CONSENT TO DISCLOSURE OF PERSONAL INFORMATION TO THE MEDIA

DATE: TO: RE: Your Request for information concerning: _________________________________

This letter is in reply to your request to Citizenship and Immigration Canada for information concerning the above-named person(s). Due to privacy laws, in order to provide the information you are seeking,we are generally not able to provide details of individual cases without a signed consent form. Knowing all of the facts of this case will help you provide a complete and balanced story to Canadians. Unless such information is publicly available, Citizenship and Immigration Canada generally requires written consent from the above-named person(s) before it can disclose their personal information to you. Where consent from a minor is required, a parent or guardian with legal custody of the minor must sign the consent form on their behalf. Attached please find the Consent to Disclose Personal Information form for completion and return. If the persons providing consent do not understand English or French, you must ensure that an interpreter translates the consent form for them. Where the services of an interpreter are used, the interpreter must complete and sign the Interpreters Declaration on the second page of the form. If you are looking for information about persons who have applied for refugee protection in Canada, you may want to contact the individual or their representative as CIC cannot provide this information. If you are looking for information about persons whose refugee or immigration applications are subject of a judicial review, you may also wish to contact the registry of the Federal Court. I may be reached at (613 ) 941-7021 if any further information is required. Please have the person(s) concerned fax the signed and dated consent form to me at (613) 941-7099. Bill Brown Citizenship and Immigration Canada

CONSENT TO DISCLOSE PERSONAL INFORMATION TO THE MEDIA FORM

I, ________________ (print name of person(s) concerned), born on ______________ (date of birth) hereby authorize Citizenship and Immigration Canada (CIC) to disclose to the following named individual(s)/ organization(s): _____________________ _____________________ _____________________ (the Recipient(s)), all information about myself, which is under the control of CIC, including, but not limited to, information and documents relating to:

any immigration, refugee or citizenship application; any hearing, review or appeal; charges and convictions (if any); medical information; any other document or information provided to, or obtained by, the Government of Canada by any source.

I understand that CIC has no control over how a Recipient will use or disseminate my information once this information is disclosed to the Recipient. I agree to release CIC (which includes, without limitation, the Minister of CIC, the Ministers staff, and CIC staff, employees, spokesmen, contractors, agents, and assignees) from any and all claims in law or equity, including negligence, misfeasance and defamation, arising from, or in any way connected to, the release or use by a Recipient of any information or records pursuant to this Consent. I understand that CIC is subject to the Privacy Act and that I have the right to examine my personal information under the control of CIC and to request corrections or notations to this information. Please note that CIC may determine that all or part of the information about which you have provided your consent cannot be disclosed per exemptions identified in the Privacy Act. These exemptions include information relating to law enforcement investigations, international affairs and defence, and solicitor-client privileged information, among others I understand that I am not obliged to consent to the disclosure of any personal information and that my decision not to provide consent will not have any bearing on any CIC decision(s) with respect to my case nor any other adverse consequences in terms of CICs processing of my case . I confirm that I have read and understand the nature and effects of this form.

This consent is to remain valid for a period of 90 days from the date of my signature. Yes I required the services of an interpreter to complete this form: No

If the answer is yes, please provide a completed Interpreters Declaration Form together with consent form (dated and signed).

__________________________ Signature

________________________ Date

Interpreters Declaration Form

I, _______________ (name of interpreter), of _________ (address), am fluent in orally translating from _____________ (name of language) to English and from English to ___________ (name of language). On the ___________ (date), I translated to _______________ (name of person(s) concerned) the content of the above Consent to Disclose Personal Information to the Media Form (consent form) from English to ______________ (name of language) and from _____________ (name of language) to English. I hereby declare that to the best of my abilities, I have faithfully and accurately translated the content of the consent form. I have been informed by the above-named person(s), and do verily believe, that they completely understand the nature and effects of the consent form.

______________________________ Interpreters signature

_________________________ Date

Please return this completed form together with the completed consent form to Citizenship and Immigration Canada (CIC) by faxing it to:

_____________________ (Name and title of CIC representative) Fax number: ( ) -