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GUARANTOR DECLARATION
Registration and Secure Certificate of Indian Status (SCIS)
General information about guarantors
A guarantor is a person who can confirm the identity of the
applicant.
Family members can only act as a guarantor if they meet
all the criteria listed below.
A parent or legal guardian applying for registration or
for the Secure Certificate of Indian Status (SCIS) for a
child or dependent adult cannot act as a guarantor for
the child or dependent adult.
The guarantor must perform the following tasks, free of
charge:
• Complete and sign the Guarantor Declaration form;
Sign and date each copy of the front and back of the
applicant's identity documents;
Sign, date and write the applicant’s name (or the name of
the child or dependent adult) on the back of one printed
photo or digital photo using the SCIS Photo App;
• Confirm information about the applicant if contacted by
Indigenous Services Canada.
Note: Failure to complete these tasks will delay application
processing.
Criteria
The guarantor must:
• have known the applicant personally for at
least 2 years;
• be 18 years of age or older;
• be registered under the Indian Act OR
employed in an eligible occupation;
• be available for verification and capable of
answering questions about the applicant.
To know the applicant personally means that the
guarantor is able to confirm information about the applicant,
such as approximate age, place of birth, place of residence
and physical description.
If the application concerns a child or dependent adult,
the guarantor must have known the parent or legal
guardian (the applicant) personally for at least 2 years and
must have knowledge of the child or dependent adult.
If the guarantor is not registered under the Indian Act, the
guarantor must be employed in an eligible occupation:
• First Nations representatives and employees (for example,
chief, councillor, Indian Registration Administrator)
• Employees of Indigenous organizations
• Elected and appointed officials (for example, mayor, member
of Parliament/Legislative Assembly, senator)
• Canadian federal, provincial, territorial or municipal
government employees
• Justice and public safety officials (for example, judge,
magistrate, lawyer, notary, paralegal, police officer, parole
officer)
• Military personnel (regular and reserve forces)
• Medical professionals (for example, dentist, medical doctor,
optometrist, pharmacist, chiropractor, nurse)
• Social services professionals (for example, social worker,
social service worker, counsellor)
• Education professionals (for example, teacher, professor,
administrator, school board member)
• Financial professionals (for example, accountant, financial
advisor, actuary)
• Veterinary professionals (for example, veterinarian, veterinary
technician)
• Scientific professionals (for example, engineer, chemist,
geoscientist)
• Religious officials
If an eligible guarantor cannot be found, the applicant must provide 2 references and complete the Statutory Declaration in lieu of
Guarantor form (83-170E). To obtain the form, visit www.canada.ca/indian-status or call 1-800-567-9604.
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GUARANTOR DECLARATION
Registration and Secure Certificate of Indian Status (SCIS)
Privacy statement
Personal information is collected, used and disclosed by Indigenous Services Canada in accordance with the Privacy Act (https://laws-lois.justice.gc.ca/
eng/acts/P-21/index.html). Only information needed to administer the Indian Registration and the Secure Certificate of Indian Status programs is collected.
The authority to collect and use personal information is derived from the Indian Act (https://laws-lois.justice.gc.ca/eng/acts/i-5/). The information collected is
used to determine entitlement to registration on the Indian Register and membership in a First Nation whose Band List is maintained by the Department, to
issue a Secure Certificate of Indian Status to registered persons and for the provision of benefits and services to those who are registered. The description
of this personal information collection (AANDC PPU 110, AANDC PPU 220) is available at Info Source (https://www.sac-isc.gc.ca/eng/1353081939455).
You have the right to access and request corrections to your personal information by contacting the department’s Privacy Coordinator at 819-997-8277.
For more information on privacy issues, complaints and the Privacy Act in general, you may consult the Privacy Commissioner at 1-800-282-1376.
Instructions
The Declaration must be signed by the applicant and guarantor; failure to sign will delay application processing.
Complete the form on-screen or write in block letters using black or dark blue ink.
SECTION 1: Applicant
The applicant is the person (16 years of age or older) applying for registration or for the Secure Certificate of Indian Status
OR the parent/legal guardian applying for a child (15 years of age or younger) or dependent adult.
Family name Given names
Family name at birth (if different from name above) Alias/Cultural name (if applicable)
Date of birth (YYYYMMDD)
Registration number (10 digits) (if applicable)
Applicant signature
Date (YYYYMMDD)
SECTION 2: Child/Dependent adult (if applicable)
Complete this section if the Declaration supports a child’s or dependent adult’s application for registration or for the Secure Certificate of
Indian Status.
Family name Given names
SECTION 3: Guarantor
Family name
Given names
Registration number (10 digits) (if registered under the Indian Act)
Date of birth (YYYYMMDD)
Occupation (if guarantor is not registered) Employer name (if guarantor is not registered)
Telephone number (daytime) Telephone number (other) Email address
Has known the applicant for
years (minimum 2 years)
Declaration: I solemnly declare that I am at least 18 years of age and have known the applicant named above for at least 2 years.
I understand that the Department reserves the right to confirm my eligibility to act as guarantor, which may include searching publicly
available information or the Indian Register in compliance with the Privacy Act. I understand that any false or misleading statement relating
to this form and any document in support of the application, including the concealment of any material fact, may be grounds for criminal
prosecution.
Guarantor signature
Date (YYYYMMDD)