name) exactly as it is shown on your passport, travel or identity document.
- Enter your given name(s) (first, second or more) exactly as it is shown on your passport, travel or identity document. Do not use initials.
- Enter your UCI
- Enter your date of birth If you do not know your complete date of birth, please use an “*” (asterisk) to fill in the spaces for the unknown year, month or day. For example, if the day and month of your date of birth is unknown you could enter 1964/*/*.
- Enter your country of citizenship
- Enter your residential address
- Enter your e-mail address
- Enter your phone number
Section 2
- Enter the extended family member’s full family name (surname or last name) exactly as it is shown on their passport, travel or identity document.
- Enter the extended family member’s given name(s) (first, second or more) exactly as it is shown on your passport, travel or identity document. Do not use initials.
- Enter their UCI, if applicable
- Enter their Place of Birth
- Enter their country of citizenship
- Enter their date of birth. If you do not know their complete date of birth, please use an “*” (asterisk) to fill in the spaces for the unknown year, month or day. For example, if the day and month of their date of birth is unknown you could enter 1964/*/*.
- Enter their passport/travel document number
Section 3
- Enter your family and given name confirming that you have read and understood the content of the form
- Enter the given and family name of your extended family member
- Select your family relationships
- Type your family and given name
- Enter your signature and the date you sign the form
Section 4
- Should be completed and signed by the notary, lawyer, commissioner of oaths or justice of the peace in Canada.