8/12/2019 Fee Payment Form
1/1
(Please indicate the type of credit card with an "X")
Card security/card verification value code (CVV)
IMM 5620 (01-2012) E
FEE PAYMENT FORM - APPLICATION FOR PERMANENT RESIDENCE
STEPS TO FOLLOW:1. Calculate the applicable fee by referring to
the fee table below.
Citizenship andImmigration Canada
Citoyennet etImmigration Canada
This form must accompany your application for Permanent
Residence under certain programs. Refer to the instruction guide to
know if you can use this fepayment form.
Please refer to step 3 of your instruction guide for acceptable
methods of payment.Applications submitted with incorrect payments
will be returned.
PROTECTED WHEN COMPLETED
2. Pay by certified cheque, bank draft or money order payable to
THE RECEIVER GENERAL FOR CANADA or by Visa, Mastercard or American
Express
3. Include the payment form and the documents specified in the
Document Checklistwith your application, specific to the class you
are applying under.
4. Check the appropriate box to indicate your method of
payment:
Note: The credit card must be valid for at least nine (9) months
from thdate of submission of your application. Otherwise your
applicatiwill be returned.
SECTION B - CREDIT CARD PAYMENT AUTHORIZATION
I agree to pay the Receiver General for Canada
CAD$ on my credit card for fees related to an application
for permanent residence.
Name of cardholder (please print)
Year Month Da
FOR OFFICIALUSE ONLY
Authorization number
SECTION A
MASTERCARDVISA AMERICAN EXPRES
Credit card number
Expiry date of the cardMonth Year
A three (3) or four (4) digit number usually found on theback or
front of the credit card.
Note: The amount authorized must be equal to a single fee or
amultiple of a single fee. Authorizations for other amountsare
incorrect.
Principal applicant
Each family member age 22 or older
Each family member under age 22 who ismarried or in a common-law
relationship
Processing FeeNumber of
persons
Amount due
$ CAD
Each family member under age 22 who isunmarried and not in a
common-lawrelationship
$ 550x $ 550
x $ 550
x $ 550
x $ 150
1
Amount per
person
Total payment:
METHOD OF PAYMENT OPTIONS
A combination of more than one method of payment is acceptable.
However, payment by each method MUSTbe equal to a single or a
multiple amount pperson that you have indicated in Step 1above.For
example: An amount of $550 paid by credit card for the principal
applicant, and 2 x $150 paid by a certified cheque for 2 dependents
for a total of $85is acceptable. However, $500 paid by credit card
and $350 by certified chequewill notbe accepted.
Name of payer (if different from the principal applicant)Name of
principal applicant (given name(s), surname)
Address of payer (if different from the principal applicant)
DateSignature of cardholder
Credit card(complete section A and B below)
Certified cheque, bank draft or money order(enclosed and
complete section A below)
