Form IMM5451 "Solemn Declaration Concerning a Permanent Resident Card That Was Lost, Stolen, Destroyed or Never Received" - Canada

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Download Form IMM5451 "Solemn Declaration Concerning a Permanent Resident Card That Was Lost, Stolen, Destroyed or Never Received" - Canada

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PROTECTED WHEN COMPLETED - B
Page 1 of 2
SOLEMN DECLARATION
CONCERNING A PERMANENT RESIDENT CARD THAT WAS LOST, STOLEN,
DESTROYED OR NEVER RECEIVED
ALL QUESTIONS MUST BE ANSWERED. IF SOME QUESTIONS DO NOT APPLY TO YOU, ANSWER "N/A" ("NOT APPLICABLE").
Surname
Given Name(s)
Client ID number
1. Details of birth
Date of Birth (
City/Town of Birth
Country of Birth
YYYY-MM-DD)
2. Permanent address:
Apt/Unit
Street no.
Street name
City/Town
Province
Postal code
Permanent Resident Card (PR Card) number
Home Telephone no.
Business Telephone no.
Ext.
(if applicable):
(Area code & no.)
(Area code & no.)
3. My Permanent Resident Card (PR Card) was:
Lost
Stolen
Destroyed
Never received
(YYYY-MM-DD)
City/Town
Country
On or
at
about
Under the following circumstances (full information must be provided below):
4. I have made the following efforts to locate this document
(if applicable indicate police authorities notified and attach a copy of police report or incident report number):
5. Should I ever regain possession of the original document, I promise to return it immediately to a Citizenship and Immigration Centre or, if I am abroad, to
the nearest Canadian Embassy, Consulate or High Commission.
I solemnly declare that the information I have provided is true, that it is of the same force and effect as if made under oath, and that it was freely given. I
authorize the department of Citizenship and Immigration Canada to verify the information I have provided. I also understand that the provision of any false
or misleading information may lead to prosecution in accordance with Section 127 of the Immigration and Refugee Protection Act.
Signature of declarant
Signature of declarant
Date (YYYY-MM-DD)
Signature of parent or guardian if declarant is under 18 years of age
Signature of parent or guardian
Date (YYYY-MM-DD)
IMM 5451 (08-2020) E
(DISPONIBLE EN FRANÇAIS - IMM 5451 F)
PROTECTED WHEN COMPLETED - B
Page 1 of 2
SOLEMN DECLARATION
CONCERNING A PERMANENT RESIDENT CARD THAT WAS LOST, STOLEN,
DESTROYED OR NEVER RECEIVED
ALL QUESTIONS MUST BE ANSWERED. IF SOME QUESTIONS DO NOT APPLY TO YOU, ANSWER "N/A" ("NOT APPLICABLE").
Surname
Given Name(s)
Client ID number
1. Details of birth
Date of Birth (
City/Town of Birth
Country of Birth
YYYY-MM-DD)
2. Permanent address:
Apt/Unit
Street no.
Street name
City/Town
Province
Postal code
Permanent Resident Card (PR Card) number
Home Telephone no.
Business Telephone no.
Ext.
(if applicable):
(Area code & no.)
(Area code & no.)
3. My Permanent Resident Card (PR Card) was:
Lost
Stolen
Destroyed
Never received
(YYYY-MM-DD)
City/Town
Country
On or
at
about
Under the following circumstances (full information must be provided below):
4. I have made the following efforts to locate this document
(if applicable indicate police authorities notified and attach a copy of police report or incident report number):
5. Should I ever regain possession of the original document, I promise to return it immediately to a Citizenship and Immigration Centre or, if I am abroad, to
the nearest Canadian Embassy, Consulate or High Commission.
I solemnly declare that the information I have provided is true, that it is of the same force and effect as if made under oath, and that it was freely given. I
authorize the department of Citizenship and Immigration Canada to verify the information I have provided. I also understand that the provision of any false
or misleading information may lead to prosecution in accordance with Section 127 of the Immigration and Refugee Protection Act.
Signature of declarant
Signature of declarant
Date (YYYY-MM-DD)
Signature of parent or guardian if declarant is under 18 years of age
Signature of parent or guardian
Date (YYYY-MM-DD)
IMM 5451 (08-2020) E
(DISPONIBLE EN FRANÇAIS - IMM 5451 F)
Page 2 of 2
To report a PR Card that was lost, stolen, destroyed or never received, immediately submit this completed and signed form to Citizenship and Immigration
Canada by one of the following methods:
Mail it to the
PR Card Processing Centre
P.O. Box 9000
Sydney, Nova Scotia
B1P 6K7
or fax it to the PR Card Processing Centre at 1-902-564-3148
Privacy Statement
Personal information provided on this form is collected by Immigration, Refugees, and Citizenship Canada (IRCC) under the authority of the Immigration and
Refugee Protection Act (IRPA). The personal information will be used for the purpose of processing an application. The personal information provided may
be disclosed to other federal government institutions, law enforcement bodies, provincial/territorial governments and foreign governments for the purpose of
validating identity.
Personal information may be used for other purposes including research, statistics, program and policy evaluation, internal audit, compliance, risk
management, strategy development and reporting, and subsequent program eligibility.
Failure to complete the form in full may result in a delay or the application not being processed. The Privacy Act gives individuals the right of access to,
protection, and correction of their personal information. If you are not satisfied with the manner in which IRCC handles your personal information, you may
exercise your right to file a complaint to the Office of the
Privacy Commissioner of
Canada. The collection, use, disclosure and retention of your personal
information is further described in IRCC’s Personal Information Bank – IRCC PPU 068
IMM 5451 (08-2020) E
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