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CIT 0002 (10-2016) E
F LANGUAGE INSTRUCTION FOR NEWCOMERS TO CANADA (LINC)
*This section needs to be completed by applicants choosing previous LINC results as proof of language.
Request for authorization
By selecting "YES" in the box below, and by signing this application form, I hereby give my consent to IRCC to access my LINC results in order to assist IRCC in determining
my citizenship eligibility.
Yes No
Note that if you do not provide consent, you will be required to submit alternate acceptable proof of language with your application.
10. INTENTION
I intend, if granted citizenship,
• to continue to reside in Canada;
• to enter into, or continue in, employment outside Canada in or with the Canadian Armed Forces, the federal public administration or the public service of a province,
otherwise than as a locally engaged person; or
• to reside with my spouse or common-law partner, or parent, who is a Canadian citizen or permanent resident and is employed outside Canada in or with the
Canadian Armed Forces, the federal public administration or the public service of a province, otherwise than as a locally engaged person.
Yes
I have a mental disability and am incapable of forming the intent referred to above. Note: You must submit supporting evidence.
No – Note: If you select `no', your application will be returned to you as you do not meet the requirements for a grant of citizenship.
11. APPOINTMENT OF A REPRESENTATIVE
Are you appointing an individual, firm or organization as your representative? ►
If yes, the Use of a Representative form (IMM 5476) must be completed and included with your application.
NoYes
Signature of
APPLICANT
12. SIGNATURE OF APPLICANT
I agree to advise Immigration, Refugees and Citizenship Canada (IRCC) if any information on this form changes before I take the Oath of Citizenship. I understand
the content 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 or someone on my behalf, makes a false representation, or commit fraud or conceal any material circumstances relevant to my application, I
could be prohibited from becoming a citizen and reapplying for citizenship for 5 years, my citizenship could be revoked and I could be charged with an offence as
provided for under the Citizenship Act or the Criminal Code.
Notice: IRCC may verify the authenticity and accuracy of any documents you have provided in support of your application for an adult grant of citizenship with
the body that issued the documents.
I have indicated in Section 8 of this form whether the prohibitions apply to me.
I have indicated my future residence intentions in Section 10 of this form.
IMPORTANT NOTE:
Remember to make sure that you are eligible to apply for citizenship on the day BEFORE you sign this application.
(you must sign inside the white box in black ink only)
City
►
Date
(YYYY-MM-DD)
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 or 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 his/
her 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.
http://bit.ly/fill_out_with_RCIC