BSF766 - Application for a Declaration of Relief under Subsection 42.1(1) of the Immigration and Refugee Protection Act (IRPA)

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Note: Print or type the details of your application in the spaces provided below. YOU MUST RESPOND FULLY TO ALL QUESTIONS. IF YOU NEED MORE SPACE, USE ADDITIONAL SHEETS OF PAPER. On each additional sheet, print your name and Canadian immigration identification number in the top righthand corner, sign your initials below your name, and write the page number in the bottom right-hand corner. Also, identify the section and question number for
each answer for which you are providing additional information. This application form is produced by the Canada Border Services Agency and is available free of charge at www.cbsa.gc.ca.

Section A – Applicant Information

Personal Information

Current Contact Information

You must immediately notify the Ministerial Relief Unit of any change in this address to avoid your application being closed.

Mailing Address (if different from above)

You must immediately notify the Ministerial Relief Unit of any change in this address to avoid your application being closed.

Section B – Inadmissibility

Inadmissibility(ies) against which you are seeking a Declaration of Relief

1. Check all boxes that apply and fill in data as appropriate. Under "Inadmissibility grounds", provide specific details, for example: membership in an organization (indicate whether the group was involved with organized criminality, terrorism, espionage, subversion, etc.); being a senior official in a designated regime; engagement in and/or instigation of an act or acts (indicate whether you were engaged in terrorism, espionage, subversion, violence, organized criminality and/or transnational crime (e.g., people smuggling, trafficking in persons, and/or money laundering, etc.)); being a danger to the security of Canada; and/or being a person whose entry into or stay in Canada is restricted pursuant to a relevant decision/ resolution/measure (also known as a sanction) of an international organization of states or association of states, of which Canada is a member. Where applicable, make sure to name the organization(s), identify the designated regime(s), and/or specify the type of act(s) you committed that resulted in your inadmissibility.

Circumstances of Inadmissibility

Check all boxes below that apply to the circumstances in which you were found inadmissible under the above-noted provisions. If available, attach a copy of the removal order, or inadmissibility or refusal decision.

Other Inadmissibility(ies)

Additional Information

Respond to the following questions by checking all boxes that apply.

If the answer to any of the above questions is YES, provide details here (indicate the question number), and include with your application form any available supporting documentation.

Section C – Background Information

Formal Education and Training

Employment and Volunteer Work

Membership in and Association with Organization(s)

Government Position(s) Held

Military, Paramilitary and/or Police Service

Criminal History

Immediately notify the Ministerial Relief Unit of any change in criminal activity, charges, and/or your criminal record.

Countries of Previous Residence or International Travel

Section D - Appointment of Representative

You do not need to hire an immigration representative; it is your choice. No one can guarantee that the Minister of Public Safety and Emergency Preparedness will make a declaration of relief in your case.

A representative is someone who has provided advice or guidance to you prior to submitting your application, following the submission of your application, and/or someone who has your permission to conduct business on your behalf with the CBSA.

You may only have one representative at a time per application.

The Immigration and Refugee Protection Act makes it an offence for any person who is not authorized under the Act to knowingly, directly or indirectly, represent or advise a person for consideration - or offer to do so - in connection with a proceeding or application under that Act. Consideration includes money or any other form of compensation or reward.

Are you using a representative with respect to your Application for a Declaration of Relief? Yes/No

If YES, you must complete the Use of a Representative form (IMM 5476), available free of charge at www.cic.gc.ca. Include the completed form with your Application for a Declaration of Relief.

You must immediately advise of any change in your representation, including cancellation, or a change of address, by submitting a new, completed and signed IMM 5476 to the Ministerial Relief Unit.

Section E - Applicant Declaration

Section F - Interpreter Declaration

I, (print full name clearly) , hereby declare that I have accurately interpreted the entire contents of this form and all attached documents for the applicant from the English language to the language (state dialect, if any).

I am proficient in both of these languages (and dialect, if any), and was able to communicate effectively with the applicant. The applicant has assured me that they have understood the entire contents of this form and all attached documents and the answers provided, as interpreted by me.

Section G - Privacy Statement

The information you provide in this document is collected under the authority of the Immigration and Refugee Protection Act (IRPA) and the Immigration and Refugee Protection Regulations (IRPR), for the purpose of processing your Application for a Declaration of Relief under subsection 42.1(1) of the IRPA. The information may be disclosed to Immigration, Refugees and Citizenship Canada; the Immigration and Refugee Board; the Canadian Security Intelligence Service; the Royal Canadian Mounted Police; the United States National Criminal Information Center; INTERPOL; and similar organizations to obtain information that will be used to help inform the Canada Border Services Agency's (CBSA) recommendation to the Minister of Public Safety and Emergency Preparedness on whether or not to make a declaration of relief.

Refusal to provide the requested information may result in processing delays or your application not being accepted for processing. Individuals have the right to access and to make corrections to their personal information under the Privacy Act. The information collected is described within Info Source under the Personal Information Bank CBSA PPU 1504, which is detailed within the CBSA Info Source Chapter. Should you have concerns about the CBSA's handling of your personal information, you have a right to file a complaint with the Privacy Commissioner of Canada.

Section H - General Information

Pursuant to subsection 42.1(1) of the Immigration and Refugee Protection Act (IRPA) and related regulations, you are eligible to apply for a declaration of relief (commonly referred to as "Ministerial relief") if you have been determined to be inadmissible to Canada under section 34 (security), paragraphs 35(1)(b) or (c) (human or international rights violations), and/ or subsection 37(1) of the IRPA (organized criminality), resulting in a removal order being issued against you and/or your application for temporary or permanent residence being refused. You are also eligible to apply if you were found to be inadmissible to Canada under a corresponding provision of subsection 19(1) of the former Immigration Act (IA). Foreign nationals who are inadmissible under IRPA paragraph 35(1)(a) or the former IA paragraph 19(1)(j) (commission of genocide, war crimes or crimes against humanity) are not eligible for Ministerial relief. Relief applications may not be submitted until all rights of judicial review against the immigration refusal or removal order have expired or been exhausted. Applications which do not meet these requirements or which do not provide the mandatory information will be returned unprocessed.

The Minister of Public Safety and Emergency Preparedness (the Minister) may declare that the matters referred to in the aforementioned provisions of the IRPA do not constitute inadmissibility in your case if you satisfy the Minister that it is not contrary to the national interest. In considering whether to make a declaration of relief, the Minister may only take into account national security and public safety considerations, but his or her analysis is not limited to considering the danger that the applicant presents to the public or the security of Canada. The onus to satisfy the Minister that making a declaration of relief is not contrary to the national interest rests with the foreign national applying for relief and not with the CBSA or the Minister to prove otherwise.

The purpose of this application is to present the Minister with a specific set of information pertaining to the circumstances of your case, in addition to any supplementary submissions you may wish to include. This information may assist the Minister in his/her decision to grant or deny relief from your inadmissibility. This application is made available by the Canada Border Services Agency (CBSA) and is not sold to applicants. It is available free of charge on the CBSA's website at www.cbsa.gc.ca.

Answering the questions

The information you provide in your Application for a Declaration of Relief, and any accompanying submissions, must be complete, true and correct; otherwise, your application may not be accepted for processing. Make sure you understand the instructions and the questions before you write your answers. If you do not understand a question, ask someone to explain it to you.

Give details where applicable, and include dates, as well as names of places and persons. You must respond fully to all questions. if you need more space, use additional sheets of paper. On each additional sheet, write your name and Canadian immigration identification number in the top right-hand corner, sign your initials beside your name, and write the page number in the bottom right-hand corner. Also, identify the section and question number for which you are providing additional information. Sign the applicant's declaration at the end of the form when you are finished (see Section E - Applicant Declaration: Declaration A). Note that a parent or legal guardian must sign for a person under 18 years of age.

Language

You can obtain and complete the Application for a Declaration of Relief in either of Canada's official languages: English or French. If you do not understand English or French, you will need to use an interpreter. Make sure that the interpreter reads to you all of the instructions and questions in the form, that you understand the questions and instructions, and that the interpreter understands your answers. You are responsible for the information provided in this application and any attachments or submissions that you choose to provide. You and the interpreter must both sign the form when you are finished (see Section E - Applicant Declaration: Declaration B; and Section F - Interpreter Declaration).

Applying for a Declaration of Relief

A completed and signed Application for a Declaration of Relief under Subsection 42.1(1) of the Immigration and Refugee Protection Act, and any related submissions, should be sent to the CBSA Ministerial Relief Unit (MRU) at the following address:

Ministerial Relief Unit
Canada Border Services Agency
100 Metcalfe Street, 10th floor
Ottawa, Ontario K1A 0L8

or via email at:

Ministerial_Relief.Exemptions_Ministerielles@cbsa-asfc.gc.ca.

If your information changes or if you want to add information, you must inform the CBSA MRU. Circle or underline the information you changed or added to your Application for a Declaration of Relief, sign and date the changed pages, and send those pages (not a copy) to the CBSA MRU at the address specified above.

For more information, consult the Guide to Applying for a Declaration of Relief under Subsection 42.1(1) of the Immigration and Refugee Protection Act.

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