Visitor Record

Are you applying to extend your visitor status or restore your visitor status?

Extend my status as a visitorRestore my status as a visitor
Please provide your UCI (if known)
Your UCI (Unique Client Identifier) is an 8- or 10-digit number found on your visitor visa (top right corner) or Visitor Record (top section, labeled UCI or Client ID).
Family Name (Last Name)*
First Name and Middle Name*
All first and middle names (as appears on your passport)
Personal Details
Your Full Name (as it appears on your passport)

Family NameGiven Names: First and Middle
Have you ever used any other name (example: maiden name)?

YesNo
Your Prior Name

Family NameGiven Name: First and Middle
Sex
Date of Birth

YearMonthDay
Date
City of Birth
Country of Birth
Your Citizenship
Current country of residence
Have you lived in any other country or territory?

YesNo
Other Country you have resided in:
Status
From

YearMonthDay
Date
To

YearMonthDay
Date
Have you resided in any other countries (in addition to the one listed above)

YesNo
Country
Status
From

YearMonthDay
Date
To

YearMonthDay
Date
Marital Status
Current Marital Status
Date you were married or entered into a common-law relationship

YearMonthDay
Date
Provide the name of your current Spouse/Common Law Partner

Family NameGiven Name(s)
Have you been previously married or in a common-law relationship?

YesNo
Provide the name of your prior Spouse or Common Law Partner

Family NameGiven Name(s): First, Middle
Type of Relationship
From

YearMonthDay
Date
To

YearMonthDay
Date
Their date of birth

YearMonthDay
Date
Language
Your Native Language
Are you able to communicate in English and/or French?
Passport Details
Passport Number
Country of Issue
Issue date

YearMonthDay
Date
Expiry date

YearMonthDay
Date
Do you have a national ID

YesNo
Document number
National ID Document Number
Country of Issue
Issue date

YearMonthDay
Date
Expiry date

YearMonthDay
Date
Are you a Permanent Resident of the USA

YesNo
Your Contact Details
Your Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Telephone Number
Email
example@example.com
Entry Details
Date of your original entry to Canada

YearMonthDay
Date
Place of entry (Name of Airport or Land Crossing)
The original purpose for coming to Canada
Date and place of your most recent entry to canada (If not the same as original entry)

YearMonthDay
Date
Place
If applicable, please provide the document number of the most recent visitor record, study permit, work permit or temporary resident permit issued to you.
Your document number is in the top right corner of your permit (starts with F, U, or W) or visitor visa sticker (starts with V).
Details of your extended stay in Canada
Purpose of your stay
How much longer do you intend to stay?
From

YearMonthDay
Date
To

YearMonthDay
Date
Funds available for your stay (CAD)
Who is paying for your visit/expenses?
Please explain
Name, address and relationship-to-you of any person(s) or institution(s) you will visit during your extension:
Your Education
Do you have any post-secondary education (education beyond high school)?

YesNo
Field and level of study
Example: Biology, Bachelor of Science
School/Facility Name
City
Country
Start

YearMonthDay
Month and year are most important.
End Date

YearMonthDay
Month and year are most important.
Personal and Work History

Give details of your personal and work history for the past 10 years, include unemployment periods
Current Activity/Occupation
Or if unemployed, type "unemployed" or describe your activity.
FROM

YearMonthDay
Year and Month are most important
Company/Employer/Facility name
City
Country
Do you have any additional personal history to add. As a reminder, you must provide 10 years of personal history from today's date. No gaps in your personal history are permitted.
Previous Activity/Occupation
Or if unemployed, type "unemployed" or describe your activity.
FROM

YearMonthDay
Year and Month are most important
TO

YearMonthDay
Year and Month are most important
Company/Employer/Facility name
City
Country
Do you have any additional personal history to add. As a reminder, you must provide 10 years of personal history from today's date. No gaps in your personal history are permitted.
Previous Activity/Occupation
Or if unemployed, type "unemployed" or describe your activity.
FROM

YearMonthDay
Year and Month are most important
TO

YearMonthDay
Year and Month are most important
Company/Employer/Facility name
City
Country
Do you have any additional personal history to add. As a reminder, you must provide 10 years of personal history from today's date. No gaps in your personal history are permitted.
Previous Activity/Occupation
Or if unemployed, type "unemployed" or describe your activity.
FROM

YearMonthDay
Year and Month are most important
TO

YearMonthDay
Year and Month are most important
Company/Employer/Facility name
City
Country
Do you have any additional personal history to add. As a reminder, you must provide 10 years of personal history from today's date. No gaps in your personal history are permitted.
Previous Activity/Occupation
Or if unemployed, type "unemployed" or describe your activity.
FROM

YearMonthDay
Year and Month are most important
TO

YearMonthDay
Year and Month are most important
Company/Employer/Facility name
City
Country
Do you have any additional personal history to add. As a reminder, you must provide 10 years of personal history from today's date. No gaps in your personal history are permitted.
Previous Activity/Occupation
Or if unemployed, type "unemployed" or describe your activity.
FROM

YearMonthDay
Year and Month are most important
TO

YearMonthDay
Year and Month are most important
Company/Employer/Facility name
City
Country
Do you have any additional personal history to add. As a reminder, you must provide 10 years of personal history from today's date. No gaps in your personal history are permitted.
Previous Activity/Occupation
Or if unemployed, type "unemployed" or describe your activity.
FROM

YearMonthDay
Year and Month are most important
TO

YearMonthDay
Year and Month are most important
Company/Employer/Facility name
City
Country
Do you have any additional personal history to add. As a reminder, you must provide 10 years of personal history from today's date. No gaps in your personal history are permitted.
Previous Activity/Occupation
Or if unemployed, type "unemployed" or describe your activity.
FROM

YearMonthDay
Year and Month are most important
TO

YearMonthDay
Year and Month are most important
Company/Employer/Facility name
City
Country
Do you have any additional personal history to add. As a reminder, you must provide 10 years of personal history from today's date. No gaps in your personal history are permitted.
Previous Activity/Occupation
Or if unemployed, type "unemployed" or describe your activity.
FROM

YearMonthDay
Year and Month are most important
TO

YearMonthDay
Year and Month are most important
Company/Employer/Facility name
City
Country
Do you have any additional personal history to add. As a reminder, you must provide 10 years of personal history from today's date. No gaps in your personal history are permitted.
Previous Activity/Occupation
Or if unemployed, type "unemployed" or describe your activity.
FROM

YearMonthDay
Year and Month are most important
TO

YearMonthDay
Year and Month are most important
Company/Employer/Facility name
City
Country
Do you have any additional personal history to add. As a reminder, you must provide 10 years of personal history from today's date. No gaps in your personal history are permitted.
Previous Activity/Occupation
Or if unemployed, type "unemployed" or describe your activity.
FROM

YearMonthDay
Year and Month are most important
TO

YearMonthDay
Year and Month are most important
Company/Employer/Facility name
City
Country
Background Information
Within the past 2 years, have you or a family member ever had tuberculosis of the lungs or been in close contact with a person with tuberculosis?

YesNo
Do you have any physical or mental disorder that would require social and/or health services, other than medication, during a stay in Canada?

YesNo
Provide Details
Have you ever remained beyond the validity of your status

YesNo
Have you ever been refused a visa or permit, denied entry or ordered to leave Canada or any other country or territory?

YesNo
Have you previously applied to enter or remain in Canada?

YesNo
Provide Details
Have you ever been arrested

YesNo
If you answered "yes", please provide details
Did you serve in any military, militia or civil defence unit?

YesNo
Provide Details
Are you, or have ever been a member of a political party?

YesNo
Have you ever witnessed or participated in the ill treatment of prisoners or civilians, looting or desecration of religious buildings?

YesNo
Should be Empty:

Personal Details

Marital Status

Language

Passport Details

Your Contact Details

Entry Details

Details of your extended stay in Canada

How much longer do you intend to stay?

Your Education

Personal and Work History

Background Information