Farm Application 004

Farm Stream

The personal information collected through the Alberta Advantage Immigration Program is collected for purpose of
administering the program. This personal information collection is authorized by section 33(c) of the Freedom of
Information and Protection of Privacy Act. If you have any questions about the collection of personal information, you
may contact the Operations Manager at 780-638-2843, by email at [email protected] or by mail to Alberta
Advantage Immigration Program, Suite 940, ATB Place North Tower, 10025 Jasper Avenue, Edmonton, Alberta,
Canada, T5J 1S6. If you have any questions about this program, please contact the Alberta Advantage Immigration
Program through the Entrepreneur Support Service at [email protected].

A. Introduction File number (office use):

Information on eligibility and how to apply to this stream is available on the Alberta Advantage Immigration Program
website at: Alberta.ca/alberta-advantage-immigration-program-farm-stream-how-to-apply.aspx.
Prepare your application, gather all supporting documents and send by registered mail or courier to:
Farm Stream, Alberta Advantage Immigration Program, Government of Alberta, Suite 940, ATB Place North Tower,
10025 Jasper Avenue, Edmonton, AB Canada T5J 1S6.

B. Candidate’s Personal Information

Candidate’s family name: Candidate’s given name(s): Candidate’s gender:
 Male  Female

Candidate’s residential address:

City/Town: Prov/Terr/State: Postal code/Zip code: Country:

Candidate’s mailing address: (if different from above)

City/Town: Prov/Terr/State: Postal code/Zip code: Country:

Candidate’s home phone: Candidate’s cell phone: Candidate’s work phone: Candidate’s fax:

Candidate’s email: Candidate’s date of birth: Candidate’s place of birth:

(yyyy/mm/dd) (city or town)

Candidate’s country of citizenship: Candidate’s country of birth: Candidate’s intended province/territory of

residence in Canada:

C. Language Proficiency

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 Total years of education:

Level of education successfully completed: (check all that apply)

 Doctorate / PhD  Diploma (2 years)  Secondary school  Master’s degree  Certificate
(1 year)  No formal education
 Bachelor’s degree  Trade Certification/Apprenticeship  Other:
____________________________
Language Proficiency:

Language of communication: English  French

Native language: Language assessment type:

Test date: (yyyy/mm/dd) Test scores:

Listening: _________ Reading: _________ Writing: _________ Speaking: _________
D. Immigration, Refugees and Citizenship Canada (IRCC) Application History

Have you, or any of your accompanying dependents, previously submitted an Application for Permanent Residence in

Canada to Immigration, Refugees and Citizenship Canada (IRCC)?  Yes  No

If yes, please indicate how many previous applications have been submitted:
If yes, please provide a response to each of the following:
IRCC (Visa Office) to which application IRCC file number: Date application submitted
was submitted: (yyyy/mm/dd)

Status of application: Principal applicant: Intended province of residence:

Have you ever had an application for Permanent Residence in Canada refused?  Yes  No

If yes, please provide a brief description of the reasons for the refusal:

Provide a photocopy of any correspondence with IRCC regarding the previous application(s).

E. Family Members
List all dependents who intend to accompany you to Canada: (do not include Canadian citizens or permanent residents)

Family name Given name Date of birth Gender

(yyyy/mm/dd)

Spouse or common- Male

law partner Female

Male
Dependent
Female

Male
Dependent
Female
Use an additional page for more dependents if required

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 F. Candidate’s Spouse/Common-Law Partner’s Occupation and Education
Family name: Given name(s):

Current job title:

Education history
Total years of education:
Level of education successfully completed:(check all that apply)
 Doctorate / PhD  Diploma (2 years)  Secondary school
 Master’s degree  Certificate (1 year)  No formal education 
 Bachelor’s degree  Trade Certification/Apprenticeship Other:
_____________________________
G. Farming History
Type of current farm:

Description of primary production/secondary production (e.g. crops, livestock) of your existing farm:

Type of ownership of your existing Please indicate the location and size Number of years your existing farm
farm: (e.g. partnership, sole of your existing farm: has been in operation:
proprietor)

Has your existing farm business been Has your farm business been What is your planned/anticipated date
sold?  Yes  No advertised for sale?  Yes No of immigration? (yyyy/mm/dd)

Briefly explain your past responsibilities and experience in farm management: (attach a separate page if required)

Have you undertaken any leadership roles in farm organizations or associations?  Yes No If
yes, please describe: (attach a separate page if required)

Briefly explain your past responsibilities and experience in non-farm activities, other training or careers prior to farming:
(attach a separate page if required)

What was your farm’s net income for the past 5 years (in Canadian dollars)?

Year 1 Year 2 Year 3 Year 4 Year 5

H. Exploration
What steps have you undertaken to research the Alberta/Canadian farming environment and opportunities? In your
response, you may want to consider the following: Exploratory visits to Alberta, including the length and dates of your visit(s),

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 discussions with government officials, realtors, producer organizations, industry representatives, Alberta farmers in the same
production sector, financial institutions, etc. regarding the development of your investment proposal, and any observations or
conclusions you came to as a result of your visit (attach a separate page).

I. Alberta Farm Investment Proposal

Proposed type of ownership: If sole proprietorship, please indicate
the date you became or will become the
registered owner of the operation:

If partnership, identify partner and their percentage of ownership. Also identify those partners who are not Canadian
citizens or permanent residents: (This is a requirement of the Alberta Foreign Land Ownership Act Regulation)
Partner: Percentage of shareholding:

Non-Canadian/permanent resident partner(s): Percentage of shareholding:

If limited company, identify directors and their percentage of shareholding. Also identify those shareholders who are not
Canadian citizens or permanent residents: (This is a requirement of the Foreign Land Ownership Act Regulation)
Directors: Percentage of shareholding:

Non-Canadian/permanent resident director(s): Percentage of shareholding:

Have you ever been involved in a business failure, receivership or bankruptcy?  Yes  No If
yes, when? Date:

J. Proposed Alberta Farm Enterprise

Please describe the farm that you intend to operate (e.g. number of acres, livestock, crop production, estimated annual
net income after expenses). Also describe any proposed venture/business arrangements you have established with a
production company or agri-food processor. (e.g. pig production, potato production, pig packer supply contract, etc.) To
assess viability of the proposed venture, the business plan will be reviewed by officials of Alberta Agriculture and Forestry.
(please attach your business plan to this application)

Have you made an offer to purchase a farm or land in Alberta? If so, please provide details:

Do you plan to expand and diversify your operation in Alberta over the next 3-5 years? Please describe your plans and
the investment that you plan to make: (attach a separate page if required)

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 K. Financial Information

Personal net worth statement

A complete and current statement of your total personal net worth is required. All assets and liabilities must be
identified. However, do not include personal items such as jewelry, furniture, etc., as the ownership of such items is
difficult to verify.
All assets listed must be your own personal holdings and must be documented. The sources of any funds or assets in
your possession for less than one year must be identified.
You may be asked to present financial documents to support the information provided in this statement.
Assets

Bank deposits (Foreign/Canadian)

CURRENT AND SAVINGS ACCOUNTS (Specify currency)

Date opened Account number Current balance

(yyyy/mm/dd)

(yyyy/mm/dd)

(yyyy/mm/dd)

(yyyy/mm/dd)

TOTAL CDN $
FIXED DEPOSITS (Specify currency)

Date of initial deposit Maturity date Current balance

(yyyy/mm/dd) (yyyy/mm/dd)

(yyyy/mm/dd) (yyyy/mm/dd)

(yyyy/mm/dd) (yyyy/mm/dd)

(yyyy/mm/dd) (yyyy/mm/dd)

TOTAL CDN $

Property

Year Estimated current market

Complete address Purchased Mortgaged Purchase price value (specify currency)

Yes No

Yes No

Yes No

Yes No

TOTAL CDN $ $

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 Other liabilities (e.g. deferred taxes, etc.)

Nature of obligation Amount (specify currency)

TOTAL CDN $

M. Total Personal Net Worth

Net worth statement

Total assets CDN$

minus Total liabilities CDN$

Net worth CDN $

N. Other Financial Information

Funds in my possession on my arrival in Canada CDN$

Funds to transfer to Canada at a later date CDN$

Funds already in Canada CDN$

Funds or equity remaining abroad CDN$

Exchange rate used: CDN$ 1= TOTAL CDN $

O. Contact Information
Canadian bank:

Contact: Telephone number:

Foreign bank:

Contact: Telephone number:

P. Program Evaluation
Alberta Advantage Immigration Program will be contacting you in the future for follow-up. Please provide the name of an
additional contact person, preferably in Canada, who we may contact if we cannot reach you. Do not list your
authorized representative or your employer.
Family name: Given name(s):

Phone number of contact person: Email of contact person:

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 Q. Declaration and Authorization of Candidate
By signing and submitting this form, I confirm that:
1. The information I have provided in this application is true, complete and correct and I, the candidate, have personally
provided it.
2. I understand that:
a. The availability of Alberta Advantage Immigration Program streams, categories, pathways and pilots is dependent
on application volumes and labour market needs. Alberta Advantage Immigration Program streams, categories,
pathways and pilots may be closed or suspended without prior notice. The Alberta Advantage Immigration
Program reserves the right to close application intake for any Alberta Advantage Immigration Program stream,
category, pathway or pilot at any time, without prior notice. Further, the Alberta Advantage Immigration Program
may decline to consider applications to closed or suspended streams or categories, regardless of when the
applications were submitted. The criteria for the Alberta Advantage Immigration Program are routinely evaluated
and may be subject to change at any time and without notice. Changes to the Alberta Advantage Immigration
Program, including notice of suspension or closure of its streams, categories, pathways, pilots and criteria
changes, are available at Alberta.ca/Alberta-Advantage-Immigration-Program.aspx
b. The Alberta Advantage Immigration Program is not obligated to assess/process any applications submitted.
Applications to the Alberta Advantage Immigration Program are treated as an expression of interest, and as such,
will be processed according to quality of the application (completeness, eligibility), labour market information,
occupational supply and demand forecasting, Alberta Advantage Immigration Program application volumes, and /
or any other factors at the Alberta Advantage Immigration Program’s discretion. By submitting an application to
the Alberta Advantage Immigration Program I acknowledge and agree that my application may not be processed
in the order received, or at all. Further, the decision to assess / process any particular application, and the
outcome of any such assessment / processing, is at the Alberta Advantage Immigration Program’s sole discretion.
The Alberta Advantage Immigration Program may choose to assess applications with the most current criteria
irrespective of the date of submission of an application. Program criteria are eligibility minimums, and meeting
program criteria does not guarantee that my application will be assessed, processed, or granted. Applicants must
have a strong likelihood of becoming economically established in Alberta and the Alberta Advantage Immigration
Program reserves the right to decline applications if the Alberta Advantage Immigration Program is of the opinion
that the applicant may not economically establish in Alberta.
3. I understand that submitting an Application for Permanent Residence in Canada to Immigration, Refugees and
Citizenship Canada (IRCC) on the basis of an Alberta Advantage Immigration Program Nomination issued by the
Government of Alberta, is subject to federal requirements. Specifically, my application for permanent residence is
subject to the statutory requirements for admissibility under the Immigration and Refugee Protection Act and its
Regulations, and the Nomination and application do not guarantee that I will be granted permanent residence in
Canada.
4. I understand that the Alberta Advantage Immigration Program may decline this application or withdraw a Nomination:
a. If I have submitted any false or misleading statements or information or concealed a relevant or significant fact
(both of which constitute misrepresentation) and that I may be banned from the Alberta Advantage Immigration
Program for an unspecified period of time.
b. If I do not comply with any request for information required by the Alberta Advantage Immigration Program to
effectively administer and maintain the integrity of the program;
c. For reasons other than the above statements.
As a result of this decline or withdrawal, the Alberta Advantage Immigration Program may refuse to consider me as a
Candidate for Nomination for an unspecified period.
5. I understand that I may be required to attend an interview, conducted by officials of the Government of Alberta, to
assist in determining my eligibility as a Candidate under the Alberta Advantage Immigration Program.
6. I understand all of the above statements, and have asked for and received an explanation, or language translation if
required, on every point about which I may have been uncertain.
Candidate Authorization Original signatures are required on the application in blue ink
Candidate’s name (print) Signature (candidate) Date signed (yyyy/mm/dd)

R. Authorizations to Collect and Disclose Personal Information

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 R. Authorizations to Collect and Disclose Personal Information
By signing and submitting this form:
1. I acknowledge that the Alberta Advantage Immigration Program will disclose, as necessary, information collected
from this application under the program, to officials in the Government of Alberta, including but not limited to partner
ministries, and to officials administering immigration, temporary foreign worker or other programs related to
permanent residence or temporary residence within the Government of Canada.
2. I acknowledge that the Government of Canada will disclose, as necessary, personal information about me collected
under the Immigration and Refugee Protection Act and its Regulations to officials administering the Alberta
Advantage Immigration Program. I also acknowledge that the Alberta Advantage Immigration Program will collect
such information.
3. I acknowledge that the Alberta Advantage Immigration Program will disclose information collected from this
application under the program to other Canadian provincial and territorial immigration officials, and to collect
information from other Canadian provincial and territorial immigration officials collected in applications under their
programs, as necessary, for the purpose of assessing or verifying information, or in the event of any suspected non-
compliance with any provincial or federal law.
4. I authorize the Alberta Advantage Immigration Program to disclose to and collect personal information from other
sources inside or outside Canada for the purpose of evaluating my eligibility for the Alberta Advantage Immigration
Program, verifying information provided in this application, maintaining program integrity and evaluating the
effectiveness of the Alberta Advantage Immigration Program. These sources may include, but are not limited to,
current and former employers, professional organizations, industry associations, educational institutions, financial
institutions, governments or their agencies and law enforcement agencies, and third party evaluators under contract
with the Alberta Advantage Immigration Program.
5. I confirm my understanding of all the previous statements, and have asked for and received an explanation, or
language translation if required, of every point that was not clear to me.
6. I understand I will be contacted to complete brief questionnaires to evaluate the program and may be contacted to
participate in future services provided by the Government of Alberta, should I become a nominee or permanent
resident as an Alberta Provincial Nominee. Questionnaires to evaluate the program are required by Immigration,
Refugees and Citizenship Canada (IRCC). I understand that a third party may be used to administer these
questionnaires.
Candidate Authorization Original signatures are required on the application in blue ink
Candidate’s name (print) Signature (candidate) Date signed (yyyy/mm/dd)

Spouse’s or common-law partner’s name (print) Signature (spouse or common-law partner) Date signed (yyyy/mm/dd)

Dependent’s name, 18 years of age or older (print) Signature (dependant) Date signed (yyyy/mm/dd)

Dependent’s name, 18 years of age or older (print) Signature (dependant) Date signed (yyyy/mm/dd)

Dependent’s name, 18 years of age or older (print) Signature (dependant) Date signed (yyyy/mm/dd)

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 S. Alberta Advantage Immigration Program Policy on Use of Representatives

What is a representative?
Representatives give immigration advice and help prepare immigration applications, including for the Alberta Advantage
Immigration Program. They can be paid or unpaid. Representatives include:
• immigration consultants
• lawyers, or
• other representatives (such family members, friends, non-profit groups and religious groups).
A person who is paid to give you immigration advice or to assist you in filling out your immigration applications must be
authorized to act as a representative for the purposes of the Alberta Advantage Immigration Program.
You do not need to use a representative to apply to the Alberta Advantage Immigration Program. All the forms and
information that you need to apply to immigrate to Alberta are available for free. If you follow the instructions online and
in the application guide, you can complete the application on your own.

Representatives Authorized for the Purposes of the Alberta Advantage Immigration Program
The Alberta Advantage Immigration Program will only conduct business with a representative who is authorized under
this policy. Only the following persons are authorized to be representatives for the purposes of the Alberta Advantage
Immigration Program:

• a person who is not paid; or

• if paid, a member in good standing of a provincial law society, the Chambre des notaires du Québec, or the College
of Immigration and Citizenship Consultants (CICC).
No other person may be paid to provide immigration advice or to help prepare immigration applications. Any person not
authorized to be a paid representative for the purposes of the Alberta Advantage Immigration Program is an
unauthorized representative and must either become authorized or refer you to someone who is.

Payment includes remuneration or compensation in any form, and can be a benefit other than money that is made now or
in the future. Payment can be direct or indirect. Even if the person who provides immigration advice or assists with an
Alberta Advantage Immigration Program application is being paid or compensated by someone other than you (the
Candidate), the person is still considered to be a paid representative.

Declaring the Use of a Representative

On your application form, you must tell the Alberta Advantage Immigration Program whether any person provided you
with immigration advice or assisted you with your Alberta Advantage Immigration Program application.

If a person did, they must provide their information to the Alberta Advantage Immigration Program and sign a declaration.
You may also authorize this person to conduct business on your behalf with officials of Alberta Advantage Immigration
Program.

If a person provided you with immigration advice or assisted you with your Alberta Advantage Immigration Program
application and you do not tell the Alberta Advantage Immigration Program, this is considered to be false and misleading
information and your application may refused or your nomination may be withdrawn and you may be banned from the
Alberta Advantage Immigration Program for an unspecified period of time.
If you decide to use a representative for your Alberta Advantage Immigration Program application, understand that:
Your Alberta Advantage Immigration Program application will not be given special attention or guaranteed approval if
you use an immigration consultant
• or lawyer or other representative.
• The Alberta Advantage Immigration Program cannot guarantee the accuracy of interpretations by other persons.
• You should never follow advice to use false documents or make false statements on your Alberta Advantage
Immigration Program forms. This will result in your application being declined or your nomination withdrawn and you
may be banned from the Alberta Advantage Immigration Program for an unspecified period of time.

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Other important information about using a representative
To confirm an immigration consultant is a member in good standing, you can check the person’s status on the College of
Immigration and Citizenship Consultants (CICC) website using the Find an Immigration Consultant link at college-ic.ca/
protecting-the-public/find-an-immigration-consultant before using their services.

To confirm a lawyer is a member in good standing, you can check a lawyer’s practice status on the website for the law
society of the province in which the lawyer is practicing before using their services. A list with links to Canada’s 14
provincial and territorial law societies (including the Chambre des notaires du Québec) is available on the Federation of
Law Societies of Canada website at flsc.ca/about-us/our-members-canadas-law-societies/.

You can look up the lawyer in the lawyer directory on each provincial/territorial law society website (usually found in a
section “for the public”) and get information on the lawyer’s current practicing status with the society.

If you have a complaint about unprofessional conduct by immigration consultants you may contact the College of
Immigration and Citizenship Consultants (CICC).

If you have a complaint about unprofessional conduct by a lawyer, you may contact the provincial/territorial law society
where you received services. For information on reporting a complaint about an unauthorized representative see the
Immigration, Refugees and Citizenship Canada (IRCC) website at canada.ca/en/immigration-refugees-citizenship/
services/immigration-citizenship-representative/file-complaint-against-representative.html.

For more tips on choosing a representative, visit the IRCC website at canada.ca/en/immigration-refugees-citizenship/
services/immigrationcitizenship-representative/choose.html.

There are internet scams and false websites. The official Government of Alberta website is www.alberta.ca. The official
Government of Canada immigration website is canada.ca/en/services/immigration-citizenship.html. Other websites may
appear to be official government websites, but the information they contain may be inaccurate or out of date

T. Declaration of Assistance with Alberta Advantage Immigration Program Application

1. Has anyone provided you with immigration advice or assisted you in preparing your Alberta Advantage Immigration
Program application?  Yes  No

If “No,” no one provided assistance in preparing your application, you must sign the declaration below and your
application is complete:
Declaration of Candidate:
1. I declare that I completed application on own with no immigration advice or assistance in preparing my Alberta
Advantage Immigration Program application from any person/organization and have not appointed a
representative to act on my behalf with the Alberta Advantage Immigration Program.
2. I understand that if a person provided me with immigration advice or assisted with my Alberta Advantage
Immigration Program application and I did not tell the Alberta Advantage Immigration Program, this is considered
to be false and misleading information and my application may refused or my nomination may be withdrawn and I
may be banned from the Alberta Advantage Immigration Program for an unspecified period of time.
Date signed (yyyy/mm/dd)

Signature (Original signatures are required on this form in blue ink)

If “Yes,” you received assistance in preparing your application, answer the following question:
Did the person receive any pay for providing immigration advice and/or assisting you in preparing your Alberta
Advantage Immigration Program application?  Yes  No
 Pay includes remuneration or compensation in any form, and can be a benefit other than money that is made now or
in the future.

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 Pay can be direct or indirect. Even if the individual who provides immigration advice or assists with an Alberta
Advantage Immigration Program application is being paid or compensated by someone other than you (the
Candidate), this individual is still considered to be a compensated representative.
 A person who is paid to assist with an Alberta Advantage Immigration Program application must be a member in
good standing of a provincial law society, the Chambre des notaires du Québec, or the College of Immigration and
Citizenship Consultants (CICC).

If “No,” the representative assisting you did not receive pay, the Alberta Advantage Immigration Program considers
this person to be an unpaid representative. You must provide information about this individual to the Alberta Advantage
Immigration Program: You and your representative must also sign the declarations below and you must indicate if you
authorize the representative to act on your behalf for your Alberta Advantage Immigration Program application.

Country

Representative’s surname Representative’s given name(s)

Relationship to you Other

Suite number Mailing address Country

City / Town Province/Territory/State Postal / Zip code

Email Daytime phone

Declaration of candidate:
I declare I did not pay or compensate, or have knowledge of payment or compensation by someone other than myself to
__________________________, to provide immigration advice or assist with the preparation of my Alberta Advantage
Immigration Program application.

Signature (Original signatures are required on this form in blue ink) Date signed (yyyy/mm/dd)

I declare I did not receive any payment or compensation, and that I will not, at any time in the future, accept any such
fee, remuneration or reward in connection with this application.

Unpaid representative’s signature (Original signatures are required on this form in blue ink) Date signed (yyyy/mm/dd)

Do you authorize the person identified above to conduct business on your behalf with officials of the Alberta Advantage
Immigration Program?  Yes  No
If “Yes,” you and your representative must fill out Sections U and V. If “No” your application is complete.

If “Yes” the representative assisting you received compensation, the Alberta Advantage Immigration Program
considers this person to be an paid representative. You must provide information about this individual to the Alberta
Advantage Immigration Program. You must also indicate if you authorize the representative to act on your behalf for your
Alberta Advantage Immigration Program application.

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 Representative’s surname Representative’s given name(s) Firm name

Type of Representative (Lawyer / Immigration Consultant / Other)

Canadian provincial or territorial law society [if lawyer selected] RCIC number: [if immigration consultant selected]

Position

Suite number Mailing address Country

City / Town Province/Territory/State Postal / Zip code

Email Daytime phone Fax number

Do you authorize the person identified above to conduct business on your behalf with officials of the Alberta Advantage
Immigration Program?  Yes  No
If “Yes,” you and your representative must fill out Sections U and V. If “No” your application is complete.

U. Declaration and Authorization of Candidate, Spouse/Common-Law Partner and Dependants

18 Years or Older
By signing and submitting this form, I confirm that:
1. I authorize the person identified above to serve as my representative and to conduct business on my behalf with
officials of the Alberta Advantage Immigration Program.
2. I am aware that a representative acts as an independent agent, and does not represent in any way the Government
of Alberta or any of its departments, including the Alberta Advantage Immigration Program.
3. I am aware that, in Alberta, the employer is responsible for any fees associated with the recruitment of workers; that
individuals cannot be charged for recruitment services.
4. I acknowledge that the Alberta Advantage Immigration Program will only conduct business with a representative who
is unpaid or who is a member in good standing of a provincial law society, the Chambre des notaires du Québec, or
the College of Immigration and Citizenship Consultants (CICC), and that if the representative is not a member in
good standing with any of these organizations that the application may be returned or declined by the Alberta
Advantage Immigration Program.
5. I authorize my representative to provide this application and attachments to the Alberta Advantage Immigration
Program.
6. I authorize my representative and the Alberta Advantage Immigration Program to discuss the contents of this
application and attachments and correspond with each other for the purposes described in this form.
7. I acknowledge that the Alberta Advantage Immigration Program reserves the right to contact the candidate directly
regarding this application, regardless of the use of a representative.
8. I acknowledge that if I received immigration advice or assistance in applying to the Alberta Advantage Immigration
Program and did not disclose the name of the person who provided me with advice or assistance, this is considered
to be false and misleading information this application may be refused or a nomination issued under this application
may be withdrawn and I may be banned from the Alberta Advantage Immigration Program for an unspecified period
of time.
9. I declare that I have read the Alberta Advantage Immigration Program Policy on Representatives and have complied
with it.

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10. I confirm that I understand all previous statements, and that I have asked for and received an explanation, or a
language translation if required, on every point about which I may have been uncertain.

Candidate Declaration:
By signing below, you agree to all points identified in the Declaration and Authorization of Candidate, Spouse/ Common-
Law Partner and Dependents 18 Years or Older section above.

Original signatures are required on this form in blue ink

Candidate’s name (print) Signature (candidate) Date signed (yyyy/mm/dd)

Spouse or Common-Law Partner Declaration:

By signing below, you agree to all points identified in the Declaration and Authorization of Candidate,
Spouse/CommonLaw Partner and Dependants 18 Years or Older section above.

Original signatures are required on this form in blue ink

Spouse’s or common-law partner’s name (print) Signature (spouse or common-law partner) Date signed (yyyy/mm/dd)

Dependant's name, 18 years of age or older:

By signing below, you agree to all points identified in the Declaration and Authorization of Candidate, Spouse/ Common-
Law Partner and Dependants 18 Years or Older section above.

Original signatures are required on this form in blue ink

Dependent’s name, 18 years of age or older (print) Signature (dependant) Date signed (yyyy/mm/dd)

Dependent’s name, 18 years of age or older (print) Signature (dependant) Date signed (yyyy/mm/dd)

Dependent’s name, 18 years of age or older (print) Signature (dependant) Date signed (yyyy/mm/dd)

V. Declaration of Representative
By signing and submitting this form, I confirm that I am the Candidate's, spouse's/common-law partner's and/or
dependant's authorized representative, and that:
1. I explained, translated, or obtained a translation of all points that were unclear to the candidate on this application.
2. I acknowledge and accept that I am the person appointed by the candidate to conduct business with officials of the
Alberta Advantage Immigration Program.
3. I acknowledge that this authorization is made in accordance with Section 84 of the Freedom of Information and
Protection of Privacy (FOIP) Act.
4. I acknowledge that the candidate, spouse/common-law partner and/or dependant may be contacted directly by
officials of the Alberta Advantage Immigration Program.
5. I have clearly indicated at all times and in all materials that I act as an independent agent, and that I do not represent
in any way the Government of Alberta or any of its departments, including the Alberta Advantage Immigration
Program.
6. I advised the candidate that applying to the Alberta Advantage Immigration Program does not require them to use a
representative, prior to their signing a contract with me or my firm.
7. I advised the candidate that they are free to communicate directly with the Alberta Advantage Immigration Program
on their own even while represented by me.

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8. The information and documents I have provided for this application are, to the best of my knowledge, truthful,
complete, and correct.
9. I advised the candidate of the requirement that applicants under the Alberta Advantage Immigration Program have a
bona fide intent to reside and work or do business in Alberta.
10. I will be truthful in all forms of communication and media and will refrain from misleading statements, exaggerations
or innuendo.
11. I have advised the candidate that there is no preferential treatment given to representatives by the Alberta
Advantage Immigration Program, Alberta Labour, and that the Government of Alberta has no special arrangement or
relationship with representatives, that would guarantee acceptance or faster processing of an application made to the
Alberta Advantage Immigration Program by using a representative.
12. I will relay any correspondence received from the Alberta Advantage Immigration Program, Alberta Labour about the
candidate's file directly to the candidate without modification or undue delay, and I will provide the candidate with
complete and accurate information regarding the Alberta Advantage Immigration Program and immigration matters.
13. I will act responsibly, with due diligence and in a timely manner for the candidate.
14. I will not engage in any unlawful activity personally or on behalf of the candidate.
15. I will not act for a candidate until all charges, fees and services have been fully disclosed to the candidate and are
fair, reasonable and agreed upon without duress and in accordance with the Fair Trading Act of Alberta.
16. I acknowledge that I must be an unpaid representative or a paid representative who is a member in good standing of
a provincial law society, the Chambre des notaires du Québec, or the College of Immigration and Citizenship
Consultants (CICC), and that if I am not a member in good standing with any of these organizations that the
application may be returned or declined by the Alberta Advantage Immigration Program.
17. I declare that I have read the Alberta Advantage Immigration Program Policy on Representatives and I am an unpaid
representative or a paid representative who is a member in good standing of a provincial law society, the Chambre
des notaires du Québec, or the College of Immigration and Citizenship Consultants (CICC).
18. I understand that if the Alberta Advantage Immigration Program is of the opinion that I am an unauthorized
representative and I received pay for giving immigration advice or providing assistance on an Alberta Advantage
Immigration Program application, I may be banned from acting as a representative on Alberta Advantage
Immigration Program applications for an unspecified period of time and may be subject to consequences under the
Immigration and Refugee Protection Act (IRPA), Fair Trading Act of Alberta, and discipline from federal/provincial
territorial regulators.
19. I acknowledge that the Alberta Advantage Immigration Program may disclose to and collect from appropriate bodies
including any professional regulatory body to which I belong, federal immigration authorities or law enforcement,
information about any suspected instance of professional misconduct on my part, and information to administer the
program, maintain program integrity and determine if I have complied with the Alberta Advantage Immigration
Program policy on representatives. I understand that the Alberta Advantage Immigration Program reserves the right
to refuse to deal with any representative who provides false or misleading information or conceals relevant
information, or who is not in compliance with the Alberta Advantage Immigration Program criteria for representatives.

If you are a member in good standing of a provincial law society, by signing below, you agree to adhere to points 1 through
11 and 16 through 19 identified in the Declaration of Representative section above. For lawyers in good standing with their
provincial law societies, their respective Codes of Conduct provide equivalent obligations to points 12 through.

Original signatures are required on this form in blue ink

Lawyer's signature Date signed (yyyy/mm/dd)

Original signatures are required on this form in blue ink

Representative’s signature Date signed (yyyy/mm/dd)

15 Farm Stream Application 004 (2022/02)