翻译文本

加拿大 完成后保密 – B（页1/1） 移民、公民、难民 仅供官方使用 未随行父母/监护人关于未成年人移民加拿大的声明 文件编号 此填写好的声明和有效、合法的身份证明文件必须提交到负责处理永久居民申请的签证处。 此表必须： • 由未随行父母/监护人、前配偶或前同居伴侣填写，并且公证人见证 • 每位到加拿大旅行的子女必须有此表的副本。 我, , 声明，我对 孩子: 孩子全名 孩子出生日期 与其父母/监护人： 父亲 父母/监护人姓名 与孩子的关系 父母/监护人姓名 与孩子的关系 移民到加拿大没有异议。 如果儿童与上述父母/监护人以外的人一同到加拿大，请填写此部分。 姓名 与儿童的关系 我通过签字并返还此信函表明已阅并了解此信函的内容，我完全了解我可能与上文提到的孩子长久分离。 我也了解，如果希望以临时居民或永久居民身份入境加拿大，申请签证时我必须遵守《移民及难民保护法》中的所有生效规定。 非同行父母/监护人、前配偶或前同居伴侣在见证人面前完成 此表，并出示身份证件原件给见证人。* 签字（在见证人面前） 日期 年 月 日 紧急联系电话号码 地址 见证人（公证人）填写此处 见证人职位和姓名（字体大写。必须是公证人） 见证人专业印章 见证人签字

(翻译文本由迪朗上海浦东翻译公司提供)

英文文本

Citizenship and Citoyenneté et PROTECTED WHEN COMPLETED – B Immigration Canada Immigration Canada FOR OFFICE USE ONLY DECLARATION FROM NON-ACCOMPANYING File no. PARENT/GUARDIAN FOR MINORS DayMonth Year IMMIGRATING TO CANADA Date Send this fully completed Declaration and a photocopy of a valid and legible identity document to the Canadian Embassy/Canadian Consulate. This form must be: • filled out by the non-accompanying parent/guardian, former spouse or former common-law partner and; • witnessed by a notary public. A copy of this form must be completed for each child travelling to Canada. I, , declare that I have no objections to my DayMonth Year child: Child’s full name Child’s date of birth immigrating to Canada with his/her parent/guardian: Parent/Guardian name Relationship to child Parent/Guardian name Relationship to child Fill out this section if this child is travelling to Canada with someone other than the parent/guardian listed above. Name Relationship to child I have read and understand the contents of this letter and by signing and returning this letter, I am confirming that I fully understand that I may be permanently separated from my above-named child. I further understand that if I wish to enter Canada, as a temporary resident or a permanent resident, I must comply with all requirements of the Immigration and Refugee Protection Act and Regulations in force at the time of my application. To be completed by the non-accompanying parent/gardian, former spouse or former common-law partner, in front of the witness. Present your original Identification Card to the witness* Signature (before witness*) Date Day Month Year Emergency contact telephone number Place To be completed by the witness (notary public) Witness title and name in block letters (*must be a notary public) Witness* professional chop/stamp Signature of witness*