BEFORE GRANTING AN ENTRY VISA TO A PROSPECTIVE VISITOR, A VISA OFFICER MUST BE SATISFIED

THAT HIS/HER LOGGING, FOOD AND INCIDENTAL EXPENSES WILL BE COVERED. TO ASSIST IN THIS
EVALUATION YOU MAY WISH TO FORWARD THIS FORM DIRECTLY TO YOUR PROSPECTIVE VISITOR. IT
SHOULD BE PRESENTED TO THE VISA OFFICER WITH THE FORMAL APPLICATION FOR A VISITOR VISA,
WHICH MUST BE OBTAINED FROM THE VISA OFFICE, BY THE VISITOR

PLEASE PRINT
PART A
HOST IN CANADA
Surname: ____________________________________ Given Names: __________________________________________
Date and Place of Birth: ________________________ Relationship to Proposed Visitor: ___________________________
Present Address: _____________________________________________________________________________________
Telephone Number: __________________________________________________________________________________
Landed Immigrant / Canadian Citizen / Other (Please Specify): ________________________________________________
Length of time as Resident in Canada: ____________________________________________________________________
HOST HOST’S SPOUSE (If applicable)
Occupation: ________________________________________________________________________________________
Employer’s Name: ___________________________________________________________________________________
Employer’s Address: _________________________________________________________________________________
Length of Time Employed: ____________________________________________________________________________

PART B
PROPOSED VISITOR
Surname: _____________________________ Given Names: ____________________________ Sex: _________________
Accompanying Family Members: _______________________________________________________________________
Present Citizenship: __________________________________________________________________________________
Address (if not residing in country of citizenship, please give reason) ___________________________________________
___________________________________________________________________________________________________
Occupation: ________________________________________________________________________________________
Purpose of Visit: _____________________________________________________________________________________
Length of Visit: _____________________________________________________________________________________

PART C
DECLARATION

I UNDERSTAND AND AGREE THAT COMPLETION OF THIS FORM IS NOT A GUARANTEE THAT THE
PROPOSED VISITOR WILL BE ISSUED A VISITOR VISA, AND THAT THE PROPOSED VISITOR MUST FIRST
DEMONSTRATE, AT A CANADIAN VISA OFFICE OUTSIDE CANADA, THAT HE/SHE COMPLIES WITH THE
REQUIREMENTS OF THE IMMIGRATION ACT, 1976 AND REGULATIONS HEREUNDER. I ALSO
ACKNOWLEDGE THAT I AM AWARE OF THE RESTRICTIONS IMPOSED ON FUNDS WHICH MAY BE
REMOVED FROM THE PROPOSED VISITOR’S CURRENT COUNTRY OF RESIDENCE, AND THAT, IF VISIT IS
APPROVED, I AM OBLIGED TO PROVIDE ADEQUATE LODGING, FOOD AND INCIDENTAL LIVING NEEDS
TO THE VISITOR WHILE HE/SHE IS IN CANADA.

_________________________________________ _________________________________________
Signature of Host Signature of Host’s Spouse (if applicable)

PLEASE NOTE THAT THIS FORM IS FOR YOUR CONVENIENCE AND IS INTENDED TO FACILITATE YOUR
VISITORS APPLICATION FOR A CANADIAN VISA. YOUR VISITORS COUNTRY OF CITIZENSHIP MAY
REQUIRE FURTHER DOCUMENTATION FOR PASSPORT OR EXIT PERMIT ISSUANCE