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)