Citizenship and

Immigration Canada

PROTECTED WHEN COMPLETED - B

Citoyennet et
Immigration Canada

FEE PAYMENT FORM - APPLICATION FOR PERMANENT RESIDENCE

This form must accompany your application for Permanent Residence under certain programs. Refer to the instruction guide to know if you can use this fee
payment form.
Please refer to step 3 of your instruction guide for acceptable methods of payment. Applications submitted with incorrect payments will be returned.

STEPS TO FOLLOW:
1. Calculate the applicable fee by referring to the fee table below.
Processing Fee
Principal applicant

Number of
persons

Amount per
person

Amount due
$ CAD

x $ 550

$ 550

Each family member age 22 or older

x $ 550

Each family member under age 22 who is

married or in a common-law relationship
Each family member under age 22 who is
unmarried and not in a common-law
relationship

x $ 550
x $ 150
Total payment:

2. Pay by certified cheque, bank draft or money order payable to THE RECEIVER GENERAL FOR CANADA or by Visa, Mastercard or American Express.
3. Include the payment form and the documents specified in the Document Checklist with your application, specific to the class you are applying under.
4. Check the appropriate box to indicate your method of payment:
Credit card
(complete section A and B below)

Certified cheque, bank draft or money order

(enclosed and complete section A below)

METHOD OF PAYMENT OPTIONS

A combination of more than one method of payment is acceptable. However, payment by each method MUST be equal to a single or a multiple amount per
person that you have indicated in Step 1 above.
For example: An amount of $550 paid by credit card for the principal applicant, and 2 x $150 paid by a certified cheque for 2 dependents for a total of $850
is acceptable. However, $500 paid by credit card and $350 by certified cheque will not be accepted.

SECTION A
Name of principal applicant (given name(s), surname)

Name of payer (if different from the principal applicant)

Address of payer (if different from the principal applicant)

SECTION B - CREDIT CARD PAYMENT AUTHORIZATION

(Please indicate the type of credit card with an "X")

I agree to pay the Receiver General for Canada

VISA
CAD$

on my credit card for fees related to an application

MASTERCARD

AMERICAN EXPRESS

Credit card number

for permanent residence.

Expiry date of the card
Note: The amount authorized must be equal to a single fee or a
multiple of a single fee. Authorizations for other amounts
are incorrect.

Name of cardholder (please print)

A three (3) or four (4) digit number usually found on the

back or front of the credit card.
Note: The credit card must be valid for at least nine (9) months from the
date of submission of your application. Otherwise your application
will be returned.
Year

Date

IMM 5620 (01-2012) E

Authorization number

Year

Card security/card verification value code (CVV)

Signature of cardholder

FOR OFFICIAL
USE ONLY

Month

Month

Day