PROTECTED WHEN COMPLETED - B

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UNDERTAKING / APPLICATION TO SPONSOR FOR CIC USE ONLY

UNDERTAKING TO SPONSOR CONVENTION REFUGEES ABROAD G#

AND HUMANITARIAN-PROTECTED PERSONS ABROAD

Check the appropriate boxes below. I am / We are:

A Sponsorship Agreement Holder (SAH) or

A Group of Five (G5) A Community Sponsor (CS)
Constituent Group (CG)

Check this box for a visa office referred sponsorship Profile no.:

Check this box if you are adding a dependant UCI or G # of Principal Applicant:

A - SPONSORSHIP AGREEMENT HOLDERS - THIS SECTION MUST BE COMPLETED BY

SPONSORSHIP AGREEMENT HOLDERS WHETHER PARTNERING WITH A CG OR NOT

Name of Sponsorship Agreement Holder

Name of representative - Surname (Family name) Given names

Other names used (include birth name, maiden, previous married names, aliases and nicknames)

Address (no. and street) Apt. - Unit City Province Postal code

Home telephone no. Business or cell telephone no. E-mail address

B - SPONSORSHIP GROUP - THIS SECTION MUST BE COMPLETED BY

CONSTITUENT GROUPS, GROUPS OF FIVE AND COMMUNITY SPONSORS

Name of Sponsorship Group (CG, G5 or CS)

Name of representative - Surname (Family name) Given names Date of birth (YYYY-MM-DD)

Other names used (include birth name, maiden, previous married names, aliases and nicknames)

Address (no. and street) Apt. - Unit City Province Postal code

Home telephone no. Business or cell telephone no. Fax no. E-mail address

C - THIS SECTION MUST BE COMPLETED BY

CO-SPONSORS (INDIVIDUAL OR GROUP) ONLY. THIS DOES NOT APPLY TO GROUPS OF FIVE.

Name of corporation (if applicable)

Name of representative - Surname (Family name) Given names Date of birth (YYYY-MM-DD)

Other names used (include birth name, maiden, previous married names, aliases and nicknames) Relationship to principal applicant (if applicable)

Address (no. and street) Apt. - Unit City Province Postal code

Home telephone no. Business or cell telephone no. E-mail address

This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants.
IMM 5373 (08-2015) E (AUSSI DISPONIBLE EN FRANAIS - IMM 5373 F)
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D - THIS SECTION MUST BE COMPLETED BY GROUPS OF FIVE ONLY

1 Group member - Surname (Family name) Given names

Other names used (include birth name, maiden, previous married names, aliases and nicknames)

Date of birth (YYYY-MM-DD) Relationship to principal applicant (if applicable)

Address (no. and street) Apt. - Unit City Province Postal code

Home telephone no. Business or cell telephone no. E-mail address

2 Group member - Surname (Family name) Given names

Other names used (include birth name, maiden, previous married names, aliases and nicknames)

Date of birth (YYYY-MM-DD) Relationship to principal applicant (if applicable)

Address (no. and street) Apt. - Unit City Province Postal code

Home telephone no. Business or cell telephone no. E-mail address

3 Group member - Surname (Family name) Given names

Other names used (include birth name, maiden, previous married names, aliases and nicknames)

Date of birth (YYYY-MM-DD) Relationship to principal applicant (if applicable)

Address (no. and street) Apt. - Unit City Province Postal code

Home telephone no. Business or cell telephone no. E-mail address

4 Group member - Surname (Family name) Given names

Other names used (include birth name, maiden, previous married names, aliases and nicknames)

Date of birth (YYYY-MM-DD) Relationship to principal applicant (if applicable)

Address (no. and street) Apt. - Unit City Province Postal code

Home telephone no. Business or cell telephone no. E-mail address

5 Group member - Surname (Family name) Given names

Other names used (include birth name, maiden, previous married names, aliases and nicknames)

Date of birth (YYYY-MM-DD) Relationship to principal applicant (if applicable)

Address (no. and street) Apt. - Unit City Province Postal code

Home telephone no. Business or cell telephone no. E-mail address

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E - REFUGEE APPLICANTS - THIS SECTION MUST BE COMPLETED BY ALL SPONSORING GROUPS. Include both accompanying and non-accompanying family
members and dependants. Refer to the Refugee Sponsorship application guide (IMM 5413) for definition of family members.

1 Principal Applicant - Surname (Family name) Given names FOR CIC USE ONLY
UCI

Sex Date of birth (YYYY-MM-DD) Place and country of birth

Male Female

Marital status Country of citizenship

2 Refugee Applicant - Surname (Family name) Given names FOR CIC USE ONLY
UCI

Sex Date of birth (YYYY-MM-DD) Place and country of birth

Male Female

Marital status Country of citizenship Relationship to principal applicant

Accompanying Non-accompanying

3 Refugee Applicant - Surname (Family name) Given names FOR CIC USE ONLY
UCI

Sex Date of birth (YYYY-MM-DD) Place and country of birth

Male Female

Marital status Country of citizenship Relationship to principal applicant

Accompanying Non-accompanying

4 Refugee Applicant - Surname (Family name) Given names FOR CIC USE ONLY
UCI

Sex Date of birth (YYYY-MM-DD) Place and country of birth

Male Female

Marital status Country of citizenship Relationship to principal applicant

Accompanying Non-accompanying

5 Refugee Applicant - Surname (Family name) Given names FOR CIC USE ONLY
UCI

Sex Date of birth (YYYY-MM-DD) Place and country of birth

Male Female

Marital status Country of citizenship Relationship to principal applicant

Accompanying Non-accompanying

6 Refugee Applicant - Surname (Family name) Given names FOR CIC USE ONLY
UCI

Sex Date of birth (YYYY-MM-DD) Place and country of birth

Male Female

Marital status Country of citizenship Relationship to principal applicant

Accompanying Non-accompanying

7 Refugee Applicant - Surname (Family name) Given names FOR CIC USE ONLY
UCI

Sex Date of birth (YYYY-MM-DD) Place and country of birth

Male Female

Marital status Country of citizenship Relationship to principal applicant

Accompanying Non-accompanying

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F - MULTIPLE UNDERTAKINGS - THIS SECTION MUST BE COMPLETED BY ALL SPONSORING GROUPS, IF APPLICABLE
FOR CIC USE ONLY
Names (last name and given names) of other principal
Date of birth (YYYY-MM-DD) Application no.
applicants linked to this undertaking

G - OBLIGATIONS, CONSENT AND DECLARATIONS

This undertaking specifies the obligations of the sponsoring group with respect to the principal applicant and all accompanying or non-accompanying family members:

Reception - Meet the refugee upon arrival in the community;

Lodging - Provide suitable accommodation, basic furniture and other household essentials;

Care - Food, clothing, local transportation and other basic necessities of life;

Settlement Assistance and Support - Assist the refugees to learn an official language, seek employment, encourage and assist them to adjust to life in Canada, as outlined
in the Settlement Plan.
I understand that, as a group member, I am jointly and severally or solidarity bound with the other group members to perform the obligations of the sponsorship undertaking
and am liable with the sponsorship group for any breach of those obligations. The sponsoring group's obligations commence upon arrival of the sponsored persons in
Canada. The refugees are supported for 12 months or until they become self-sufficient.

As per subsection 140.2(1) of the Immigration and Refugee Protection Regulations:

Check this box if:

you, the sponsors, are submitting the application package (the IMM 6000 and the Sponsorship application) directly to CIC; or
you, the sponsors, are submitting a sponsorship application for a Blended Visa Office Referred (BVOR) case.

I understand that I am prohibited from using or disclosing any personal information provided to me by the principal applicant I have agreed to sponsor for the purpose of
submitting their application for permanent residence. I agree not to further disclose or use the information for any purpose other than this sponsorship application.

OR

Check this box if the application package (the IMM 6000 and the Sponsorship application) is being submitted directly to CIC by the principal applicant you
have agreed to sponsor.

I authorize CIC to collect the personal information requested in my sponsorship undertaking from the principal applicant I have agreed to sponsor. I understand this
information is being collected indirectly for the purposes of processing the sponsorship undertaking and for assisting CIC in assessing and processing the application for
permanent residence submitted by the principal applicant I have agreed to sponsor.

AND

Check this box if you consent to disclose ineligibility information.

In the event that I am found to be ineligible to be a party to a sponsorship pursuant to subsection 156(1) of the Immigration and Refugee Protection Regulations (IRPR), I
hereby authorize CIC to disclose to the remaining parties that I cannot be a party to the sponsorship. I understand that this information is required to give the remaining
parties to the sponsorship an opportunity to seek out another sponsor to replace me, and that the reason for my ineligibility finding will not be disclosed to anyone other than
myself. I also understand that I am not required to consent to this disclosure.

IMM 5373 (08-2015) E

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We declare that the information provided is to the best of our knowledge true, complete and accurate.

We are not in default of any other sponsorship undertakings.

We are not in default of any immigration loans.

We have made or will make adequate arrangements in the expected community of settlement for the reception and settlement of the person(s) identified in this undertaking,
as evidenced in the Settlement Plan.

We have sufficient financial resources and expertise to fulfill this undertaking.

To the best of our ability, we will not knowingly or deliberately allow any individual to participate in the group's settlement activities who may be considered a threat to the
safety and security of the refugees.

We understand that any false statements or concealment of any material fact may result in, but is not limited to, the following consequences:

Refusal to approve this or future undertakings;

Refusal of the sponsored individual's application for permanent residence;
Vacation of the sponsored individual's refugee status;
Revocation of the existing sponsorship application with CIC;
Prosecution or other enforcement action.

We understand that the sponsorship undertaking constitutes a financial obligation that could result in collection action, should there be a breach of that obligation.

SIGNATURES FOR SAH AND, IF APPLICABLE, CG:

SAH representative name (print name) Signature Date (YYYY-MM-DD)

CG representative name (print name) Signature Date (YYYY-MM-DD)

SIGNATURES FOR GROUPS OF FIVE:

Member 1 name (print name) Signature Date (YYYY-MM-DD)

Member 2 name (print name) Signature Date (YYYY-MM-DD)

Member 3 name (print name) Signature Date (YYYY-MM-DD)

Member 4 name (print name) Signature Date (YYYY-MM-DD)

Member 5 name (print name) Signature Date (YYYY-MM-DD)

SIGNATURE FOR COMMUNITY SPONSORS:

CS representative name (print name) Signature Date (YYYY-MM-DD)

SIGNATURES FOR CO-SPONSORS:

Co-sponsor name (print name) Signature Date (YYYY-MM-DD)

Co-sponsor name (print name) Signature Date (YYYY-MM-DD)

The information you provided on this form is collected under the authority of the Immigration and Refugee Protection Act and will be used to maintain a record of
application and sponsorship undertakings by private sponsors in Canada according to the requirements of the Act. It will be retained in the Personal Information Bank CIC
PPU 008 identified in Infosource. It may be shared with other organizations in accordance with the consistent use of information under the Privacy Act. Under the
Privacy Act and the Access to Information Act individuals have the right to protection of and access to their personal information. Details on these matters are available at
infosource.gc.ca and through the Citizenship and Immigration Call Centre. Infosource is also available at Public Libraries in Canada.

IMM 5373 (08-2015) E