A 0522 Oa Form

CONTRACT RESPECTING FINANCIAL SELF-SUFFICIENCY Principal Applicant excluding live-in caregivers and persons authorized to apply for permanent residence in Canada on humanitarian grounds INSTRUCTIONS Who must fill out this form The principal applicant including a foreign student or foreign worker living temporarily in Qu bec and his or her accompanying spouse or de facto spouse if any who applies for a Certificat de s lection du Qu bec Quebec selection certificate under the subclass of Skilled Workers Entrepreneurs or Self-Employed Persons. If you are a live-in caregiver or if you are authorized by Citizenship and Immigration Canada to apply for permanent residence in Canada on humanitarian grounds this form is not intended for you. You must instead fill out the form entitled Contract respecting financial self-sufficiency Live-in caregiver and person authorized to apply for permanent residence in Canada on humanitarian grounds. What is the Contract respecting financial self-sufficiency The Contract respecting financial self-sufficiency is a legal act by which you undertake for the entire term of the contract to provide for your basic needs and where applicable those of your spouse or de facto spouse and your dependent children including those who are Canadian citizens who accompany you to Qu bec* The term of the contract is three months starting on the date of your arrival in Qu bec as a permanent resident. Basic needs include food clothing personal necessities and housing-related expenses. You must sign this contract or else your application for a selection certificate will not be accepted* For more information see the Act respecting immigration to Qu bec R*S*Q* c* I-0. 2 and the Regulation respecting the selection of foreign nationals R*R*Q* 1981 c* M-23. 1 r. 2. How to fill out this form Section A identifies you and where applicable your spouse or de facto spouse and dependent children including Canadian citizens who are accompanying you. Answer the questions accurately. Section B of the contract. Read the contract carefully and sign it. Don t forget to enter at Point 1 the amount at your disposal when you arrive in Qu bec to support your needs and where applicable the needs of your spouse or de facto spouse and of your dependent children* To learn the minimum amount required in your situation use the calculation table below use the greyed spaces to enter the amounts that apply to your situation and to calculate your minimum required amount. TABLE FOR CALCULATING THE MINIMUM AMOUNT REQUIRED FOR THE ESSENTIAL NEEDS OF PRINCIPAL FAMILY UNITS FOR THE THREE-MONTH PERIOD FOLLOWING ARRIVAL IN QU BEC AMOUNTS IN EFFECT FROM JANUARY 1 TO DECEMBER 31 without spouse or with accompanying spouse Number of accompanying dependent children including ones who are Canadian citizens Under 18 years old State the number of additional children 18 years or older of children Add 506 per Add 381 per Add 1 364 per child Calculation of minimum amount required for your basic needs Minimum required Examples of calculations based on accompanying persons Minist re de l Immigration et des Communaut s culturelles A-0522-OA 2013-01 Reserved for Administration Individual Reference No* File No* Section A IDENTIFICATION OF THE PRINCIPAL APPLICANT Family name at birth First name F M Date of birth Year / Month / Day Marital status Single Married De facto spouse Separated Divorced Marriage annulled Widowed Residence address Telephone number DE FACTO SPOUSE AND DEPENDENT CHILDREN Family Name at birth FIRST NAME DATE OF BIRTH SEX ADDRESS if different from the principal applicant A - Spouse or de facto spouse B - Dependent children including children who are Canadian citizens Page 1 of 2 CONTRACT I acknowledge having read the information on this form and I understand the nature and scope of the contract respecting financial self-sufficiency.