Language Bank - Personal Information Consent and Disclaimer Form for Language Bank Services Please read carefully the form below, and fill out the required information. All fields are mandatory. NOTE: Verifications of translations, letters for Manitoba Health Services (and other letters), and certified true copies are available to Immigrant Centre clients only. If you do not have an Immigrant Centre Client number yet, or have not registered as a client yet, email email@example.com for instructions to register. IC Client Number*Enter your IC Client number.Immigration Status*Select your current immigration status from the list below.Permanent Resident - Non-RefugeePermanent Resident - RefugeeRefugee ClaimantStudent VisaConvention RefugeeCanadian Citizen (Naturalized)Canadian Citizen (Born in Canada)Visitor VisaOpen Work PermitClosed Work PermitFull Name*Enter your name as it appears on your immigration documents. First Middle Last Current Address in Manitoba*Enter your current address in Manitoba. Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone Number*Enter your telephone number. Email Address*Enter your email address. Enter Email Confirm Email Personal Information Protection*Under the Personal Information Protection and Electronic Documents Act (PIPEDA), the Government of Canada requires the Immigrant Centre to explain how we use your personal information. This act has been designed to protect you. We must also have your permission to use this information. By selecting Understood, you confirm that you read and understood this information.UnderstoodImmigrant Centre Data Use*Your personal information will be entered into our electronic data base and may be used, by any or all the services at the Immigrant Centre. Some of your information may be included in statistical information given to funders. You will not be identified by name. This information may also be used by the Immigrant Centre to contact you in the future. By selecting Understood below, you confirm that you have read the above, and understand which information is being collected and what it is being used for.UnderstoodDisclaimer - Enter your Name Below*DISCLAIMER: The Immigrant Centre is funded by Immigration Refugees & Citizenship Canada to provide information to ensure newcomers have ongoing, clear and up to date information. The Immigrant Centre offers general information which should not be viewed as legal advice or opinion. It is an individual’s own decision how to proceed with the information provided. By entering your name below, you confirm that you read and understood this disclaimer by Immigrant Centre.Date*Please enter today's date. Date Format: MM slash DD slash YYYY Once you have submitted this form, please follow these instructions, depending on the service you need: I. If you require a verification of translation 1. Translate the documents into English. 2. If you are a permanent resident, you must include a copy of your permanent resident card. Scanned PDFs and photos are acceptable. 3. Send the documents by email, along with your full name and IC number, to: firstname.lastname@example.org 4. The Language Bank will send the documents back to you by mail; please expect a turnaround of 2 to 3 weeks. II. If you require a certified true copy 1. Scan the documents, and save them into PDF format. If the document is in colour, the PDF must be in colour as well. 2. If you are a permanent resident, you must include a copy of your permanent resident card. 3. Send the documents by email, along with your full name and IC number, to: email@example.com 4. The Language Bank will send the documents back to you by mail; please expect a turnaround of 2 to 3 weeks. III. If you require a letter of physical address for your Manitoba Health Card application, or other types of letter: 1. Send your IC number, full name, address, and specific request by email to: firstname.lastname@example.org 2. The Language Bank will send the letter to you by mail; please expect a turnaround of 2 to 3 weeks. NOTE: The Language Bank will only process any services or requests once this form has been received. We are unable to reply to any requests made without sending this form. CommentsThis field is for validation purposes and should be left unchanged.