Operational Bulletins 135 – July 24, 2009

Instruction guide for individuals seeking refugee protection to complete form “Claim for Refugee Protection in Canada” (IMM 5611)

Overview
 

This form is used to make a refugee claim in Canada.

This form must be completed by persons applying for refugee protection who are:

  • 18 years of age and older
  • unaccompanied minors* or
  • accompanied minors if instructed by an officer to do so.

* An unaccompanied minor is a person under the age of 18 who is not accompanied by a parent or legal guardian.

The form must be completed in English or French only.

Print clearly in ink. You must answer all questions except the ones starting with “for office use only” or that are shaded. If a section does not apply to you, write “not applicable”. If you leave any section blank, the processing of your refugee protection application may be delayed.

Do not use acronyms or abbreviations in your answers.

If there is not enough space to fully answer a question, use an additional sheet of paper. Write your name and date of birth at the top right corner of each additional sheet. For each answer, indicate the question number and if the answer applies to one of your accompanying minors, also indicate his or her name. For question 43, do not use an additional sheet of paper; use only the space provided.

Question

Identity

1

Print your family name (surname) as it appears on your passport or official government document.

2

Print your given name(s) as they appear on your passport or official government document.

3

List all other name(s), including;

  • maiden name
  • names from previous marriage(s)
  • nickname(s)
  • name at birth (if different from present name)
  • current or past name(s) by which you are known (aliases); etc.
4

If applicable, write your name in your native alphabet (for example: Arabic, Cyrillic, Chinese, Korean, Japanese, etc).

6

Indicate the city or village and country of birth. For country of birth, please indicate the name of the country at the time of your birth (for example: Zaire, Czechoslovakia, USSR, etc).

7 Indicate the city or village and country in which your birth was registered. For country of registration, please indicate the name of the country at the time of registration (for example: Zaire, Czechoslovakia, USSR, etc).
8

List all countries in which you have citizenship. If you are stateless*, indicate that fact and list your country of former habitual residence (the country in which you lived, even if you were not legally admitted).

*Statelessness is a situation of not having a country of nationality, a fact which is beyond your control (i.e. you cannot choose to be stateless).

9 Indicate the last country to which you were admitted legally to reside permanently (this may or may not be the country in which you fear persecution). This does not include countries in which you were a foreign student, temporary worker or without status.
12 Note that the word “separated” here only refers to a legal separation. It does not refer to a geographical separation (for example, your spouse is living in another country but you are still married to him or her).
Question

Address In Canada

13

Address cannot be a post office box.

14

Indicate if someone is providing you with lodging/shelter during your stay in Canada. This could be a friend, a family member, an organization in Canada, etc.

Question

Family Members

16

List the following family members:

  • spouse, common-law partner or same-sex partner; and
  • all of your children (including those who are no longer dependent upon you), whether they are accompanying you to Canada or not.

This includes all children born outside of marriage, legally adopted children or children of whom you are the legal guardian.

Question

Parents

17

Provide the current address of your parents. If no longer alive, state the date of death. List the maiden name of your mother. This is the last name (surname) with which your mother was born.

Question

Sibling(s)

18

This question only applies to unaccompanied minors. An unaccompanied minor is a person under the age of 18 who is not accompanied by a parent or legal guardian.

Question

Identity Documents

19

List all identity documents, genuine or false, that you have in your possession or used to travel to Canada. Examples of identity documents include:

  • passport
  • seaman’s book
  • driver’s license
  • birth certificate
  • electoral card

Include any documents that were lost, destroyed or that you returned to persons who helped you get to Canada. Also include any documents you used to travel to the U.S. if different from the documents you used to enter Canada.

20

List all documents, genuine or false, that your accompanying minors have in their possession or used to travel to Canada. Include any documents that were lost, destroyed or returned to smugglers. Include any documents that they used to travel to the U.S. if different from the documents they used to enter Canada. Examples of identity documents include:

  • passport
  • seaman’s book
  • driver’s license
  • birth certificate
  • electoral card
Question

Trip to Canada

21

Describe the exact route of your journey to Canada. List the cities you went through, starting with the departure from your country of citizenship or the country in which you last resided and ending with your arrival in Canada.

Your route/itinerary may have taken many months or years to complete and you may have used different modes of transportation (for example: plane, bus, boat, train).

Examples of details by mode of transportation:

Mode of transportation Details
Air name of carrier, flight number, last embarkation point, ticket number, etc
Land method of crossing (foot, car, truck), vehicle identification (licence, owner, etc), port of entry used or point of arrival, etc
Marine type of vessel, name of vessel, port of arrival, type of client (crew member, stowaway, passenger), etc
22

If any persons helped you get to Canada, provide information about them. Such a person could be a travel agent, lawyer, consultant, smuggler, etc.

Explain how they helped you (for example: purchased plane ticket, provided false travel documents, traveled with you to Canada, crossed the Canadian border with you, etc).

Question

Education

23

Starting with the most recent, list all post-secondary academic programs or training you have participated in, whether completed or not.

Field of study refers to the name or title of the educational program such as law, medicine, history etc.

Include the type of certificate or diploma received for each course taken, for example: Bachelor of Arts degree, landscaper certificate, electrical engineering degree.

Question

Occupations

24

Starting with the most recent, list all of your occupations during the past 10 years, including work as a homemaker. If you were unemployed, indicate what you were doing instead; for example: studying, traveling, in the hospital, in prison, in a refugee camp, looking for employment, etc. Note: “various employers” is not an acceptable answer. If you worked at two or three different jobs at any given time, list all of them.

Do not exclude any period of time within the past 10 years. Every month and year must be accounted for. Otherwise, processing of your application may be delayed.

Question

Addresses

25

Starting with the most recent, list all addresses where you have lived in the past 10 years. If you had two addresses during the same period of time, this must also be listed.

Do not exclude any period of time within the past 10 years. Every month and year must be accounted for. Otherwise, processing of your application may be delayed.

Question

Membership in Organizations

26

List any organizations or groups you belonged to, supported, or were associated with. Examples include: political or social party, academic organization, religious organization, research organization, workers union, human rights group, city council or alumni association.

Describe the activities and/or positions you held, and the length of time you were involved in each organization or activity.

Question

Government Positions

27

Indicate if you have ever held any type of Government position, such as:

  • bureaucrat / civil servant
  • judge
  • police officer
  • parliamentary official
  • diplomat
Question

Military Service

28

If you or your accompanying minors have ever done military or paramilitary service or training, or belonged to a branch of the military that exercises guard or police functions, describe the rank (level) of authority or leadership. Include dates and places of active duty, and the names of superior officers.

Indicate whether the military or paramilitary service or training was mandatory (compulsory).

Question

Previous Claim(s) for Refugee Protection

29 If you or your family members have made previous refugee claims, you must indicate the date the claims were made and who made the claims.
Question

Basic Information

30

31 to 40

Indicate how much money you have in your possession and the currency (Canadian or American dollars, Euros, British Pounds, etc).

Check “yes” or “no” in the box provided for each question. If you answer “yes” to any question, provide details in the appropriate box (located below question 40). These questions apply to you and your accompanying minors.

Question

Claim for Refugee Protection

41

For your claim for refugee protection to succeed, you must establish that you are unable or unwilling to return to your country of citizenship or, if stateless, your country of former habitual residence:

  • because of a well-founded fear of persecution based on race, religion, nationality, political opinion or membership in a particular social group; or
  • because your removal from Canada to that country would place you in danger of torture, risk to life or cruel and unusual treatment or
    punishment.

In this section, indicate the countries in which you fear persecution, torture or cruel and unusual treatment or punishment.

42

43

Indicate who you are afraid of. This can be a person, an organization such as the government, etc. Be precise.

Be concise and do not use an additional sheet of paper as you will have the opportunity to explain all the facts and details related to your claim to the Immigration and Refugee Board of Canada. Explain briefly why you are asking for Canada’s protection.

 

Third Party Declaration

Important
Graphic logo indicating important item

If someone assisted you in completing this form, they must complete, sign and date this section.

They must indicate if they work for a non-government organization (NGO), are a lawyer or a friend. If they do not fit any of these descriptions, they must check ‘other’ and explain. They must provide their address.

 

Your Declaration

Important
Graphic logo indicating important item

You must sign your application in the presence of a representative of the
Canadian Government.

By signing this form, you solemnly declare that the facts you stated in this form are complete, correct and truthful.

By signing this form, you also declare that you will immediately provide any changes to the information included in this form (for example: change of address).

Date Modified: