Authorization to Disclose Personal Information


To whom it may concern


I , hereby notify Citizenship and Immigration Canada that I have authorized the following representative, who is pursuant to the Law a corporation in Canada, to act on my behalf in connection with my application for Permanent Residency in Canada. I have given consent to the below mentioned representative solely to obtain a copy of the CAIPS notes pertaining to my application under the Access to Information Act.



Details of the Canadian representative:



Name: CAIPS Notes Services


Address:

9 Grantbrook Crt

Brampton, Ontario L6S 2K8

Canada





Signature of the Applicant: ______________________________

Full name of the Applicant:

Date signed (Month/Date/Year):