Acknowledgement & Declaration
I, ____________________________________________________________________hereby
acknowledge, understand and declare that the information provided by me under the
Background Information Section of our Visa Application Forms are clear, true and correct.
I further acknowledge, understand, and declare that the information provided in all the
application forms and documents provided to me by the Company with respect to our Visa
Applications are clear, true and correct.
I further confirm and acknowledge that ALL the documents, evidencing proof of our
family/economic ties, purpose of visit and funds provided by me, for onward submission by the
Immigration Consultant to the embassy, are genuine and were legally obtained by me.
I acknowledge that we have answered truthfully to all questions in my application forms, and
in each of the sections below, truthfully and in line with Section 16 (1) of Immigration and
Refugees Protection Act (IRPA) which states.
“16 (1) A person who makes an application must answer truthfully all questions put to
them for the
purpose of the examination and must produce a visa and all relevant evidence and
documents that the officer reasonably requires”.
I declare and acknowledge that I have fully read and understood the full meaning of each of
this section and the content of this declaration. I further declare that I have also sought
clarification on all points that were unclear to me prior to my signature.
I bear responsibility for the correctness or otherwise of the information provided below in each
of the sections below, and I hereby absolve, indemnify, hold harmless and defend Canada
Choice Immigration Inc. (CCII), its Subsidiaries, Directors, Employees, Officers and Agents,
from and against any allegations, claims, liabilities, suits, demands, damages, judgements,
possesses, fines, charges, and expenses which CCII may suffer; and /or any negative outcome
which may arise out of, related to, or resulting from my act in providing an incorrect or false
information, misrepresentation or withholding relevant facts, thereby violating the terms and
provisions of my Visa Agreement, the Immigration and Refugee Protection Act (IRPA) and
Immigration and Refugee Protection Regulations (IRPR).
Canada Choice Immigration Inc. / 4711 Yonge Street, 10th Floor, Toronto, ON. M2N 6K8, Canada / Info@infoccii.com / www.canadachoiceimmigration.com
Ph: (Canada) +1-416-890-0485 / (Nigeria) +234-909-047-5024
BACKGROUND INFORMATION
You must complete this section if you are 18 years of age or older.
1 NO YES
a) Within the past two years, have you or a family member ever
had tuberculosis of the lungs or been in close contact with a
person with tuberculosis?
b) Do you have any physical or mental disorder that would
require social and/or health services, other than medication,
during a stay in Canada?
c) If you answered "yes" to question 1a) or 1b), please provide details and the
name of the family member (if applicable).
2 NO YES
a) Have you ever remained beyond the validity of your status?
b) Have you ever attended school without authorization or
worked without authorization in Canada?
c) Have you ever been refused a visa or permit to Canada?
d) Have you ever been refused a visa or permit to any other
Country?
e) Have you ever been denied entry to Canada?
f) Have you ever been denied entry to any other Country?
g) Have you ever been ordered to leave Canada?
h) Have you ever been ordered to leave any other Country?
i) Have you previously applied to enter or remain in Canada?
j) Has anyone ever applied for a Canadian visa on your behalf?
k) Has anyone ever applied for visa on your behalf to any other
country?
l) Have you ever made a refugee claim to Canada?
m) Have you ever made a refugee claim to any other country
(e.g., USA, UK, Australia, and others)?
n) Have you ever been banned entry to Canada – for any
reason, including misrepresentation?
o) Have you ever been banned entry to any other country - for
any reason, including misrepresentation?
p) Have you ever done biometrics fingerprint for Canada before?
Canada Choice Immigration Inc. / 4711 Yonge Street, 10th Floor, Toronto, ON. M2N 6K8, Canada / Info@infoccii.com / www.canadachoiceimmigration.com
Ph: (Canada) +1-416-890-0485 / (Nigeria) +234-909-047-5024
q) Have you ever done biometrics fingerprint for any other
country before?
r) If you answered "yes" to question 2a), 2b), 2c), 2d) or 2n), please provide
details.
3 NO YES
a) Have you ever committed an offence, been arrested for, or
been charged with or convicted of any criminal offence in any
country or territory?
b) if answered "yes" to question 3a) above, please provide
details.
4 NO YES
a) Did you ever serve in any military, or civil defence unit or
serve in a security organization or police force (including non-
obligatory national service, reserve, or volunteer units)?
b) If you answered yes to question 4a), please provide dates of service and
countries where you served.
5 NO YES
Are you, or have you ever been a member or associated with any
political party, or other group or organization which has engaged in or
advocated violence as a means to achieving a political or religious
objective, or which has been associated with criminal activity at any
time?
6. Have you ever witnessed or participated in the ill treatment of NO YES
prisoners or civilians, looting or desecration of religious buildings?
If you answer "yes" to any of questions 3 to 6 above, or upon request of a visa officer,
you MAY BE REQUIRED to fill out IMM 5257 Schedule 1.
Further Mandatory Declarations:
Applicants must read and accept the following conditions to retain our services:
1. While your applications are in process, if the embassy (IRCC) should raise concerns
through Procedural Fairness Letter or other methods – with accusation of non-
disclosure of previous visa applications or refusals, untruthfulness or misrepresentation,
or fraudulent documents, for non-payment of previous application fees, etc.
Repercussion:
CCII will require immediate payment of any outstanding balances– before we proceed with
representation.
Canada Choice Immigration Inc. / 4711 Yonge Street, 10th Floor, Toronto, ON. M2N 6K8, Canada / Info@infoccii.com / www.canadachoiceimmigration.com
Ph: (Canada) +1-416-890-0485 / (Nigeria) +234-909-047-5024
2. If the embassy (IRCC) refuses your applications based on non-disclosure of
previous visa applications or previous refusals, or based on untruthfulness or
misrepresentation, or fraudulent documents
Repercussion:
The applicants will not be eligible for CCII fee waivers in relation to e-file (GCMS Notes)
applications, resubmissions, and appeal. In such situation, CCII will require full professional
fees and payments to proceed.
Declaration:
I solemnly declare that ALL the documents and information provided to Canada Choice
Immigration Inc., by me and/or by my sponsors are genuine (including, but not limited to,
proof of funds and bank statements, employment documents, etc,).
I fully understand that it’s NOT the duty of Canada Choice Immigration Inc. to verify the
authenticity of supporting documents submitted by applicants. The Canadian embassy (IRCC),
at their discretion, verifies application information.
I acknowledge that Canada Choice Immigration Inc. does not bear responsibility in the event
that IRCC (the embassy) finds my documents or information to be fraudulent; and I exonerate
CCII from any obligations or resultant repercussions.
Full Name: __________________________________________
Address: ____________________________________________
Signature: __________________________________________
Dated this ______ day of _____________ 2023
2024
Canada Choice Immigration Inc. / 4711 Yonge Street, 10th Floor, Toronto, ON. M2N 6K8, Canada / Info@infoccii.com / www.canadachoiceimmigration.com
Ph: (Canada) +1-416-890-0485 / (Nigeria) +234-909-047-5024
