Fillable RIGHT OF CANADIAN CITIZENSHIP

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RIGHT OF CANADIAN CITIZENSHIP

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SERVICE ORDER FORM
INSTRUCTIONS
Read all instructions and follow carefully
DOCUMENT CHECKLIST
Include the following documents in your application package
CITIZENSHIP APPLICATION FEES
*We accept Visa, Mastercard, American Express, bank drafts and bank transfers
CREDIT CARD INFORMATION
Cardholder
Signature:
DISCLAIMER
Applicant must sign below
* By signing below I assert that I have read and agreed to the terms and
conditions as listed
on https://www.immigroup.com/terms-conditions and agree to the
following conditions:
* Immigroup Inc is not responsible for applications that are rejected.
* All fees are non-refundable once applications are submitted to the
government.
* I agree to being charged the total fees corresponding with my
required service
* I assert that I am applying for my documents using Immigroup as my
representative
* Government fees can be higher than stated on this application
1. Please complete the order form and application forms included herein.
Make sure to include your telephone number and email address where
you can be contacted.
2. Fax or scan and email all forms and documents in the document
checklist to our office for review at 416-640-2650 or info@immigroup.com
3. You will be contacted within 1 - 2 business days regarding your
application. If you have not been contacted after 2 business days,
please contact our office at 1-866-760-2623 to confirm we have
received your order.
4. After we have reviewed your forms and documents, we will advise you
to send the original forms and copies of documents to our office at
ADULT APPLICATIONS
$450 service fee
$58.50 HST (harmonized sales tax)
$630 government fee
MINOR (UNDER 18) APPLICATIONS
$350 service fee
$45.50 HST (harmonized sales tax)
$100 government fee
$1168.50
$525.50
SIGN HERE:
IMMIGROUP ORDER FORM (this page
)
RIGHT OF CITIZENSHIP APPLICATION FORM
- duly completed and signed (don't forget page 9)
RESIDENCE CALCULATOR FORM
- included in this package
COPY OF THE FRONT AND BACK OF YOUR
PERMANENT RESIDENT CARD
COPY OF YOUR RECORD OF LANDING
(IMM1000)
COPIES OF BIOGRAPHICAL PAGES IN ALL
PASSPORTS HELD DURING THE LAST 4
YEARS
2 DOCUMENTS SHOWING PROOF OF
IDENTITY (one must have a photo - health card,
driver's license, provincial ID card are all acceptable)
PROOF OF LANGUAGE
(Please see attachment for more information)
2 PHOTOS
size must be 50 mm x 70 mm (2″ x 2 ¾″)
SCHOOL RECORDS FOR YOU AND ANY
DEPENDENT CHILDREN FOR LAST 4 YEARS
IF APPLICABLE:
Immigroup Inc 57 Westchester Drive, London, ON N6G 2K6 Phone:1-866-760-2623 Fax: 416-640-2650 Email: info@immigroup.com
Cardholder Name
Card Number
Expiry Date
CVV Code
IMMIGROUP INC.
Immigroup Inc 57 Westchester Drive, London, ON N6G 2K6 Phone:1-866-760-2623 Fax: 416-640-2650 Email: info@immigroup.com
RIGHT OF CANADIAN CITIZENSHIP
$30 courier fee
$30 courier fee
Family Discount: 10% off each additional application
$395.50
URGENT PROCESSING
(Includes $45.50 HST)
5. Our office will contact you each time we receive correspondence from
CIC until a decision is reached on your application.
Please note that additional documentation may be requested on an as-needed basis. If you are missing any
information or documents, send what you have and our office will advise you how to proceed.
IMMIGROUP
57 Westchester Drive, London, ON N6G 2K6
Your immigration specialist may ask you to send the documents to a different address
Print Form
(DISPONIBLE EN FRANÇAIS - CIT 0002 F)
PROTECTED WHEN COMPLETED - B
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APPLICATION FOR CANADIAN
CITIZENSHIP ADULTS
(18 years of age or older)
APPLYING UNDER SUBSECTION 5(1)
FOR OFFICIAL USE ONLY
UCI number
Certificate number
FOR OFFICIAL USE ONLY
Space reserved for applicant's label
Thank you for your interest in becoming a Canadian citizen!
Use this form if you are a permanent resident over 18 years of age, and would like to
apply to become a Canadian citizen.
If you are completing this form by hand and need more space for any questions,
continue answering your question on a separate sheet of paper.
1
In which language would you like to receive service? English French
2
Do you have special needs requiring accommodation? This might include
wheelchair access, sign language interpretation, braille or large print
reading material, or access for an assistant or seeing eye dog.
No Yes
If yes, please select the type of accommodation required.
If you choose "Other", provide more information about your accommodation in this box.
TELL US ABOUT YOURSELF
3
a) Have you applied for Canadian Citizenship before? If you submitted an
application for citizenship that was returned to you as incomplete, answer
"no" to this question.
No Yes
b) What is your Client identification (ID) # or Unique Client Identifier
(UCI) as shown exactly on your most recent immigration document?
Canada immigration documents include your Permanent Resident Card (PR Card), Confirmation
of Permanent Residence, or Record of Landing.
c) What date did you become a permanent resident of Canada (landed
immigrant)? Copy the date that you became a permanent resident as
it appears on your most recent immigration document: Permanent
Resident Card (PR Card), or Confirmation of Permanent Residence,
or Record of Landing.
(YYYY-MM-DD)
4
a) What is your name as shown exactly on your most recent immigration document? Copy your
name exactly as it appears on your most recent immigration document: Permanent Resident
Card (PR Card), or Confirmation of Permanent Residence, or Record of Landing.
Family name (Last name)
Given name(s)
b) Have you changed your name or gender designation since becoming
a permanent resident?
No Yes
If your gender designation has changed, refer to Request for a Change of Sex or Gender Identifier
form.
Insert new legal name:
Family name (Last name) Given name(s)
c)
Gender
F Female M Male X Another gender
Height
cm
OR
ft in Natural eye colour
d) What is your date of birth as shown exactly on your most recent immigration document? Copy your date of birth as it appears
on your most recent immigration document: Permanent Resident Card (PR Card), or Confirmation of Permanent Residence, or
Record of Landing.
(YYYY-MM-DD)
Note: If your Date of Birth is incorrect, see Appendix B: Date of Birth Correction in the Instruction Guide.
e) What is your city/town and country or territory of birth?
City/Town Country or territory
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5
List all names that you have used, including name at birth, previously married name(s), alias(es) and nicknames.
Family name (Last name) Given name (First name) Why was this name used
6
Please indicate your marital status - are you:
Single (never married) Married Legally separated Divorced Widowed Common law
7
How can we contact you about your application?
Email address Confirm email address
Home address (residence in Canada) Apt/Unit
City Province Postal code Best phone number to reach you Other phone number
Is the mailing address the same as the home address? No Yes
Mailing address Apt/Unit
City Province Postal code
8
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, to either question above, 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 Québec, or the Immigration Consultants of Canada
Regulatory Council (ICCRC)
Would you like to name a (such as an immigration or citizenship consultant, lawyer, friend or family member) to do business with us for
you?
No Yes If yes complete the
ASSESSING YOUR ELIGIBILITY
Some of the information in the following section is based on the online physical presence calculator. Please fill out the calculator now if you have not
already done so by visiting or
9
a) Are you eligible based on the Physical Presence Calculator to apply for a grant of citizenship? Yes No
If you checked NO, you should wait until you meet the physical presence requirement before completing the application.
I will provide a signed copy of: the Online Physical Presence Calculator or the How to Calculate Physical Presence form (CIT 0407)
Enter the dates from the calculator here: Your five (5) year eligibility period is from
(YYYY-MM-DD)
to
(YYYY-MM-DD)
b) During your five (5) year eligibility period did you have Temporary Resident or Protected Person status in Canada before becoming a permanent
resident?
No Yes
If yes, provide details in the chart below starting with the most recent:
Temporary resident status includes lawful authorization to enter or remain in Canada as a:
• Visitor,
• Student,
• Worker or,
• Temporary resident permit holder
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representative
Use of a Representative Form (IMM 5476).
How to Calculate Physical Presence form (CIT 0407)
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Note: If you were issued work or study permits while your refugee claim and/or Pre-Removal Risk Assessment (PRRA) was being assessed,
these documents did not grant you Temporary Resident status. You cannot claim Temporary Resident time for those periods.
A protected person is someone who:
• Was found to be in need of protection or a convention refugee by the Immigration and Refugee Board or,
• A person who received a positive decision on a Pre-Removal Risk Assessment from IRCC.
Note: If you are claiming time as a Protected Person, the only time allowed is the time from when you received a positive Protected Person
decision on your refugee claim or PRRA application until the day before you became a permanent resident.
Status (e.g. Visitor, student, worker, temporary resident permit holder, or
protected person)
Date your status was obtained/
effective (YYYY-MM-DD)
Date your status expired
(YYYY-MM-DD)
c) During your five (5) year eligibility period, did you live outside of Canada as a crown servant or with your spouse or common law partner or parent
who was a crown servant? Find out who is a crown servant and the specific situations that apply in the help text or instruction guide.
No Yes
If you checked YES please complete and submit the with your complete application, along with your
print out of the Physical Presence Calculator.
If you checked NO please continue to the next question.
10
a) Please list all addresses inside and outside of Canada during your entire five (5) year eligibility period. Start with the most recent. If there are any
missing days or periods of time, your application will be returned to you.
From
(YYYY-MM)
To
(YYYY-MM)
Apartment/
Suite/Unit #
Number and Street name City/Town
Province, State
or Region
Country or
territory
Postal Code
b) In the past four (4) years, were you in a country or territory other than Canada for 183 days or more in a row (since the age of 18)?
No Yes
If yes, list each country or territory in the chart below. You must provide a police certificate for each country or territory where you have been present for
183 days or more in a row (since the age of 18). If you cannot get a police certificate, tell us why below.
Country or territory Explanation
Note: If you were in your country or territory of origin immediately prior to becoming a permanent resident and landing in Canada and this time falls within this
four (4) year period, you are not required to provide a police certificate. Please indicate this in the explanation box.
The police certificate must either have been issued:
• After the last time you were in that country or territory; or
• No more than 6 months before the date you sign your citizenship application.
Consult for specific and up-to-date information on how to obtain police certificates from any country or territory.
11
Tell us what you have been doing during your five year eligibility period, inside and outside of Canada. Enter details of your employment and
education history below. Please include any period of unemployment, period of retirement, period working at home as a homemaker or being self-
employed. Be sure to provide information for the five year eligibility period. Start with the most recent. If there are any missing days, periods of time or
if the section is left blank, your application will be returned to you.
From
(YYYY-MM)
To
(YYYY-MM)
Occupation, field of
employment, field of studies.
Also include unemployment,
retirement, working in the
home as a homemaker or
being self-employed.
Name of employer,
school, business or
other
Address of the place of
employment, study or
other activity
City
Country or
territory
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Residence Outside of Canada form (CIT 0177)
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How to get a police certificate
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From
(YYYY-MM)
To
(YYYY-MM)
Occupation, field of
employment, field of studies.
Also include unemployment,
retirement, working in the
home as a homemaker or
being self-employed.
Name of employer,
school, business or
other
Address of the place of
employment, study or
other activity
City
Country or
territory
12
a) Do you have a Social Insurance Number (SIN), Temporary Tax Number (TTN), and/or Individual Tax Number (ITN)?
Yes,
Provide the most recent federally issued 9-digit number you use to file your income taxes so that we may verify with Canada Revenue Agency:
No, I declare that I do not have a SIN, an ITN or a TTN and was not required to file income taxes for any of the past five (5) taxation years.
b) Tell us when you filed your income taxes in the last five (5) years using the chart below.
Tax Year Required to file Taxes filed
Yes No Yes No
c) SIN, ITN OR TTN RELEASE TO THE CANADA REVENUE AGENCY (CRA)
I authorize IRCC to disclose my SIN, ITN, or TTN, as the case may be, to the CRA for the purpose of requesting my income tax information and filing
history from the CRA. Additionally, I authorize the CRA to disclose my income tax information and filing history from the CRA's Income Tax and Benefit
Return file to IRCC for the taxation year(s) indicated above for the purpose of assessing my citizenship application against the tax filing requirement of
subparagraph 5(1)(c)(iii) of the Citizenship Act and the physical presence requirement of subparagraph 5(1)(c)(i) of the Citizenship Act.
With this consent to the sharing of your income tax filing history between IRCC and Canada Revenue Agency (CRA), IRCC will use this information to
determine if you meet the income tax filing requirement and physical presence requirement of the Citizenship Act. Note that if you do not provide
your consent for these specific purposes, your application will be returned as incomplete and will not be processed.
I also authorize IRCC to examine my tax information in activities to support quality assurance and integrity in the the citizenship program.
Yes No
13
Do you currently, or have you ever held immigration or citizenship status in a country or territory other than Canada
(this includes your country of birth)?
No Yes
Complete details below.
Country or territory
Status (e.g. student, employment/worker,
refugee, permanent resident or citizen)
Date Obtained/Effective
date (YYYY/MM)
If your status is no longer valid
indicate the end date (YY/MM). If your
status is still valid indicate “current”
14
a) Have you held travel documents and/or passports during your five (5) year eligibility period?
Yes, Complete details below in Table A No, Complete details below in Table B
Tell us about all of your travel documents and/or passports covering your five (5) year eligibility period. If there were any gaps between passports please
explain why in Table B.
*Note you will be asked to show us the original documents during the processing of your application.
Table A
Document # Country or territory of Issue Place of Issue Date Issued Expiry Date
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Document # Country or territory of Issue Place of Issue Date Issued Expiry Date
If you do not have a travel document or passport that was/is valid during your five year eligibility period or if there is a gap between your passports, please
explain why here.
Table B
b) I hereby give my consent to the Canada Border Services Agency (CBSA) to disclose the details of my history of travel to IRCC
in order to assist IRCC in determining my citizenship eligibility. I also hereby authorize IRCC to collect the history of my travel
from the CBSA.
Yes No
*Please do not contact the CBSA to request your history of travel.
15
Language evidence:
If you are 18 to 54 years of age, you must submit proof that demonstrates that you have knowledge of English or French. If you are younger than 18 or
older than 54, you are NOT required to provide language evidence.
a) If you are between 18 and 54 years of age, do you have proof of knowledge of English or French? Yes No
Did you successfully complete the LINC or CLIC courses at CLB 4/NCLC 4 or higher from January 1, 2008 to October 31, 2012? Yes No
If yes and you do not have a copy of your certificate, please check the following box and your participation will be verified in our system.
b) I am hearing impaired, which prevents me from submitting the proof of language described in 15A with my application.
No Yes If you check yes, you must submit supporting evidence with your application.
c) I have a disorder, disability or condition that is cognitive, psychiatric or psychological in nature which prevents me from submitting proof of
language with my application.
No Yes If you check yes, you must submit supporting evidence with your application.
16
Prohibitions: To be eligible to become a Canadian citizen, you cannot be prohibited under the Citizenship Act.
Please read the and select the applicable statement below.
1. Are you now:
• On probation?
No Yes
• On parole? No Yes
• Serving a term of imprisonment? No Yes
2. Are you now serving a sentence outside Canada for an offence? No Yes
3. Are you now charged with, on trial for, or subject to or a party to an appeal relating to:
• An offence under the Citizenship Act or an indictable offence in Canada?
No Yes
• An offence outside Canada? No Yes
4. Are you now, or have you ever been, under a removal order (have you been asked by Canadian officials to leave Canada)? No Yes
5. Are you now under investigation for, charged with, on trial for, subject to or a party to an appeal relating to, or have you been
convicted of a war crime or a crime against humanity?
No Yes
6. In the five years immediately before the date of your citizenship application, were you prohibited from being granted citizenship or
taking the Oath of Citizenship because of misrepresentation or withholding material circumstances?
No Yes
7. In the 10 years immediately before the date of your citizenship application, was your Canadian citizenship taken away (revoked) for
reasons of false representation, fraud, or knowingly concealing material circumstances?
No Yes
8. In the 4 years immediately before the date of your citizenship application, have you:
• Been convicted of an indictable offence under any Act of Parliament or an offence under the Citizenship Act?
No Yes
• Been convicted of an offence outside Canada, regardless of whether you were pardoned or otherwise granted amnesty for the
offence?
No Yes
9. While a permanent resident, have you:
• Been convicted in Canada of terrorism, high treason, treason, or spying offences? No Yes
• Been convicted outside Canada of terrorism? No Yes
• Served as a member of an armed force of a country or territory or an organized armed group and that country or territory or
group engaged in armed conflict with Canada?
No Yes
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situations that prevent you from becoming a Canadian citizen
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a) I have read and understand the prohibitions under the Citizenship Act.
b) If you have checked "YES" to any of the questions listed above, provide details. You may need to provide fingerprints and/or court documents and/
or attend an in-person interview to make sure you are not prohibited under the Citizenship Act.
17
Consent to Disclose Personal Information after you acquire citizenship
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 IRCC to forward your name,
home (residential) address,and preferred official language to your Member of Parliament? No other information will be forwarded.
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 IRCC to give your name, home (residential) and mailing addresses, gender, date of birth, Unique Client Identifier (UCI), and the date
your citizenship was granted to Elections Canada, after you acquire citizenship, so that Elections Canada can include this information in the National
Register of Electors?
Yes No
Whether you answer “Yes” or “No” is completely your choice. Your answer will not affect your citizenship application. Inclusion in the National Register
of Electors is optional.
If you answer yes, your information will automatically be included on the lists of electors during a federal election and you will receive a voter
information card during the elections to inform you when and where to vote.
If you answer no, you will still be able to vote, but you will have to register at your local Elections Canada office during the election, or at your polling
station.
Your information will be used only for purposes permitted under the Canada Elections Act, which includes sharing it with provincial and territorial
election agencies, members of Parliament, political parties and candidates at election time. The UCI and the date your citizenship was granted will only
be used by Elections Canada for administrative purposes, and will not be shared by Elections Canada except as required by law.
For more information, please refer to Section 17 of the instruction guide. If you have any other questions, please call Elections Canada at
1-800-463-6868 or visit
c) QUÉBEC'S PERMANENT LIST OF ELECTORS
Request for authorization
In Québec, the permanent list of electors is used to compile the lists of electors used in provincial, municipal and school elections. If you are 18 years
of age and older and reside in Québec, to make sure that you are on the lists of electors (voters), the Chief Electoral Officer of Québec needs your
authorization to add your name to Québec’s permanent list of electors.
Do you authorize IRCC to forward your name, home (residential) address and the date at which you started to reside at that address, gender, date of
birth, Unique Client Identifier (UCI), and the date your citizenship was granted to the Chief Electoral Officer of Québec so that this information can be
added to the permanent list of electors?
Yes No
Whether you answer "yes" or "no" is completely your choice. Your answer will not affect your citizenship application. Inclusion in the permanent list is
not mandatory. No information will be forwarded until you acquire Canadian citizenship. Your information will be used only for purposes permitted
under the (RLRQ, C. E-3.3).
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www.elections.ca.
Election Act
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18
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 commits fraud or conceals any
material circumstances relevant to my application, I could be prohibited from becoming a citizen 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.
IMPORTANT NOTE:
Remember to make sure that you are eligible to apply for citizenship on the day BEFORE you sign this application.
Signature of applicant 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 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 InfoSource is also
available at public libraries across Canada.
Congratulations on completing your application form for an adult grant of Canadian citizenship! If you have not already started, you should begin studying
for your Canadian citizenship test.
Next Steps:
1) Pay your application fee ($630 per applicant 18 years of age and older) and print receipt
2) Complete the document checklist, to submit with the application
3) If you are applying with your family, include all applications in the one envelope
4) Print and send your application and documents to:
Regular Mail Courier Address
Case Processing Centre-Sydney
GRANTS Adults
P.O. Box 7000
SYDNEY, NS
B1P 6V6
Case Processing Centre-Sydney
GRANTS Adults
49 Dorchester Street
Sydney, Nova Scotia
B1P 5Z2
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http://infosource.gc.ca.
Click here to access the official study guide
online
SECTION D: YOUR DECLARATION
10. Your declaration
• I declare that I have fully and truthfully answered all questions on this form and any attached application (if applicable).
• I also declare that I have read and understood all the statements on this form, having asked and obtained an explanation for every point that was not
clear to me.
Signature of applicant Date (YYYY-MM-DD)
Signature of spouse or common-law partner for sponsorship application Date (YYYY-MM-DD)
Warning! It is a serious offence to give false or misleading information on this form.
Personal information provided on this form is collected by Immigration, Refugees, and Citizenship Canada (IRCC) under the authority of the Immigration and
Refugee Protection Act (IRPA) and of the Citizenship Act. The personal information of the applicant is used for identification and authorization purposes. The
personal information of the immigration representative is used to verify that the representative is authorized to offer representation services according to the
provisions of IRPA and of the Citizenship Act.
The personal information of both the applicant and the representative may be disclosed to other federal government institutions, non-governmental and inter-
governmental organizations, regulatory bodies, investigative bodies, and provincial/territorial governments for the purposes of validating identity, information,
and supporting an investigation.
Personal information of both the applicant and the representative may be used for other purposes including research, statistics, program and policy evaluation,
internal audit, compliance, risk management, strategy development and reporting.
Failure to complete the form in full will result in a delay to processing. The Privacy Act gives individuals the right of access to, protection, and correction of
their personal information. If you are not satisfied with the manner in which IRCC handles your personal information, you may exercise your right to file a
complaint to the Office of the Privacy Commissioner of Canada. The collection, use, disclosure and retention of your personal information is further described
in IRCC's Personal Information Bank - IRCC PPU 013, 042, 054, 068.
PROTECTED WHEN COMPLETED - B
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Language abilities
As of November 1, 2012, if you are between 18 and 54, you will have to send
proof of your ability to speak and
listen in English or French
with your citizenship application. Some examples of this proof can be:
− The results of a CIC-approved third-party test; or
− Transcripts or a diploma from a secondary or post-secondary education in English or French, in Canada
or abroad; or
− Evidence of achieving
Canadian Language Benchmark (CLB)/Niveau de compétence linguistique
canadien (NCLC)
level 4 or higher in certain government-funded language training programs.
Important: Applications received on or after November 1, 2012 must have proof of language included in the
application package. If your application is received after November 1, 2012 without the acceptable proof, it will
be considered incomplete and will be returned to you.
Where do I go?
http://www.celpiptest.ca/
Why CELPIP?
− Completely Computer-Delivered
− Easy Online Registration
− Quick Online Results (within 8 business days!)
− Uses Canadian Accents
The CELPIP-General Test is a complete English language testing program that assesses general levels of
functional competency. The test is completely computer-delivered and consists of following components:
− Listening
− Speaking
− General Reading and Writing
How much does it cost?
The Basic English Language proficiency test is $150.00 plus taxes. Coarse code: CELPIP General – LS.
The Canadian Test
The CELPIP-General Test uses the English variety spoken in Canada. Individuals wishing to immigrate to and
adapt to life in Canada relate more to understanding and using Canadian English than other varieties of
English used in other comparable testing systems.
1. Allows test candidates to complete all components of the test in just one three-hour sitting. The Speaking
component requires no additional appointments with an examiner. This allows test candidates to demonstrate
their English proficiency without the confounding effects associated with human interaction as used in other
testing systems.
2. Completing the test with a keyboard and mouse rather than paper and pen can provide a considerable
advantage to the test candidate, especially in the Writing component.
3. The use of a headset for the Listening component allows test candidates to adjust the volume to suit their
own needs.
4. The Writing component includes an automatic “word count” function.
5. Each component of the test includes a timer, which allows test candidates to keep track of their own time.
Test Locations & Dates:
http://www.celpiptest.ca/registration-information/test-dates-and-locations/
Test Format & Scoring:
http://www.celpiptest.ca/about-celpip-g/test-format-and-scoring/
PAGE 1 OF 2
CIT 0177 (06-2015) E
PROTECTED WHEN COMPLETED -
B
(DISPONIBLE EN FRANÇAIS - CIT 0177 F)
RESIDENCE OUTSIDE CANADA
FOR ADULT CITIZENSHIP APPLICANTS DECLARING RESIDENCE OUTSIDE
CANADA AS A CROWN SERVANT OR WITH A CROWN SERVANT FAMILY MEMBER
(SPOUSE, COMMON-LAW PARTNER OR PARENT)
Surname Given name(s)
Date of birth (YYYY-MM-DD)
Complete either Section A or Section B, as applicable.
SECTION A – CROWN SERVANT FAMILY MEMBER
Complete this section if you were residing outside Canada with your Canadian spouse or common-law partner, or your permanent resident spouse, common-
law-partner, or parent, who was employed outside Canada in or with the Canadian Armed Forces, the federal public administration or the public service of a
province or territory, otherwise than as a locally engaged person.
Citizenship applicants who are minors (under 18 years of age) at the time of application do not need to complete this form.
Attach clearly legible photocopies of the following documents:
Proof of your spouse, common-law partner, or parent's employment in or with the Canadian Armed Forces, the public service of Canada
or a province/territory.
Note: The proof of employment must confirm that your spouse, common-law partner, or parent is not a locally engaged person.
One of the following:
Marriage certificate, or
Statutory declaration of common-law union (CIT 0458), or
Proof of parent-child relationship, for example your long form birth certificate or adoption order
One of the following:
Proof of spouse or common-law partner's citizenship, for example a certificate of Canadian citizenship or a provincial/territorial birth
certificate, or
Proof of spouse, common-law partner, or parent's permanent resident status, for example their Record of Landing (IMM1000),
Confirmation of Permanent Residence (IMM 5292 or IMM 5688), or Permanent Resident Card
1. Name of spouse, common-law partner, or parent you were living with during the
relevant period immediately before the date of your application for citizenship:
2. Relationship to you:
Spouse Common-law partner Parent
Note: A common-law partner is a person you have been living with for at least 12 consecutive months in a conjugal relationship (a relationship
like a marriage). That means living together for one year without any long periods where you did not see each other. Either partner may have
left the home for work or business travel, family obligations, and so on. However, that separation must have been temporary and short. A
common-law relationship ends when at least one partner does not intend to continue it.
3. With whom was your spouse, common-law partner, or parent employed and in what capacity? Specify the duration of the posting and the
department or agency, whether federal or provincial/territorial, and the title of the position. If the employment was with the Canadian Armed
Forces, indicate the unit and location.
Details of employment
From
(YYYY-MM-DD)
To
(YYYY-MM-DD)
PAGE 2 OF 2
CIT 0177 (06-2015) E
4. Provide details of your residence outside Canada during the relevant period immediately before the date of your application. Include trips
outside of the country (or countries) of residence and if the purpose was to accompany your family member for their work (e.g., business trip,
official leave/rest and relaxation) or for purposes other than for their work (e.g., vacation).
From
(YYYY-MM-DD)
To
(YYYY-MM-DD)
City, country
Were you in this location with your eligible family
member for their employment?
Yes No
Yes No
Yes No
Yes No
Yes No
5. Was the marriage or common-law union valid at all times during
this period (i.e., you did not divorce, both common-law partners
intended to continue the relationship)?
Yes No Not applicable
6. When did the common-law relationship begin (YYYY/MM/DD)?
Note: This must be at least one year after you began living together in a
conjugal relationship.
Not applicable
SECTION B – CROWN SERVANT APPLICANT
Complete this section if you were employed outside Canada as a permanent resident in or with the Canadian Armed Forces, the federal public administration
or the public service of a province or territory, otherwise than as a locally engaged person.
Attach clearly legible photocopies of the following documents:
Proof of your employment in or with the Canadian Armed Forces, the public service of Canada or a province/territory.
Note: The proof of employment must confirm that you were not a locally engaged person.
1. With whom were you employed and in what capacity? Specify the duration and the department or agency, whether federal or provincial/
territorial, and the title of the position. If the employment was with the Canadian Armed Forces, indicate the unit and location.
Details of employment
From
(YYYY-MM-DD)
To
(YYYY-MM-DD)
2. Provide details of your residence outside Canada during the relevant period immediately before the date of your application. Include trips
outside of the country (or countries) of residence and if the purpose was for your work (e.g., business trip, official leave/rest and relaxation) or
for purposes other than for your work (e.g., vacation).
From
(YYYY-MM-DD)
To
(YYYY-MM-DD)
City, country Were you in this location for your employment?
Yes No
Yes No
Yes No
Yes No
Yes No
SECTION C – SIGNATURE OF APPLICANT
I understand the contents of this form. I declare that the information provided is true, correct, and complete. 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 five (5) years, my Canadian citizenship could be revoked, and I could be charged with an offence as provided for under the
Citizenship Act or the Criminal Code.
Note: CIC 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.
Signature
Date (YYYY-MM-DD)
PAGE # OF ##
PROTECTED WHEN COMPLETED -
B
(DISPONIBLE EN FRANÇAIS - CIT 0003 F)
APPLICATION FOR CANADIAN CITIZENSHIP - MINORS (under 18
years of age) under subsection 5(2)
Before you start, read the instructions.
Complete the form on a computer or by hand in block letters with black ink.
UCI no.
Certificate no.
For official use only
1
I want service in English FrenchOR Please check one
2
3
No Yes
Does the child have
special needs that
require accommodation?
►
If yes, explain:
Have you applied for the child to obtain
citizenship in the past?
No Yes
►
When?
Year
4
a) The person applying
for the child is the
Parent GuardianOR
Print your name
b) Is the child legally adopted? No Yes
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).
IMPORTANT INFORMATION:
The parent or guardian applying on behalf of a minor (under 18) who is a
permanent resident should complete this form.
Do not use this form if your child is eligible for citizenship through birth outside
Canada to a Canadian parent (citizenship by descent).
5
For official use only
B
Child's name
(exactly as it appears
on the immigration
document)
Surname/Last name
Given name(s)
C The child's current
name, if different from
5B. Note: You must
provide supporting
documents for any
change in the child's
name. Consult “Step
1. Gather documents”
in the instruction
guide.
Given name(s)
Surname/Last name
D. 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.
Given name(s)
Surname/Last name
A. What is the child's
client ID# or Unique
Client Identifier (UCI)
as shown exactly on
the child's most recent
immigration
document?
UCI
✔
PAGE # OF ##
6
A Birth details
(as shown on the
immigration document)
Date Place
Country or TerritoryCity,town, etc.
B Indicate the child's
current citizenship
C Personal
information
OR
Male Female
Sex Height
OR
ftcm in
Colour
of eyes
Marital status
Single Married Common-law Widowed Divorced Separated
(YYYY-MM-DD)
7
A Home address
B Mailing address
(if different from home
address)
C Telephone no.(s)
D E-mail address (if applicable)
* If you provide us with your email address, we may correspond with you via email.
Postal code
Postal code
Ext.
DETAILS OF CHILD'S PARENTS
A Surname/Last name (Maiden name if applicable)
Given name(s)
Other name(s) used
B Country or territory of birth C Was the child's grandparent(s) a Canadian
citizen at the time of their parent's birth
YesNo
D Proof of Canadian
citizenship
Certificate number
E Indicate whether the child's parent is the
natural or adoptive parent
Natural Adoptive
F Did the parent leave Canada for more than 1 year before
February 15th, 1977?
(see instructions in the guide)
No Yes
From
(YYYY-MM)
To
(YYYY-MM)
Destination (Country or
Territory)
PARENT
Home Work Cell
8
Date of birth (YYYY-MM-DD)
Date on certificate (YYYY-MM-DD)
A Surname/Last name (Maiden name if applicable)
Given name(s)
Other name(s) used
B Country or territory of birth C Was the child grandparent(s) a Canadian
citizen at the time of their parent's birth
YesNo
D Proof of Canadian
citizenship
Certificate number
E Indicate whether the child's parent is the
natural or adoptive parent
Natural Adoptive
F Did the parent leave Canada for more than 1 year before
February 15th, 1977?
(see instructions in the guide)
No Yes
From
(YYYY-MM)
To
(YYYY-MM)
Destination (Country or
Territory)
PARENT
Date of birth (YYYY-MM-DD)
Date on certificate (YYYY-MM-DD)
G Was the parent employed outside Canada as a
Crown servant (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 the child's birth
or adoption?
No Yes
H Were either of the child's grandparents employed
outside Canada as a Crown servant (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 the parent's birth or adoption?
No Yes
G Was the parent employed outside Canada as a
Crown servant (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 the child's birth
or adoption?
No Yes
H Were either of the child's grandparents employed
outside Canada as a Crown servant (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 the parent's birth or adoption?
No Yes
PAGE # OF ##
9
A When did the child become a permanent resident of Canada?
B Has the child left Canada for a total of 6 months or longer since becoming a permanent resident?
Yes No
If yes, give details of the time the child spent away from Canada.
FROM
(YYYY-MM-DD)
TO
(YYYY-MM-DD)
DESTINATION
What country or territory did the child go to?
REASON
Why did the child go to this country or territory?
Number of days
absent
days
days
days
days
days
days
days
days
days
days
days
Use another piece of paper if you need more space.
TOTAL days
Date (YYYY-MM-DD)
If no, explain why these documents are not in your possession in the box below.
Note: if your passport validity was extended, include a photocopy of the page(s)
containing the extension stamp(s).
C You must include photocopies of the biographical pages of any passports or travel documents covering the five (5) years immediately before the date of the child's
application, or since the child became a permanent resident, if the child became a permanent resident within the past five years.
Do you have all of the required photocopies?
No ►
Yes
If yes, explain why the child's passports or travel documents do not cover the entire period of time in the box below. If you do not provide
an explanation for any period when your child did not have a valid passport, your application will be returned to you.
D Are there any gaps in time in the validity period of the child's passports or travel documents during the past five (5) years, or since the child became a permanent resident,
within the past five years?
Yes ►
No
E In the past four (4) years, was the child present in a country or territory other than Canada for a total of 183 days or more while the child was 14 years of age or older?
Yes
No Not applicable (child under 14 years of age)
If you have checked “YES”, indicate each country or territory in the box below. You must provide police certificates for each country or territory where the child has been
present for 183 days or more. If the child cannot get a police certificate from a country or territory, provide an explanation in the box below.
PAGE # OF ##
10
PROHIBITIONS UNDER THE CITIZENSHIP ACT
A Is the child now:
►
No Yes
• on probation in Canada?
►
No Yes
• on parole in Canada?
►
No Yes
• serving a term of imprisonment in Canada?
B Is the child now serving a sentence outside Canada for an offence?
►
No Yes
C Is the child now charged with, on trial for, or subject to or a party to an appeal relating to an offence under the Citizenship Act or an
indictable offence in Canada?
►
No Yes
D Is the child now charged with, on trial for, or subject to or a party to an appeal relating to an offence committed outside Canada?
►
No Yes
E Is the child now, or has the child ever been, under a removal order (has the child been asked by Canadian officials to leave Canada)?
►
No Yes
F Is the child now under investigation for, charged with, on trial for, subject to or a party to an appeal relating to or has the child ever
been convicted of a war crime or a crime against humanity?
►
No Yes
G In the past five (5) years, was the child prohibited from being granted citizenship or taking the Oath of Citizenship for reasons of
misrepresentation or withholding of material circumstances?
►
No Yes
H In the past four (4) years, has the child been convicted in Canada of an indictable offence under any Act of Parliament or an offence
under the Citizenship Act?
►
No Yes
I In the past four (4) years, has the child been convicted outside Canada of an offence, regardless of whether the child was pardoned
or otherwise granted amnesty for the offence?
• been convicted in Canada of terrorism, high treason, treason, or spying offences?
►
• been convicted outside Canada of terrorism?
►
• served as a member of an armed force of a country or territory OR organized armed group and that country or
territory or group engaged in armed conflict with Canada?
►
No Yes
No Yes
YesNo
J While a permanent resident, has the child:
►
No Yes
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.
Yes ►No
11
I am the parent or guardian of this child. I have read and understand the prohibitions under the Citizenship Act.
If you have checked "YES" to any of the prohibitions listed above, provide details below. If applicable, attach court documents.
PAGE # OF ##
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 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.
12
SIGNATURE(S)
I agree to advise Immigration, Refugees and Citizenship Canada (IRCC) if any information on this form changes before the child takes 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 the child. I understand
that if I or someone on my behalf, make a false representation, or commit fraud or conceal any material circumstances relevant to the child's application, the child could be
prohibited from becoming a citizen and reapplying for citizenship for five years, the child's citizenship could be revoked and I could be charged with an offence as provided for
under the Citizenship Act, or the Criminal Code.
Note: IRCC may verify the authenticity and accuracy of any documents you have provided in support of your application for a minor grant of citizenship with the
body that issued the documents.
PARENT'S/GUARDIAN'S Signature
(you must sign inside the white box in black ink only)
City
Children (14 years of age and older) must also sign this application:
CHILD'S Signature
(you must sign inside the white box in black ink only)
City
Date (YYYY-MM-DD)
Date (YYYY-MM-DD)
I have read and understand the prohibitions under the Citizenship Act.
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Completed 9 September 2021

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