Transcription of Credit card - Immigration-Québec
1 Minist re de l Immigration, de la Diversit et de l InclusionIt is compulsory to providecontact information for theprincipal applicant if he isnot the Credit card the family and first names of the creditcard holder. You must sendus the original formsigned by the cardholder. A photocopy will not be nameFirst nameDate of birthA-0591-A0 (2016-08)Visa MasterCardNumber:Expiry date:American ExpressNumber:Expiry date: Credit card I authorize the Minist re de l Immigration, de la Diversit et de l Inclusion to charge the amount of $CA to my Credit card :AuthorizationPrincipal applicant (person who makes the application)Application from an employer concerning a job:TemporaryPermanent Application for a Certificat d acceptation du Qu bec (Qu bec acceptance certificate) for:StudyTemporary workMedical treatment Application for an undertaking Family reunificationApplication for a Certificat de s lection du Qu bec (Qu bec selection certificate) as:Skilled worker (Qu bec experience program only) Self-employed workerEntrepreneurLive-in caregiverRecognition as immigration consultant.
2 Application for recognitionRenewalComparative evaluation of studies done outside Qu becReason for the applicationMonthYearMonthYearYearMonthDa yImportant You must sign this form and attach it to your application if you are paying the required fee by Credit use onlyIndividual reference number: File number: Payment by Credit cardConfidential A-0591-A0 (2016-08)Last name of cardholderFirst name of cardholderCardholder s signature requiredYe a rMonthDayX