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IMM 5669 E : Schedule A - Background / Declaration

PAGE 1 OF 4 IMM 5669 (12-2012) EPROTECTED WHEN COMPLETED - B(DISPONIBLE EN FRAN AIS - IMM 5669 F)This form is made available by Citizenship and Immigration Canada and is not to be sold to A Background / DECLARATIONFOR CIC USE ONLYC lient ID/UCI/FOSS IDBefore you start completing this form, make enough photocopies for your needs. You can also print all or part of this form from our Web site at If there is not enough space to provide all the necessary information, attach to this form a separate sheet of paper with further details.

Under "Activity", write your occupation or job title if you were working. If you were not working, provide information on what you were doing (for example: unemployed, studying, travelling, retired, in detention, etc.). ... declaration conscientiously believing it to be true and knowing that it is of the same force and effect as is made under oath.

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