Fillable Form 1: 2 3 Under Paragraph 5(2)(a) Application (Canadian Immigration and Study Abroad Information Platform)

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Form 1: 2 3 Under Paragraph 5(2)(a) Application (Canadian Immigration and Study Abroad Information Platform)

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Personal
information
(AUSSI DISPONIBLE EN FRANÇAIS - CIT 0003 F)
AVAILABLE ON CIC WEB SITE AT: http://www.cic.gc.ca
CIT 0003 (04-2009) E
PAGE 1 OF 3
Citizenship and
Immigration Canada
Citoyenneté et
Immigration Canada
Application for Canadian Citizenship -
Minors
(under 18 years of age)
Under Paragraph 5(2)(a)
For official use only
4
Before you start, read the instructions
For official use only
a) The person applying
for the child is the
3
2
1
I want service in
Have you applied for the child to obtain
Canadian citizenship before?
Does the child have
special needs?
Protected when completed
Please PRINT in ink or TYPE
Yes
If yes, explain:
No
Yes
OR
No
Please check (9) oneEnglish
French
Note: guardians can apply but one of the natural or adoptive parents must be a Canadian
citizen or applying to become a Canadian citizen. You must provide a birth certificate,
adoption order or a legal document showing guardianship (see instructions about Quebec
issued documents in the section on documents).
Print your name
Parent
OR Guardian
6
C
When?
Year
UCI no.
Certificate no.
Sex
b) Is the child adopted?
No Yes
A Birth details
(as shown on the
immigration
document)
Home address
7
Telephone number(s)
Postal code
Mailing address
(if different from
home address)
Postal code
A
B
C
Home (
)
Work ( ) Ext.
Cell ( )
Height
OR
OR
Colour
of eyes
Female
ft in
cm
Marital status Single Married Widowed Divorced Separated
Common-law
List any other names the
child has used in the past
or now uses
(i.e. alias, birth name,
nickname) These names
will not appear on the
child's certificate of
citizenship
5
Child's name
(exactly as it
appears on the
immigration
document)
You must provide a clear and legible copy of the legal change of
name document.
(See instructions in Section 5 about Quebec issued documents)
Surname/Last name
Given name(s)
Surname/Last name
Given name(s)
A
B
C
Surname/Last name
Given name(s)
Name to appear on
citizenship
certificate
(supporting
documentation
required)
B Indicate the child's
current citizenship
Place
City, town, etc. Country
Date
Male
Day
Month
Year
Fillable Form
CIT 0003 (04-2009) E
Yes
No
Yes
No
CHILD'S PARENTS
8
Surname/Last name
Given name(s)
Other name(s) used
FATHER MOTHER
A
Maiden name
PAGE 2 OF 3
2. In the past three (3) years, has the child been convicted in Canada of an indictable offence
(crime) or an offence under the Citizenship Act?
PROHIBITIONS
UNDER THE
CITIZENSHIP ACT
10
I am the parent or guardian of this child. I have read and understand the prohibitions under the Citizenship Act.
I declare that these prohibitions:
1. Is the child now:
• an inmate of a penitentiary, jail, reformatory, or prison?
• on probation?
• on parole?
3. Is the child now charged with a crime, or a crime under the Citizenship Act?
4. Is the child now, or has the child ever been, under a removal order (has the child been
asked by Immigration officials to leave Canada)?
5. Is the child now under investigation for or charged with a war crime or a crime against
humanity or has the child ever been convicted of a war crime or a crime against humanity?
6. In the past five (5) years, has the child had Canadian citizenship which has been taken
away (revoked)?
Provide detailsDo apply to the child
Do not apply to the child
9
When did the child become a permanent resident of Canada?
Has the child left Canada for 6 months or longer
since becoming a permanent resident?
If yes, give details of the time the child spent away from Canada.
M
DESTINATION
What country did the child go to?
DY DMY
FROM
TO
REASON
Why did the child go to this country?
# of days
absent
days
days
days
days
TOTAL
Use another piece of paper if you need more space.
Year Month
Day
If no, go to Section 10.
Yes No
Proof of Canadian
citizenship
Citizenship certificate number
Citizenship certificate number
D
Indicate whether you are
the natural or adoptive
mother and father
E
Destination (Country)Destination (Country)
Did you leave Canada for
more than 1 year before
February 15th, 1977?
(see instructions in the
guide)
F
Month Day Month Day
From To
YMYM
From To
YMYM
Year
Year
Was your parent(s) a
Canadian citizen at the
time of your birth
C
Natural Adoptive Natural Adoptive
Country and date of birth
B
Yes
No
Yes
No
YearDay Month YearDay Month
CIT 0003 (04-2009) E
SIGNATURE(S)
11
Children (14 years of age and older) must also sign this application:
I agree to advise Citizenship and Immigration Canada if any information on this form changes before
the child takes 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 the child. I understand that if I make a false declaration, or fail to disclose all information
material to the child's application, the child could lose his/her Canadian citizenship and I could be
charged under the Citizenship Act.
I have indicated in Section 10 whether the prohibitions apply to the child.
PAGE 3 OF 3
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
Year Month Day
REMEMBER:
If you are sending more than one application, send all of them together in one envelope.
The applications will be processed together.
INDIVIDUAL, FIRM OR ORGANIZATION WHO ASSISTED IN THE COMPLETION OF THIS APPLICATION
(The applicant does not complete this section)
12
Date
Name of individual who assisted in
completing this application form:
Signature of Individual
Name of firm, organization:
Address:
PARENT'S/GUARDIAN'S signature
(you must sign inside the white box in black ink only)
Date
DayMonthYear
City
CHILD'S signature
(you must sign inside the white box in black ink only)
Date
DayMonthYear
City
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Form 1: 2 3 Under Paragraph 5(2)(a) Application (Canadian Immigration and Study Abroad Information Platform)

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Completed 9 February 2022

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