eTA Canada - APPLICATION FORM ONLINE

Please fill out the following travel authorization information:

Gender*

Female

Male

First Name*

Last Name*

Birthdate*

Country of Birth*

City of Birth*

Are you a lawful permanent resident of the United States of America with a valid alien registration card (Green Card)?*

Yes

Country of Citizenship*

USA Permanent Resident Card Number*

Confirm USA Card Number*

Expiration Date*

Country of Residence*

Phone*

Email*

Enter Email

Confirm Email

Marital status*

Residential Address*

Street Address/Name (Enter the address where you live. Do not enter a post office box)

Street Address/Name 2

City/Town

Apartment / House Number Unit

District/Region

Country/Territory

Have you previously applied to enter or remain in Canada?*

Yes

Select “yes” if, in the past, you submitted an application to come to Canada, such as a study permit, work permit or visitor visa

Unique client identifier (UCI) / Previous Canadian visa or permit number*

Confirm Unique client identifier (UCI) / Previous Canadian visa or permit number*

Funds available for travel to Canada (in Canadian dollars)*

Employment information

Occupation*

Job Title*

Please provide the name of the company, employer, school or facility as applicable*

Employed since*

Country/Territory*

City/Town*

Passport information

Passport Number*

Passport Issuance Date*

Passport Expiration Date*

Passport Issuing Country*

Are you a citizen of any other country?*

Yes

Other Citizenship*

Passport Number*

Travel information

Do you know when you will travel to Canada?*

When do you plan to travel to Canada?*

Please enter the time your flight to Canada will Depart

Select Hour*

Please enter a value between 00 and 23.

Select Minute*

Please enter a value between 0 and 60.

Time Zone*

Please answer the following questions

1. Have you ever been refused a visa or permit, denied entry or ordered to leave Canada or any other country?*

Yes

Please provide as many details as possible to help with processing*

2. Have you ever committed, been arrested for, been charged with or convicted of any criminal offense in any country?*

Yes

Please provide as many details as possible to help with processing*

3. Have you or a family member ever had or been in close contact with a person with tuberculosis?*

Yes

Indicate the nature of the relationship, if applicable, and approximate date on which you or a family member had or were in close contact with a person with tuberculosis. Please provide as many details as possible to help with processing.*

4. Do you have a serious health condition for which you are receiving regular medical treatment?*

Yes

Do you have a kidney condition that requires dialysis?*

Yes

Are you traveling for medical reasons or treatment?*

Yes

If you are travelling for the purpose of obtaining medical services or treatment, you must provide, at the border, proof from the Canadian institution that arrangements have been made for treatment. You must also show proof that satisfactory financial arrangements have been made to cover the cost of the treatment as well as all related expenses, including follow-up care and living expenses during your stay in Canada.

Have you made financial arrangements to cover the cost of the treatment, as well as, all related expenses?*

Yes

5. Please briefly indicate if there are additional details pertinent to your application.*

Yes

Please provide as many details as possible to help with processing.*

Consent and declaration

Information provided to CIC is collected under the authority of the Immigration and Refugee Protection Act (IRPA) to determine admissibility to Canada. Information provided may be shared with other Canadian government institutions such as, but not limited to, the Canada Border Services Agency (CBSA), the Royal Canadian Mounted Police (RCMP), the Canadian Security Intelligence Service (CSIS), the Department of Foreign Affairs, Trade and Development (DFATD), Employment and Social Development Canada (ESDC), the Canada Revenue Agency (CRA), provincial and territorial governments and foreign governments in accordance with subsection 8(2) of the Privacy Act. Information may be disclosed to foreign governments, law enforcement bodies and detaining authorities with respect to the administration and enforcement of immigration legislation where such sharing of information may not put the individual and or his/her family at risk. Information may also be systematically validated by other Canadian government institutions for the purposes of validating status and identity to administer their programs.

Where biometrics are provided as part of an application, the fingerprints collected will be stored and shared with the RCMP. The fingerprint record may also be disclosed to law enforcement agencies in Canada in accordance with subsection 13.11(1) of the Immigration and Refugee Protection Regulations. The information may be used to establish or verify the identity of a person in order to prevent, investigate or prosecute an offence under any law of Canada or a province. This information may also be used to establish or verify the identity of an individual whose identity cannot reasonably be otherwise established or verified because of physical or mental condition. Canada may also share immigration information related to biometric records with foreign governments with whom Canada has an agreement or arrangement.

Depending on the type of application made, the information you provided will be stored in one or more Personal Information Banks (PIB) pursuant to section 10(1) of Canada's Privacy Act. Individuals also have a right to protection and access to their personal information stored in each corresponding PIB under the Access to Information Act. Further details on the PIBs pertaining to CIC's line of business and services and the Government of Canada's access to information and privacy programs are available at the Infosource website (http://infosource.gc.ca) and through the CIC Call Centre. Infosource is also available at public libraries across Canada.

Declaration of Applicant

I have read and understand the above declaration.

I declare that the information I have given in this application is truthful, complete and correct.

I understand that misrepresentation is an offence under section 127 of the Immigration and Refugee Protection Act and may result in a finding of inadmissibility to Canada or removal from Canada.

I agree that by typing my name and clicking sign, I am electronically signing my application.

Confirm that you agree*

I Agree

Manually type your name*

Terms and Conditions*

I have read and accepted the TERMS AND CONDITIONS