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    Imm5409e PDF

    Uploaded by

    Melanie Tulipa Mendoza
    This statutory declaration of common-law union document contains information for two individuals declaring their common-law partnership. It includes sections for them to provide details about how long they have cohabited, whether they jointly own property or have joint bank accounts, and to sign declaring their partnership. Any personal information provided will be kept private and stored securely according to Canadian privacy laws.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Imm5409e PDF

    Uploaded by

    Melanie Tulipa Mendoza
    661 views1 page
    This statutory declaration of common-law union document contains information for two individuals declaring their common-law partnership. It includes sections for them to provide details about how long they have cohabited, whether they jointly own property or have joint bank accounts, and to sign declaring their partnership. Any personal information provided will be kept private and stored securely according to Canadian privacy laws.

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    IMM5409E.pdf

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    This statutory declaration of common-law union document contains information for two individuals declaring their common-law partnership. It includes sections for them to provide details about how long they have cohabited, whether they jointly own property or have joint bank accounts, and to sign declaring their partnership. Any personal information provided will be kept private and stored securely according to Canadian privacy laws.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    661 views1 page

    Imm5409e PDF

    Uploaded by

    Melanie Tulipa Mendoza
    This statutory declaration of common-law union document contains information for two individuals declaring their common-law partnership. It includes sections for them to provide details about how long they have cohabited, whether they jointly own property or have joint bank accounts, and to sign declaring their partnership. Any personal information provided will be kept private and stored securely according to Canadian privacy laws.

    Copyright:

    © All Rights Reserved
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    You are on page 1of 1

    PROTECTED WHEN COMPLETED - A

    PAGE 1 OF 1

    STATUTORY DECLARATION OF COMMON-LAW UNION


    BEFORE YOU START, READ THE INSTRUCTION GUIDE. TYPE or PRINT in black ink.
    (IF APPLICABLE)

    Country

    Province/State/territory

    In the matter of an application made pursuant to the Immigration and Refugee Protection Act and Regulations and in the matter of common-law union,
    We,

    and

    (name of declarant)

    county of

    (name of city, town, village)

    in

    (if applicable)

    in the country of

    (name of province, state, territory)

    , solemnly declare that we have cohabited in a conjugal relationship for

    (name of country)

    of

    (name of declarant's partner)

    (number of years)

    continuous year(s) from

    to
    Date (YYYY-MM-DD)

    Date (YYYY-MM-DD)

    My common-law partner and I:


    a) Have jointly signed a residential
    lease, mortgage or purchase
    agreement relating to a
    residence in which we both live.
    Yes

    b) Jointly own property other than


    our residence.

    No

    I have life insurance on myself which names


    my common-law partner as beneficiary.

    Yes

    No

    c) Have joint bank, trust, credit


    union or charge card accounts.

    Yes

    d) Have declared our common-law


    union under the Canadian
    Income Tax Act. (T-1 "General Individual Income Tax Return")

    No

    Yes

    No

    Yes

    No

    3 My common-law partner has life insurance on


    Yes

    No

    him/herself which names me as beneficiary.

    If none of the above sections applies, what other documentary evidence do you have that would indicate your relationship as common-law partners?
    __________________________________________________________________________________________________________________________
    __________________________________________________________________________________________________________________________
    __________________________________________________________________________________________________________________________
    __________________________________________________________________________________________________________________________
    __________________________________________________________________________________________________________________________

    5 SOLEMN DECLARATION

    We make this solemn declaration conscientiously believing it to be true, and knowing that it is of the same force and effect as if made under oath.

    Name of declarant

    Signature of declarant

    Name of declarant's partner

    Signature of declarant's partner

    Declared before me at (City, Town, Village)

    Name of the person who administered the declaration

    county of

    Choose person's title from one of the following:


    Notary Public

    in the province/state/territory of

    in (country)

    Commissioner of Oaths
    Commissioner of Taking Affidavits

    this

    day of

    of the year

    Signature of the person who administered the declaration

    Information to be provided on the Statutory Declaration of Common-law Union is collected under the authority of the Immigration and Refugee Protection Act and is required to determine your eligibility or that of
    your partner with respect to an application for sponsorship, an application for permanent residence or an application for temporary residence. It may be used to enforce any provisions of the Act or its
    regulations and may be provided to provincial authorities pursuant to federal/provincial information exchange agreements. Information you provide on this form will be stored in Personal Information Banks CIC
    PPU 013 (Sponsors of immigrants), CIC PPU 015 (Immigration case files), CIC PPU 051 (Foreign students records and case file), CIC PPU 053 (Permanent resident data system), CIC PPU 054 (Foreign
    workers records and case file). It is protected and accessible under the provisions of the Privacy Act and the Access to Information Act. Instructions for obtaining information are provided in InfoSource, a copy
    of which is located in all Citizenship and Immigration offices.

    IMM 5409 (04-2015) E

    (DISPONIBLE EN FRANAIS - IMM 5409 F)

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