Fillable APPLICATION FOR CITIZENSHIP CERTIFICATE FOR ADULTS AND MINORS (Government of Canada)

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APPLICATION FOR CITIZENSHIP CERTIFICATE FOR ADULTS AND MINORS (Government of Canada)

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(DISPONIBLE EN FRANÇAIS - CIT 0001 F)
PROTECTED WHEN COMPLETED - B
Page 1 of 13
APPLICATION FOR CITIZENSHIP CERTIFICATE
FOR ADULTS AND MINORS
(Proof of Citizenship)
Under Section 3 of the Citizenship Act
CIT 0001 (07-2020) E
FOR OFFICIAL USE ONLY
UCI No.
Current Act Former Act
Certificate no.
Return original
document(s)
Approved
Signature
YYYY-MM-DD
Notify
Send certificate to
IMPORTANT
The parent or guardian applying for a citizenship certificate on behalf of a minor (under 18)
should complete this form.
Do not use this form if you or your child is a permanent resident applying to be granted
Canadian citizenship.
Do any of these apply to you?
I need to replace my citizenship certificate;
I want to pass down my Canadian citizenship to my child born outside Canada AND I
was born in Canada or naturalized in Canada before my child was born; I didn’t adopt my
child.
I never had a citizenship certificate and I was born outside Canada to a Canadian
parent who was born in Canada or naturalized in Canada before I was born; I wasn’t
adopted by my Canadian parent.
I think I am Canadian and want to know for sure.
Yes: proceed to the application No: you may need a different type of application
NOTE: If you (or the child you are applying for) was adopted outside of Canada by a Canadian
citizen, you can only use this application for a replacement certificate. If your adopted child
was never granted Canadian citizenship, you can apply for
Instructions below apply to your child or minor as the applicant if you are filling out the
form on their behalf.
1
Language
I want service in: English French Please check One
2
Provide your Unique Client Identifier (UCI) if you have one:
3
Reason for application
Are you applying to replace your citizenship certificate? Yes No - skip to section 4
If yes, give information that appears on the certificate
Certificate no. Date of certificate (YYYY-MM-DD)
Surname/Last name
Given name(s)
I am applying for a replacement because I need to
Update certificate (previous certificate enclosed) Replace a stolen/lost/destroyed certificate
Was the theft/loss reported to the police? Yes No
Give details of the theft/loss/destruction (when, where and how?)
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Canadian citizenship for an adopted
person.
✔
Page 2 of 13
CIT 0001 (07-2020) E
4
Tell us about yourself (or the minor you are applying for)
Surname/Last name (as it appears on your birth certificate) Given name(s) (as it/they appear on your birth certificate)
Date of birth (YYYY-MM-DD) Place of birth Country of birth or territory
Specify (if not on list)
Gender
F Female M Male X Another gender
Height cm OR ft in
Natural eye colour
List any other names (include current or former married name(s), aliases and nicknames). These names will not appear on your citizenship certificate
5
Are you requesting a change to the personal details you have provided above?
Yes No No - skip to section 6
If Yes, please specify
I want a different name to appear on my citizenship certificate.
Requested Surname/Last name Requested Given name(s)
I want a different date of birth to appear on my citizenship certificate.
New date of birth (YYYY-MM-DD)
I want a different gender to appear on my citizenship certificate.
What gender would you like to appear? F Female M Male X Another Gender
6
Details about your birth certificate (or the minor you are applying for)
Will you provide a birth certificate that was changed or replaced?
Yes No – my birth certificate is the original record on file since the time of my birth (skip to section 7) I don't know
If ‘Yes’ or ‘I don’t know’, explain why your birth certificate was changed, replaced or the reasons why you don’t know. (ex. my document was changed
to include my step parent; my original birth certificate was destroyed and I received a new one, etc). Provide an explanation letter if you need more
space.
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(please consult the instruction guide for required supporting documentation)
(please consult the instruction guide for required supporting documentation)
(please consult the instruction guide for required supporting documentation)
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CIT 0001 (07-2020) E
7
Tell us about your parents - (If you do not know the information requested, enter 'unknown'. If the information does not apply, enter 'not applicable'
or 'NA'.)
Parent 1
Details
Surname/Last name
Given name(s)
Other names used by parent (name at birth, maiden name, etc.)
Parent's country or territory of birth Date of birth (YYYY-MM-DD)
Canadian birth certificate registration number, if applicable
Date of marriage (YYYY-MM-DD) Place of marriage
A - Relationship to you (select one) – See page 10 definition
* Select biological parent if biological AND legal parent at birth
This parent is my
biological
parent
adoptive
parent
legal parent
at birth
B - Parent 1's Citizenship Status
Parent 1 is not / was not a Canadian citizen - skip to section C
I am not sure if parent 1 is (or was ever) a Canadian citizen
Please tell us the circumstances
Parent 1 is/was a Canadian citizen
How did parent 1 obtain Canadian citizenship?
Parent 2
Details
Surname/Last name
Given name(s)
Other names used by parent (name at birth, maiden name, etc.)
Parent's country or territory of birth Date of birth (YYYY-MM-DD)
Canadian birth certificate registration number, if applicable
Date of marriage (YYYY-MM-DD) Place of marriage
A - Relationship to you (select one) – See page 10 definition
* Select biological parent if biological AND legal parent at birth
This parent is my
biological
parent
adoptive
parent
legal parent
at birth
B - Parent 2's Citizenship Status
Parent 2 is not / was not a Canadian citizen - skip to section C
I am not sure if parent 2 is (or was ever) a Canadian citizen
Please tell us the circumstances
Parent 2 is/was a Canadian citizen
How did parent 2 obtain Canadian citizenship?
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CIT 0001 (07-2020) E
7
Tell us about your parents - Continued
Parent 1 continued
B - Parent 1's Citizenship Status - Continued
Parent 1's citizenship certificate
number, if applicable
On what date did parent 1 first
enter Canada to live? (YYYY-MM-DD)
Did parent 1 leave Canada for more than 1 year
before 1977?
Yes No
If Yes, give details
From (YYYY-MM-DD) To (YYYY-MM-DD) Destination (Country or territory)
Is (or was) parent 1 a citizen of a country or
territory other than Canada before 1977?
No Yes
If Yes, give details: (country or territory, date of citizenship, description of
how citizenship/nationality was obtained and/or recognized, etc.)
Was parent 1 born in Canada before January 1,
1947 or in Newfoundland and Labrador before
April 1, 1949?
No Yes
Was parent 1 naturalized as a British subject in
Canada before January 1, 1947 or in
Newfoundland and Labrador before April 1, 1949?
No Yes
Was parent 1 a British subject and living in
Canada on January 1, 1947 or Newfoundland and
Labrador before April 1, 1949?
No Yes
C - Foreign Government Employment
If you were born in Canada, was parent 1 employed in Canada by a
foreign government or international agency at the time of your birth?
Not applicable, not born in Canada No Yes
If Yes, give details
If parent 1 was born in Canada, was one of their parents (i.e. your
grandparents) employed in Canada by a foreign government or
international agency?
Not applicable, not born in Canada No Yes
If Yes, give details
Parent 2 continued
B - Parent 2's Citizenship Status - Continued
Parent 2's citizenship certificate
number, if applicable
On what date did parent 2 first
enter Canada to live? (YYYY-MM-DD)
Did parent 2 leave Canada for more than 1 year
before 1977?
Yes No
If Yes, give details
From (YYYY-MM-DD) To (YYYY-MM-DD) Destination (Country or territory)
Is (or was) parent 2 a citizen of a country or
territory other than Canada before 1977?
No Yes
If Yes, give details: (country or territory, date of citizenship, description of
how citizenship/nationality was obtained and/or recognized, etc.)
Was parent 2 born in Canada before January 1,
1947 or in Newfoundland and Labrador before
April 1, 1949?
No Yes
Was parent 2 naturalized as a British subject in
Canada before January 1, 1947 or in
Newfoundland and Labrador before April 1, 1949?
No Yes
Was parent 2 a British subject and living in
Canada on January 1, 1947 or Newfoundland and
Labrador before April 1, 1949?
No Yes
C - Foreign Government Employment
If you were born in Canada, was parent 2 employed in Canada by a
foreign government or international agency at the time of your birth?
Not applicable, not born in Canada No Yes
If Yes, give details
If parent 2 was born in Canada, was one of their parents (i.e. your
grandparents) employed in Canada by a foreign government or
international agency?
Not applicable, not born in Canada No Yes
If Yes, give details
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CIT 0001 (07-2020) E
7
Tell us about your parents - Continued
Parent 1 continued
D - Canadian Crown Service
If you were born outside Canada, was parent 1 employed outside
Canada in or with the Canadian Armed Forces, the federal public
administration, or the public service of a province or territory, other than as
a locally engaged person at the time of your birth?
Not applicable, I was born in Canada No Yes
If Yes, give details
Parent 2 continued
D - Canadian Crown Service
If you were born outside Canada, was parent 2 employed outside
Canada in or with the Canadian Armed Forces, the federal public
administration, or the public service of a province or territory, other than as
a locally engaged person at the time of your birth?
Not applicable, I was born in Canada No Yes
If Yes, give details
8
Tell us about your grandparents - (If you do not know the information requested, enter 'unknown'. If the information does not apply, enter 'not
applicable' or 'NA'.)
Full name of Parent 1
If parent 1 was born outside Canada, was one of parent 1's parents (i.e. your grandparents) a Canadian citizen and/or a Crown servant of Canada at the
time of this parent's birth or adoption?
Was parent 1 born outside Canada? No: skip to parent 2 Yes
Was one of parent 1's parents (your grandparents) Canadian? No: skip to parent 2 Yes
If you chose a 'Yes' response, please provide the following details
Parent A) of parent 1
Surname/Last name
Given name(s)
Other names used (name at birth, maiden name)
Country or territory of birth Date of birth (YYYY-MM-DD)
Canadian birth certificate number
(if applicable/known)
Canadian citizenship certificate
number (if applicable/known)
Details on how this grandparent obtained Canadian citizenship
Details on Crown Service (if applicable)
Parent B) of parent 1
Surname/Last name
Given name(s)
Other names used (name at birth, maiden name)
Country or territory of birth Date of birth (YYYY-MM-DD)
Canadian birth certificate number
(if applicable/known)
Canadian citizenship certificate
number (if applicable/known)
Details on how this grandparent obtained Canadian citizenship
Details on Crown Service (if applicable)
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Page 6 of 13
CIT 0001 (07-2020) E
8
Tell us about your grandparents - Continued
Full name of Parent 2
If parent 2 was born outside Canada, was one of parent 2's parents (i.e. your grandparents) a Canadian citizen and/or a Crown servant of Canada at the
time of this parent's birth or adoption?
Was parent 2 born outside Canada? No: skip to section 9 Yes
Was one of parent 2's parents (your grandparents) Canadian? No: skip to section 9 Yes
If you chose a 'Yes' response, please provide the following details
Parent A) of parent 2
Surname/Last name
Given name(s)
Other names used (name at birth, maiden name)
Country or territory of birth Date of birth (YYYY-MM-DD)
Canadian birth certificate number
(if applicable/known)
Canadian citizenship certificate
number (if applicable/known)
Details on how this grandparent obtained Canadian citizenship
Details of Crown Service (if applicable)
Parent B) of parent 2
Surname/Last name
Given name(s)
Other names used (name at birth, maiden name)
Country or territory of birth Date of birth (YYYY-MM-DD)
Canadian birth certificate number
(if applicable/known)
Canadian citizenship certificate
number (if applicable/known)
Details on how this grandparent obtained Canadian citizenship
Details of Crown Service (if applicable)
9
Additional citizenship information
Have you ever lived in Canada? No: skip to section 10 Yes
If Yes, on what date did you first enter Canada to live Date (YYYY-MM-DD)
or
I was born in Canada
10
Were you born before 1977?
No: skip to section 12 Yes: fill out this section
Were you absent from Canada for 1 year or longer before 1977? No Yes: fill out this section
From (YYYY-MM-DD) To (YYYY-MM-DD) Destination (Country or territory) Reason
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CIT 0001 (07-2020) E
10
Were you born before 1977? - Continued
Were you a citizen of one or more countries other than Canada before 1977? No Yes
If Yes, give details (country or territory, date of citizenship, description of how citizenship/nationality was obtained and/or recognized)
11
Were you born before 1950?
No: skip to section 12 Yes: fill out this section
Were you born in Canada before January 1, 1947 or in Newfoundland and Labrador before April 1, 1949? No Yes
Were you naturalized in Canada before January 1, 1947 or in Newfoundland and Labrador before April 1, 1949? No Yes
Were you a British subject and a resident of Canada on January 1, 1947 or in Newfoundland and Labrador before April 1, 1949? No Yes
Were you married before January 1, 1947 to a man who was born in Canada or naturalized as a British subject in Canada?
Yes
No, I was not married before 1947
Yes, I was married before 1947 but not to a man born or naturalized in Canada
If you selected a Yes response, please provide details: (husband's name, husband's country or territory of birth, his date of birth, nationalities obtained or
lost (if applicable), details on naturalization certificate (if applicable), country or territory of marriage, date of marriage)
12
Contact Information
How can we contact you about your application?
Surname/Last name Given name(s)
Email address Confirm email address
Home address
No. and street Apt./Unit
City Province Country or territory Postal code
Is the mailing address the same as the home address?
Yes No
No. and street Apt./Unit
City Province Country or territory Postal code
If you are applying from outside Canada and the U.S., your documents will be sent to the Canadian embassy, high commission, or consulate nearest
you. If you know which Canadian embassy, high commission, or consulate you would like your documents sent to, please provide the details
Telephone numbers
Home (Area code and number) Work (Area code and number) Extension Cell (Area code and number)
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CIT 0001 (07-2020) E
13
Representative
Is someone helping you fill out this form? No Yes
Are you paying someone to help you fill out this form? No Yes
If yes complete the following details about the person helping you:
Family name (last name) Given name(s) Company name
Note: A representative can be paid or not. If your representative is paid, they must be a member in good standing of: a law
society of a province or territory, the Chambre des notaires du Quebec, or the Immigration Consultants of Canada
Regulatory Council (ICCRC)
Would you like to name a (such as an immigration consultant, lawyer, friend or family member) to do business with us for you?
No Yes If yes complete the
14
Declarations/Permissions/Signatures
I agree to advise IRCC if any information on this form changes before the processing of my application is complete.
I understand the content of this form.
I declare that the information provided is true, correct and complete.
I declare that the photographs enclosed are a true likeness of me.
I understand that if I, or someone on my behalf, make a false representation, commit fraud or conceal any material circumstances relevant to my
application, my application could be denied, my citizenship certificate could be taken away, and I could be charged with an offence as provided for
under the Citizenship Act or the Criminal Code.
I declare that I am NOT using this form to apply for a grant of Canadian citizenship for a person adopted outside of Canada by a Canadian citizen. I
understand that persons adopted outside of Canada can only use this form to apply for a replacement certificate.
APPLICANT'S Signature
(you must sign inside the box in black ink only)
City Date (YYYY-MM-DD)
If applicant is under 14 years of age, signature of parent/guardian
PARENT'S/GUARDIAN'S Signature
(you must sign inside the box in black ink only)
City Date (YYYY-MM-DD)
Remember: If you are sending more than one application, send all of them together in one envelope. The applications will be processed together.
Protected Information
Personal Information Bank CIC PPU 050
The information you provide on this form is collected under the authority of the Citizenship Act to determine whether your citizenship application may be approved. It will be stored in
the Personal Information Bank (CIC PPU 050 entitled Application and Assessment for Canadian Citizenship). The information may be shared with other Canadian government
institutions such as the Canada Border Services Agency (CBSA), the Royal Canadian Mounted Police (RCMP), the Canadian Security Intelligence Service (CSIS), and foreign
governments in accordance with the Citizenship Regulations and subsection 8(2) of the Privacy Act. Information may also be disclosed to foreign governments, law enforcement
bodies and detaining authorities with respect to the administration and enforcement of citizenship legislation where such sharing of information may not put the individual and/or their
family at risk. Information may also be systematically validated by other Canadian government institutions under the terms of an agreement or arrangement for the purposes of
validating status and identity to administer their programs. In accordance with the Privacy Act and the Access to Information Act, individuals have a right to protection of, access to
and correction of their personal information. Details on these matters are available at the InfoSource Website at http://infosource.gc.ca
. InfoSource is also available at public libraries
across Canada.
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Use of a Representative Form (IMM 5476).
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CIT 0001 (07-2020) E
Follow the step-by-step instructions below to complete the application form.
Important Information
•
Make sure that you read the to help you complete your application.
•
If a section does not apply to you, write “Not Applicable” or “NA”. If your application is incomplete it may be returned to you and this
will delay processing.
•
If you're completing this application for a minor under 18 years of age, remember all questions are about the minor and you
should answer as though you are the minor.
•
If you need more space to answer any questions, use an extra sheet of paper and indicate the number and/or letter of the question
you're answering.
•
All of your answers must be complete and true.
Section 1 - Language of service
►
Would you like to receive service) in English or in French? Your correspondence will be in the language that you choose. Please
check one.
Section 2 - Unique Client Identifier
►
Please enter your UCI or 'Unique Client Identifier', the 8 or 10 digit number that is unique to your IRCC immigration and citizenship
records.
►
If you do not have a UCI, enter 'not applicable' or 'NA'. If you do not know your UCI, enter 'unknown'.
Section 3 - Reason for application
►
Check a 'Yes' response if you have had a previous Canadian citizenship certificate and are applying to replace it. Otherwise, check
`No' and proceed to section 4.
►
If you check 'Yes', you'll need to complete all the questions in this section. Enter certificate number or, if unknown, enter 'unknown'.
Indicate the surname/last name(s) and given name(s) on the certificate.
►
Indicate why you're applying to replace your certificate by checking the applicable box in this section. If it was stolen, lost or
destroyed, describe the circumstances (indicate if the theft/loss was reported to the police by checking a 'Yes' or 'No' response to
that questions) and provide details the theft/loss or destruction in the space provided.
►
If you're applying for a replacement because you want to update the information on the certificate, you'll need to return the previous
certificate.
Section 4 - Tell us about yourself
Important Information: As this is the first time you are applying for a citizenship certificate, the name, date of birth and gender on your
citizenship certificate will be the same as the information that appears on your birth certificate unless you request a change to that
information in section 5.
►
Please enter the following information from your birth certificate in the spaces provided:
○
family/last name(s) and given names(s)
○
date of birth
○
place and country or territory of birth (e.g. Paris, France)
○
gender (please check either 'F Female' or 'M Male' as per birth certificate or previous citizenship certificate).
►
Enter your current height and natural eye colour.
►
Enter any other names by which you are known, or have been known (for example previous family names, other given names,
aliases, nicknames).
Note: Your height, eye colour, other names, and country or territory of birth will not appear on your citizenship certificate but are recorded so
that other service providers, such as Passport Canada, can confirm your identity.
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instruction guide
Page 10 of 13
CIT 0001 (07-2020) E
Section 5 - Are you requesting a change to the personal details you have provided above?
In this section you can request a change to the personal details that appear on your previous citizenship certificate or, if this will be your first
certificate, the personal details that appear on your birth certificate.
►
If you want to change your name(s) or your date of birth or your gender, please check the 'Yes' response. Otherwise, check the 'No'
response and proceed to section 6.
►
If you check 'Yes', you'll need to check the box that describes your change of personal details request, and then enter the requested
information in the spaces provided.
○
Request for a different name: If you want a name that is different from the name(s) you provided in section 3, or section
4 if this is your first certificate, enter the requested surname/last name and given name(s) in the spaces provided. Include
the required supporting documents with your application. Refer to Appendix C: Name Change of the instruction guide
to
find out which documents you need.
○
Request for a different date of birth: If you want a date of birth that is different from the date of birth you provided in
section 3, or section 4 if this is your first certificate, enter the requested date of birth in the space provided. Include the
required supporting documents with your application. Refer to Appendix D: Date of Birth Correction of the instruction guide
to find out which documents you need.
○
Request for different gender: If you want a different gender to appear on your citizenship certificate, check the requested
gender (F Female, M Male, X Another Gender). Refer to Request form for a Change of Sex or Gender form.
Section 6 - Details about your birth certificate (or the minor you are applying for)
Explain why your birth certificate was changed or replaced, or provide reasons why you don’t know.
Provide an explanation letter if you need more space.
Section 7 - Tell us about your parents
Important Information: We collect information about your parents and your grandparents because it helps us accurately determine what
section of the Citizenship Act describes your claim to citizenship. If you are claiming citizenship by descent through a parent, complete
information will help us search for citizenship records.
It is important that you provide the fullest and most accurate information about your parents and grandparents. If we don't have enough
information about your parents, your application may be delayed or we may not be able to assess your claim.
If you do not know the information requested on the form, enter 'unknown'. If the information requested does not apply, enter 'not
applicable' or 'NA'.
In the following section, you need to answer each question for Parent 1 (first column) and for Parent 2 (second column).
Reminder: If you are filling out this application for your minor child, then you are the parent referred to in this section.
Parent's personal information
►
Please provide full and accurate information about your parents: names, date of birth, country or territory of birth, other names, and
date and place of marriage. If you do not know the information requested on the form, enter 'unknown' in the spaces provided. If it
does not apply to your parents, enter 'not applicable' or 'NA'.
►
If your parent was born in Canada, please provide the registration number found on their Canadian birth certificate.
Note: Canadian birth certificates include two numbers: a certificate number and a registration number. For the purpose of this application,
please make sure to provide the registration number.
7A - Relationship to you
Select ONE option:
“biological parent” (means you have a genetic or gestational connection to that parent)
○
select “biological parent” if your parent is both your biological AND legal parent at birth, or
○
your parent has a biological connection to you and they are NOT listed on your birth certificate but you have birth records
and documents that recognize your parent(s).
(ex. pre-birth orders, court orders, surrogacy agreements, hospital records, etc.)
○
Note: After submitting your application, IRCC might request a DNA test to confirm parentage. IRCC will also provide a list
of accredited laboratories to complete the DNA test. In these cases, DNA results must have an accuracy of 99.8% or
higher.
“adoptive parent” (means that you were legally adopted after you were born)
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CIT 0001 (07-2020) E
“legal parent at birth” (means that your biological or non-biological parent was listed on the original birth certificate or
birth record issued at the time of your birth)
○
your parent was listed on your original birth certificate issued at the time of your birth, and / or
○
you have birth records and documents that recognize your parent(s) at the time of your birth
(ex. pre-birth orders, court orders, surrogacy agreements, hospital records, etc.)
○
does not include adoptive parents (even those recognized right after birth) or legal guardians.
7B - Parent's citizenship status
►
Indicate your parent's citizenship status by checking one of the three boxes provided.
○
If you check parent is not/was not a Canadian citizen, you can proceed to section 7C, or
○
If you check parent's status is unknown, explain the circumstances in the box provided - you should also try to provide as
much information as possible about Parent 1 in the spaces provided in the rest of 7B, well as in 7C and 7D, or
○
If you check parent is/was a Canadian citizen, tell us how they obtained citizenship in the box provided - for example, 'born
in Canada' or 'granted citizenship' or 'born outside Canada to a Canadian parent'.
►
Enter number of parent's citizenship certificate in space provided - if you do not know the number, enter 'unknown', or if no
citizenship certificate was issued to your parent enter 'not applicable' or 'NA'.
►
Enter date parent first entered Canada to live - please provide the most accurate date you can - for example, the date from a
parent's passport or from another immigration record. If you are not certain, provide your best estimate of the month and year this
parent entered Canada.
►
Check a 'Yes' or 'No' response to indicate:
○
if your parent was outside Canada for more than 1 year before 1977. If you check 'Yes', provide details in the table
provided. If you are not certain of the dates, provide your best estimate of the month and year.
○
if your parent was a citizen of a country or territory other than Canada before 1977. If you check 'Yes', provide details in
the space provided.
○
if your parent was born in Canada before January 1, 1947 (or in Newfoundland and Labrador before April 1, 1949).
○
if your parent was naturalized as a British subject in Canada before January 1, 1947 (or in Newfoundland and Labrador
before April 1, 1949).
○
if your parent was a British subject and a resident of Canada on January 1, 1947 (or of Newfoundland and Labrador before
April 1, 1949).
7C - Foreign government employment
►
Check 'Not applicable', or 'Yes', or 'No' to indicate:
○
if your parent was employed in Canada by a foreign government or international agency.
○
if your parent's parent (your grandparent) was employed in Canada by a foreign government or international agency.
○
if your parent was employed outside Canada as a Crown servant of Canada.
►
If you check a 'Yes' response to any of the three questions, provide details in the space provided.
Section 8 - Tell us about your grandparents
In the following section, there is an area to provide information about both of Parent 1's parents and about both of Parent 2's parents.
Whether or not full personal details for all four grandparents will be required depends on your responses to the initial 'Yes' or 'No' questions.
If you do not know the information requested, enter 'unknown'. If the information requested does not apply, enter 'not applicable'
or 'NA'.
Reminder: If you are filling out this application for your minor child, then you (and your child's other parent) are the Parent 1 and Parent 2
who will be named in this section.
Parent 1's Parents
►
Enter the full name of Parent 1 (same parent named as Parent 1 in section 7).
►
Check 'Yes' or 'No' to the first question to indicate if Parent 1 was born outside Canada.
►
If you check 'No' to the first question, no further information about this set of grandparents is required and you can proceed to the
area in section 8 about Parent 2's parents.
►
If you check 'Yes' to the first question, proceed to the second question and check a 'Yes' or 'No' response there to indicate if either
of your grandparents were Canadian.
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CIT 0001 (07-2020) E
►
If you check 'No' to the second question, no further information about this set of grandparents is required and you can proceed to
the area in section 8 about Parent 2's parents.
►
If you have checked 'Yes' to both questions 1 and 2, you will need to provide full and accurate information about Parent 1's parents,
including:
○
all known names
○
country or territory of birth and date of birth
○
the registration number found on their Canadian birth certificate
○
citizenship certificate number
○
date and place of marriage
○
details on how Canadian citizenship was obtained
○
details on Crown service.
Enter the information in the spaces provided. If you do not know the information requested on the form, enter 'unknown'. If the
information requested does not apply, enter 'not applicable' or 'NA'.
Parent 2's Parents
►
Enter the full name of Parent 2 (same as Parent 2, first column, in section 7)
►
Follow the same steps as you did for Parent 1's parents.
Section 9 - Additional citizenship information
Important Information: The information collected in this section, and in section 10 and section 11, will allow a citizenship official to
accurately determine what section of the Citizenship Act describes your claim to Canadian citizenship today.
►
Check a 'Yes' or 'No' response to indicate if you have ever lived in Canada. If 'No', you can proceed to section 10 now. If 'Yes',
enter the date you came to live in Canada. You can also check 'Since birth', if applicable.
►
If you are not certain of exact dates, provide your best estimate of the month and year.
Section 10 - Were you born before 1977?
If you were born before February 15, 1977, you need to complete this section. If you were born on or after February 15, 1977, you do not
need to provide this information - you can check the `No' response and proceed to section 12.
►
If you give a 'Yes' response to the first question, and you have had absences of more than one year before 1977, provide details
about those absences in the table provided (if you are not certain of exact dates, provide your best estimate of the month and year).
►
Check a 'Yes' or 'No' response to indicate if you were a citizen of any countries other than Canada before 1977. If 'Yes', provide
details in the space provided - country or territory (or countries) of citizenship, date of citizenship, and how citizenship was
acquired.
Section 11 - Were you born before 1949?
If you were born before April 1, 1949, you need to complete this section. If you were born on or after April 1, 1949, you do not need to
provide this information - you can check the 'No' response and proceed to section 12.
►
If you give a 'Yes' response to the first question, answer all questions in this section.
Section 12 - Contact information
In this section you must provide the contact information for the applicant.
►
Provide an email address where you can be reached. If the email address is that of a representative, you must indicate their e-mail
address in this section and complete the IMM 5476 form.
If applicable, write your e-mail address using a format similar to the following: name@provider.net
Note: By indicating your e-mail address, you're hereby authorizing us to transmit correspondence, including file and personal
information to this specific e-mail address.
►
Provide your current home address including your postal code.
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CIT 0001 (07-2020) E
►
If your mailing address is different from your home address, indicate your mailing address.
If the mailing address is that of a representative, you must indicate their mailing address in this section and complete the IMM 5476
form.
Note: We only send mail to Canadian and US addresses. If you live outside of Canada and the United States, correspondence will
be sent to the Canadian embassy, high commission or consulate where you applied (unless you provided an email address). If you
do not want your certificate sent to a mission you need to provide a Canadian or US mailing address.
►
We may need to contact you by phone. Provide the telephone number(s) where you can be reached.
Section 13 - Representative
►
Tell us if someone helped you fill out your forms.
►
If you appoint an individual, firm or organization as your representative, you must complete the
Note that once you appoint a representative, all correspondence from us regarding your application will be directed to
them and not to you.
For help completing the , see:
Section 14 - Declarations/Permissions/Signatures
►
Read and check off each of the five declarations. If you can attest to the declarations truthfully, sign and date the application form
with the signature you currently use on your other official documents.
►
If the application is for a person under 14 years of age, it must be signed by a parent or guardian in the space provided.
Note: Your application will be returned to you if:
•
the form is not signed and dated
•
stale-dated (dated more than 90 days before we receive it)
•
post-dated (dated into the future)
•
you have appointed an individual, firm or organization as your representative and did not submit the Use of a Representative form
(IMM 5476) with your application or this form was submitted incomplete.
•
you appoint a compensated representative who is not a member of the following designated bodies:
○
Immigration consultants who are members in good standing of the Immigration Consultants of Canada Regulatory Council
(ICCRC);
○
Lawyers and paralegals who are members in good standing of a Canadian provincial or territorial law society and students-
at-law under their supervision; or
○
Notaries who are members in good standing of the Chambre des notaries du Québec and students-at-law under their
supervision.
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Use of a Representative Form
Use of a Representative form (IMM 5476)
Guide 5561 - Instructions - Use of a Representative.
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APPLICATION FOR CITIZENSHIP CERTIFICATE FOR ADULTS AND MINORS (Government of Canada)

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Completed 11 September 2020

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