SCHEDULE 4 ECONOMIC CLASSES - PROVINCIAL NOMINEES

1 PAGE 1 OF 1 IMM 0008 (10-2015) E SCHEDULE 4 PROTECTED WHEN COMPLETED - BSCHEDULE 4 ECONOMIC CLASSES - PROVINCIAL NOMINEES (DISPONIBLE EN FRAN AIS - IMM 0008 F ANNEXE 4)This form is made available by Citizenship and Immigration Canada and is not to be sold to PROVINCIAL nominee Class principal applicants must complete this form. PROVINCIAL NOMINEES nominated under a business, entrepreneur, or self-employed stream/category must also complete SCHEDULE 4A. 1. Your full nameFamily nameGiven name(s)Given name(s)2. Your date of birthDate (YYYY-MM-DD) Amount of unencumbered transferable and available funds you have, in Canadian dollars3. Which PROVINCIAL government has nominated you?

2 PROVINCIAL stream/category:4. Funds$ Declaration I declare that my family members and I intend to live in the Province that nominated me. I understand that my participation in an immigration-linked passive investment scheme (as defined in the Immigration and Refugee Protection Regulations) could exclude me from consideration as a member of the PROVINCIAL nominee Class. I authorize the Government of Canada to share all necessary information respecting my application for permanent residence in Canada, including the status to the application decision, with officials of the PROVINCIAL government that nominated (YYYY-MM-DD)