UCI No: Date of birth (yyyy/mm/dd) Visa Office:

This area to be completed by IAD

IAD File No:

Notice of Appeal - Residency Obligation Appeal

Section 63(4) of the Immigration and Refugee Protection Act

TIME LIMIT: You must provide to the Immigration Appeal Division (IAD) this Notice of Appeal and a copy of the
Immigration, Refugees and Citizenship (IRCC) decision made outside Canada on your residency obligation. These documents
must be received by the IAD Registry Office for the region in Canada where you last resided no later than SIXTY (60) DAYS
after you received the IRCC written decision.

TO BE COMPLETED BY THE APPELLANT:

I, , (appellant)
Family name First and middle names

appeal the Immigration, Refugees and Citizenship (IRCC) decision made outside Canada on my residency obligation.

Check the appropriate box:

I choose the language of my appeal to be: English French I need an interpreter at the proceeding:
IN PUNJABI
Language, including any dialect, if applicable

I wish to return to Canada to appear at my hearing in person.

(Note: If you need a travel document to return, and you cannot get one from IRCC, then you must make an application to the IAD. Under the IAD Rules,
your written application for a travel document to return to Canada must be received by the IAD Registry Office and the Minister's counsel no later than
60 days after the IAD receives this Notice of Appeal. The IAD will decide your application based upon whether it is necessary for you to be present at your
hearing.)

I do not intend to return to Canada for the hearing of my appeal. I would like to participate in my hearing by telephone or some other manner

Please list your family members (spouse or partner, dependent children) who are also submitting Notices of Appeal about IRCC's decision on their residency
obligation. Use an additional sheet if necessary. This is for cross-referencing of your family's appeals ONLY. Each family member must submit their own
individual Notice of Appeal using a separate copy of this form.

Family name First name and middle names Relationship to me Date of birth (yyyy/mm/dd)

In Canada, I may be contacted through:

Name Address, number and street Apt. # City Province Postal code

Telephone number Fax number My last physical residence in Canada was in:

( ) ( ) 43 WEST SIDE DR MARKHAM ON L3P 7G3 Ontario

Area code Area code City / District Province

Disponible en français Immigration and Refugee Board of Canada

http://www.irb-cisr.gc.ca
Notice of Appeal - Residency Obligation
IRB / CISR 665 (2020.01) Page 1
 This area to be completed by IAD
IAD File No:

My current address is:

Number and street Apt. # City Province / State Postal code

MOH SHAH TAKIA DINGA TEHSIL KHARIAN DISTRICT GUJRAT
50280
Country Telephone Number (Home) Telephone Number (Cell)

( +92 ) ( 308 ) ( +92 ) ( 300 )

PAKISTAN Country code Area code Country code Area code

I authorize the Immigration and Refugee Board (IRB) and Canada Border Services Agency (CBSA) to correspond with me by email for the purposes of this appeal
using the email address below. I understand the IRB and CBSA cannot guarantee the security of email messages I send to them or I receive from them.

Email Address:
om

COUNSEL:
You have the right to be represented by counsel, at your own expense. If you choose to retain counsel who charges a fee or other consideration, the
counsel must be a member in good standing of either a provincial law society (including a lawyer or paralegal), the Chambre des notaires du Québec,
or the College of Immigration and Citizenship Consultants (CICC). If you have retained counsel, please complete the section below. If you will be
retaining counsel later, you must provide to the IAD, in writing and without delay, the contact information for your counsel (name, address, telephone
and fax numbers, any e-mail address, their membership identification number and the name of their organization).
Is your counsel receiving a fee or other consideration to represent you in this appeal? Yes No

I authorize the following person to be my counsel (to be completed by your counsel):

Given Name and Surname (Mr., Mrs., Ms., Miss, Me) Occupation Organization or Company

Number and Street Apt. # City Province Postal Code

Telephone Number Fax Number

( ) ( )
Area code Area code

I authorize the Immigration and Refugee Board (IRB) and Canada Border Services Agency (CBSA) to correspond with me by email for the purposes of this appeal
using the email address below. I understand the IRB and CBSA cannot guarantee the security of email messages I send to them or I receive from them.

Email Address:
com

Membership Identification No.: Lawyer / Paralegal / Notary:

Province
College of Immigration and Citizenship Consultants (CICC)

Disponible en français Immigration and Refugee Board of Canada

http://www.irb-cisr.gc.ca
Notice of Appeal - Residency Obligation
IRB / CISR 665 (2020.01) Page 2
 IMPORTANT - CHANGE IN CONTACT INFORMATION FOR YOU OR YOUR COUNSEL:
You must notify the IAD, in writing and without delay, if the contact information for you or your For Office Use Only
counsel changes. Please direct all communication to the IAD Registry Office that serves the province
or territory where you are residing (see attached instructions for addresses). Received on:
IMPORTANT: If you fail to appear for a hearing, or fail to communicate with the IAD when
requested, or fail to provide information required by the IAD (such as your most recent
address), the IAD may declare your appeal abandoned in accordance with subsection
168(1) of the Immigration and Refugee Protection Act without any further notice to you. If
your appeal is abandoned, this means that your appeal has ended.

I have attached a copy of the officer's written decision, which I received on: 2024-05-03
Date (yyyy/mm/dd)

signed at on 2024-06-05
Appellant's signature City Date (yyyy/mm/dd)

Disponible en français Immigration and Refugee Board of Canada

http://www.irb-cisr.gc.ca
Notice of Appeal - Residency Obligation
IRB / CISR 665 (2020.01) Page 3