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Citizenship and Immigration Canada
Citoyennete et Immigration Canada PROTE
IMMIGRATIONr.V.
RECORD OF LANDING FICHE RELATIVE AU DROIT D'ETABLISSEMENT
,s QE LINE FOlq RpIPLIX003646602
WHEN COMPLETED
PERMANENT RESIDENT STATUS MAY BE CHECKED WITH IMMIGRATION CANADA LE DROIT D'ETABLISSEMENT PEUT ETRE VERIFIE AUPRES D'IMMIGRATION CANADA
IMMIGRANT IDENTIFICATION2. Surname - Nom de famille
-
IDENTIFICATION DE L'/MMIGRANT3. Given Names Prenoms
3868-
-
ESPANO4. Name Flag
- /ndicateur du nom - Pays de naissance
I5. Date of Birth Date de naissance
SHYR ILL BES I TE6. Place of Birth
D -J
M
Y-A
- Lieu de naissance9. Marital Status
19
068. Sex
1975
7. Country of Birth
PHIL I PP I PH I L 1PP I PHILIPPI
227227
- srt MALE - Passeport n1
-,Ktt .
51 feiL E
1
10. Citizen of Citoyen de
-
11. Passport No
Valid Until
GG484064
- Valide jusqu'au ..
12. If applicable, Country of Issue of Travel Document
- S'll y a lieu, indiquer le pays de delivrance du document de voyage
13. Family Status- Situation par rapport a la famille
I
_ 14/03/2006
PRINCIPALh - Date de naissance Relationship Lien de parente
I
1
14. Accompanying Family Members
- Membres de la famille qui accompagnent l'immigrant Name - Nom '''''''''''''''''TrePt nOrit -atzepeini, and Ci tyPnne , Firnm:qration Canada trrmigration Canad a:
-
THE HOLDER IS NO _iNGER A PERMANENT RESIDENT ".:;?,_E NE ST PLUS .._.... ' PERMANENT ,
, . . ., ,_
4
rwegermarasemse.,
Have you any dependants other than those listed above? Outre celles qui soot mentionnees ci-dessus, avez-vous d'autres personnes a votre charge? 15. Full Name, Address and Relationship of Person willing to assist
Al
p 7,4. . .__
- Nom et adresse au long de la personne disposoe a offrir son aieetlien de parente
22
ELKPATH AVENUE 381 217. Mother Tongue Langue matemelle
TORONTO ONT M2L2W116. Intended Occupation
- Profession envisagee6474-200
-
NANNIES & LIVE-IN CAREGIVERS
H I L I GAY NON
I;)0 t3
021
I certify that the above statements are true and correct Je certifie que les renseignements ci-dessus soot exacts et veridiques19. Imm. Cat.
Signature
Date
Y-A
ea.-1:-- 1.-t,"7 41. Carrier/Flight No. Transporteur/vo n
AO 6) -Z..
- Cat d'imm. -
I I
LC1
el 20 poea nprog. ent special 22. Years of Schooling -Annees d'etudes
L CP 1442. Money in possession Argent en main $
21. Educ. Qual. Certificats, diplomes, e c.
03
23. Employment Code
- Code de l'emploi
24. Official Lang. Ability Conn. des longues off.
-
I
25. C.L.P.R.
26. Trans. Warrant No.
I
IO
= C.O.B. - D.P.R.P. = P.D.N.r
I27. P.C. Number C.P. numero
227
43. Conditions of Landing Imposed Conditions d'obtention du droit d'etablissement imposees
IC I
1
I
I,
-
N du bon de transp.
-
28. "S" Code Code de surv.
-
29. Medical File No. -Dossier medical n
30. Type of Case
- Genre de cas
31. Medical Validity Validito de l'examen medical
D-J
M
Y- A
32. Date Issued Delivre le
1
m02
(:902
Visa Validity Validite du visa'
D-J
M
Y-A
44. understand these conditions conditions
I
- Je comprends ces_M'
90Y A
34. Office of Issue Bureau d'origine
-
P.S. Code Code du P.S.
CPC VEG35. Signature of Visa Officer Signature de /'agent des visas
- 9518
i 45. Landed Dro t d tabl ssement obtenu le
-
3\0
iniCI'ON,P.S. C / 60
-
46. AT A
SCAT BORO GH36. PrigLa itTUD-J
r`i
Y-A
37Recommended
- Recommande
47. Signature of d'immigration
g
o
0
cer- Signatur 'eler
gent
1438. Utilities Libres 39. Remarks - Observations
05
1999
ANOT VALID FOR TRAVEL NON VALIDE POUR LES VOYAGES[
/Err.
i'il 9 28 2 2 9 17 5I
LFC .
I000440338SEE BACK OF COPY 1 (HOLDER) FOR WARNING AND PRIVACY STATEMENT. THIS FORM HAS BEEN ESTABLISHED BY THE MINISTER OF CITIZENSHIP AND IMMIGRATION. THIS DOCUMENT IS THE PROPERTY OF THE GOVERNMENT OF CANADA. 1MM VOIR LAVERTISSEMENT ET LENONCE PORTANT SUR LA PROTECTION DES RENSEIGNEMENTS PERSONNELS AU VERSO DE LA COPIE I (TITULAIRE). FORMULAIRE ETABLI PAR LE MINISTRE DE LA CITOYENNETE ET DE L'IMMIGRATION. LE PRESENT DOCUMENT EST LA PROPRIETE DU GOUVERNEMENT DU CANADA.
1000 (CON) (01/2000) B
0-te
C Canada
HOLDERTITULAIRE
Municipal Form No. 102 (Revi' d 1983)
(To be accomplished in Triplicate)
REPUBLIC OF THOSHILIPPINES CERTIFICATE OF LIVE BIRTH (Fill out completely, accurately and legibly in ink or typewritten)
PROVINCE CITY / MUNICIPALITY 1. NAME 2. SEX
.11010
LOCAL CIVIL REGISTRY NO.
179
Legnnes(First) (Middle)
(Last)
SHYRILL(Place 'X' on appropriate answer) -2 Female (Name of hospital/Institution; If not in hospital, give street / barangay) --1 Male
BESITEDATE OF BIRTH3. (Day)
ESPANO(Month) (Year)
19
'June(Province)
1975
4. PLACE OF BIRTH
(City / Municipality)
Cagamutan Norte Le anes5a. TYPE OF BIRTHx- 1 Single (Place 'X' on appropriate answer) 2 Twin _ 3 Three or more (Middle) (Last) 5b. IF MULTIPLE BIRTH CHILD WAS
Iloilo 3 Third, 4th,etc.
1 First
2 Second
6. [. MAIDEN NAME
(First)
7. NATIONALITY
, 8. RELIGION
Ketchy9. NAME(First) --(Middle)
Besite(Last)
Filipina10. NATIONALITY
Roman Catholic11. RELIGION
Jesus
Espailo
Filipino
Romari Catholic
12. DATE AND PLACE OF MARRIAGE OF PARENTS
(Important:If not applicable,fill Affidavit of Acknowledgement at the back)
13.
CERTIFICATE OF ATTENDANT AT BIRTH
hereby certify that I attended the birth of thechild who was born alive at o'clock am/pm on the date stated above.
(SGD.) AMPARO BOLIVAR AMPARO BOLIVAR Name in print "Hilot" Title or positionSignature
Address
Leganes, Tloilo September 12, 1975
Date
14. INFORMANTSignature Name in print,. Relationship to child Datet\
Address
15a.PREPAIIED BYSignattirte t IT Name inlprint Title qr Position Date
b. RECEIVED AT THE OFFICE OF THE LOCAL CIVIL REGISTRARSignature Name in print Title or position DateIlk I! DOVERO NFIRTA P. coRnovp:Rn
Se Rtgabar12,1915
CERTIFIED TRUE'COPY: _April_ 23_,_199..1._
16a. INFORMATION GIVEN IN SUPPLEMENTAL REPORT
7ki
MA. FE G FE NANDEZ Asst. *mak vil RegistrarCITY/MUNICIPALITY17. Weight at Birth (In grams)
(Important: Informant should also provide information for items 17 to 2.S. The code boxes arc to be filled out at the Office of the Local tivil Registrar) Registration L oical Civil Registry No. Status I
_ _ _ --_ _ _ _ _ _ _ _ _I I I 1 118. Birth Order of Child Ex,first, second, etc.
b. DATE WHEN INFORMATION WAS SUPPLIED
15
il, 16
20
19a. Total Number of Children Born Alive 20. Usual Occupation0U.
22
b. How Many children are i' now living including this birth ?
I24
ri 1 1= 38 i
c. How many children ' . were both alive but are nor dead?
I I I-26
1
22. Usual Residence (Barangay) 23, Usual Occupation
2_8 (City/Municipality .
21. Age at the time of this Birth
,
(Province) 24. Age at the time of this Birth
L [1 1 1 1 131 '33 I 41 1 1
LU
25. Attendant at Birth (Place 'X' an appropriate answer) 1 Physician _ 2 Nurse 3 Midwife Sex Date of Birth Place of Birth
4 Hilot
wccI 45
44
111.1iFirst
51 NAME OF CHILDM.I.
IHIL70 71
5 Others Mother's Father's Nationality Nationality
C71 ,
rl56Last
I
I157
LIE 1111 E158