declaration spouse dyn
DESCRIPTION
Declaration Spouse DynTRANSCRIPT
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IMPORTANT
IDENTIFICATION OF THE PRINCIPAL APPLICANT
DECLARATION BY SPOUSE
Ministre de lImmigration et des Communauts culturelles A-0521-CA (2012-11)Page 1 of 2
This declaration must be signed by the principal applicant and by his accompanying spouse or de facto spouse if the principalapplicants marital status is that of spouse or if he has a de facto spouse.
Both individuals must sign this form. Otherwise, it will be returned.
Declaration of the principal applicant
I __________________________________________________________________________________________ declare that I am the spouse
of _________________________________________________________.
In witness whereof, I have signed in ______________________________________________________ , on ______ / ______ / ______.
____________________________________________________________________
Signature of the principal applicant
Family name at birth First name Date of birth
Please indicate if the statements below correspond to your situation.
Please indicate if the statements below correspond to your situation.
Yes NoAt the time of my marriage to this person, I was married to another person.I have a de facto spouse, and have been living separated and apart from my spouse since ______ / ______ / ______.
Declaration of the spouse accompanying the principal applicant
I __________________________________________________________________________________________ declare that I am the spouse
of _________________________________________________________.
In witness whereof, I have signed in ____________________________________________________ , on .
____________________________________________________________________
Signature of the spouse accompanying the principal applicant
Yes NoAt the time of my marriage to this person, I was married to another person.I have a de facto spouse, and have been living separated and apart from my spouse since .
First name and family name
City and country
City and country
First name and family name
First name and family name
First name and family name
Reserved for AdministrationIndividual Reference No. :
File No. :
Declaration by spouse or de facto spouse
Year Month Day
Year Month Day
A-0521-CA(2012-11)
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Declaration of the principal applicant
I ____________________________________________________________________ declare that:
In witness whereof, I have signed in ____________________________________________________ , on .
____________________________________________________________________
Signature of the principal applicant
In witness whereof, I have signed in ____________________________________________________ , on .
____________________________________________________________________
Signature of de facto spouse accompanying the principal applicant
Yes NoI live conjugally with and cohabit with __________________________________________________________________since .
I have a conjugal relationship with ________________________________________ since .
but, being subject to persecution or penal control, we cannot live together.
Declaration of de facto spouse accompanying the principal applicant
I ____________________________________________________________________ declare that:
DECLARATION BY DE FACTO SPOUSE
Please indicate if the statements below correspond to your situation.
Please indicate if the statements below correspond to your situation.
First name and family name
First name and family name
First name and family name
First name and family name
City and country
Ministre de lImmigration et des Communauts culturelles A-0521-CA (2012-11)Page 2 of 2
Year Month Day
Year Month Day
Year Month Day
Yes NoI live conjugally with and cohabit with __________________________________________________________________since .
I have a conjugal relationship with ________________________________________ since .
but, being subject to persecution or penal control, we cannot live together.
First name and family name
First name and family name
City and country
Year Month Day
Year Month Day
Year Month Day
decl_req_nom: decl_req_conj: decl_req_ques1:
decl_req_ques2:
decl_req_date: decl_req_signe_ville: decl_req_signe_pays: decl_req_signe_date: decl_req_nom2: decl_req_conj2: decl_req_ques12:
decl_req_ques22:
decl_req_date2: decl_req_signe_ville2: decl_req_signe_pays2: decl_req_signe_date2: decl_cf_nom: decl_cf_ques1:
decl_cfa_conj: decl_cfa_date: decl_cf_ques2:
decl_cfb_conj: decl_cfb_date: decl_cf_signe_ville: decl_cf_signe_pays: decl_cf_signe_date: decl_cf_nom2: decl_cf_ques12:
decl_cfa_conj2: decl_cfa_date2: decl_cf_ques22:
decl_cfb_conj2: decl_cfb_date2: decl_cf_signe_ville2: decl_cf_signe_pays2: decl_cf_signe_date2: cmdImprimer: cmdEffacer: cmdInfo: rg_nom: rg_prenom: rg_date_naissance: