CIT 0002 (03-2010) E
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9. SIGNATURE OF APPLICANT
I agree to advise Citizenship and Immigration Canada if any information on this form changes before I take the Oath of Citizenship. I
understand the contents of this form. I declare that the information provided is true, correct, and complete, and that the photographs
enclosed are a true likeness of me. I understand that if I make a false declaration, or fail to disclose all information material to my
application, I could lose my Canadian citizenship and be charged under the Citizenship Act.
I have indicated in Section 7 of this form whether the prohibitions apply to me.
I hereby acknowledge that Section 10 below must be completed if an individual, firm or organization assisted me in the completion of this
application. If Section 10 is blank, I confirm that I completed this form myself without any help.
IMPORTANT NOTE:
Remember to make sure that you are eligible to apply for citizenship on the day BEFORE
you sign this application.
Did you receive assistance in completing this form
If yes, have the individual, firm or organization
complete the following Section 10.
No
Yes
Signature of
APPLICANT
Date
City
(you must sign inside the white box in black ink only)
Year Month Day
10. INDIVIDUAL, FIRM OR ORGANIZATION WHO ASSISTED IN THE COMPLETION OF THIS APPLICATION
(The applicant does not complete this section)
Request for authorization
To make sure that you are on the list of electors (voters) for provincial, municipal or school elections, the Chief Electoral Officer of Québec
needs to add your name to Québec's Permanent list of electors.
Do you authorize Citizenship and Immigration Canada to forward your name, address, gender and date
of birth to the Chief Electoral Officer of Québec so that this information can be added to the permanent list?
No information will be forwarded until you acquire Canadian citizenship. By law this information will be used for electoral purposes only.
For more information, please refer to Section 8 of How to complete this Form.
C QUÉBEC'S PERMANENT LIST OF ELECTORS
8. CONSENT TO DISCLOSE PERSONAL INFORMATION
A CONGRATULATORY LETTER
Request for authorization
Federal Members of Parliament (MPs) send a letter of congratulations to new citizens in their ridings. Do you authorize Citizenship and
Immigration Canada to forward your name, address, gender and preferred official language to your Member of Parliament? No other
information will be forwarded.
This information will be disclosed once your Canadian citizenship is granted.
Yes
No
B NATIONAL REGISTER OF ELECTORS
Request for authorization
Canadian citizens who are 18 years of age or older have the right to vote in federal elections and referendums. Elections Canada needs your
authorization to add your name to the National Register of Electors which is used to produce the voters lists for federal elections and
referendums.
Do you authorize Citizenship and Immigration Canada to give your name, address, gender and date of
birth to Elections Canada, after you obtain your citizenship, so that Elections Canada can include this
information in the National Register of Electors?
Whether you answer "yes" or "no" is completely your choice. Your information will be used only for purposes permitted under the Canada
Elections Act, which include sharing the information with provincial and territorial election agencies, members of Parliament and political
parties, as well as candidates at election time. Your answer will not affect your citizenship application.
For more information, please refer to Section 8 of the instruction guide. If you have any other questions, please call Elections Canada at
1-800-463-6868 or visit our Web site at www.elections.ca.
Do you reside in Québec?
Yes No
The information you provided on the application is collected under the authority of the Citizenship Act and is required to determine whether your citizenship application may
be approved. The information will be retained in the Personal Information Bank CIC PPU 050 identified in Infosource. It may be shared with other organizations in
accordance or disclosed, without notice or consent, pursuant to s. 8(2) of the Privacy Act. Under the Privacy Act and the Access to Information Act, individuals have the
right to protection of, access to and correction of their personal information. Details of these matters are available at Infosource.gc.ca
, at www.cic.gc.ca, at the local CIC
offices, at the CIC Call Centre and at any Canadian public library.
Protected Information
Personal Information Bank CIC PPU 050
Signature of
INDIVIDUAL
Date
Name of individual who assisted in completing this application form Name of firm, organization
Address
Year Month Day
Yes No
Yes No
