(Please indicate the type of credit card with an "X")

Card security/card verification value code (CVV)

Name of payer (if different from the principal applicant)Name of principal applicant (given name(s), surname)

IMM 5620 (12-2010) E

FEE PAYMENT FORM - APPLICATION FOR PERMANENT RESIDENCEFEDERAL SKILLED WORKER CLASS

STEPS TO FOLLOW:

1. Calculate the applicable fee by referring to this table:

Citizenship andImmigration Canada

Citoyenneté etImmigration Canada

This form must accompany all applications for Permanent Residence under the Federal Skilled Worker class. A separate paymentform is required for each application. Please refer to step 3 of the Federal Skilled Worker instruction guide for acceptable methods of payment. Applications submittedwith incorrect payments will be returned.

PROTECTED WHEN COMPLETED - B

2. Pay by certified cheque, bank draft or money order payable to THE RECEIVER GENERAL FOR CANADA orby Visa, Mastercard or American Express.

3. Include the payment form and the documents specified in the Document Checklist (IMM 5612) with yourapplication.

4. Check the appropriate box to indicate your method of payment:

Credit card (complete section A and B below)

Certified cheque, bank draft or money order(enclosed and complete section A below)

Note: The credit card must be valid for at least nine (9) months from thedate of submission of your application. Otherwise your applicationwill be returned.

SECTION B - CREDIT CARD PAYMENT AUTHORIZATION

I agree to pay the Receiver General for Canada

CAD$ on my credit card for fees

related to an application for permanent residence.

Name of cardholder (please print)

Year Month Day

FOR OFFICIALUSE ONLY

Authorization number

SECTION A

Address of payer (if different from the principal applicant)

MASTERCARDVISA AMERICAN EXPRESS

Credit card number

Expiry date of the cardMonth Year

A three (3) or four (4) digit number usually found on the back or front of the credit card.

Note: The amount authorized must be equal to a single fee or amultiple of a single fee. Authorizations for other amounts are incorrect.

DateSignature of cardholder

Principal applicant

Each family member age 22 or older

Each family member under age 22 who ismarried or in a common-law relationship

Processing Fee Number ofpersons

Amount due$ CAD

Each family member under age 22 who isunmarried and not in a common-lawrelationship

$ 550x $ 550

x $ 550

x $ 550

x $ 150

1

Amount perperson

Total payment:

METHOD OF PAYMENT OPTIONSA combination of more than one method of payment is acceptable. However, payment by each method MUST be equal to a single ora multiple amount per person that you have indicated in Step 1 above.For example: An amount of $550 paid by credit card for the principal applicant, and 2 x $150 paid by a certified cheque for 2dependents for a total of $850 is acceptable. However, $500 paid by credit card and $350 by certified cheque will not be accepted.