Free Proof of Canadian Citizenship - Additional Information - Canada


File Size: 40.2 kB
Pages: 1
Date: April 14, 2009
File Format: PDF
State: Canada
Category: Passport
Author: Passport Canada
Word Count: 671 Words, 4,163 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.ppt.gc.ca/form/pdfs/pptc001_eng.pdf

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Preview Proof of Canadian Citizenship - Additional Information
WARNING ­ Any false or misleading statement on this form or relating to any document in support of your application, including concealment of any material fact, may lead to refusal or revocation of a passport and be grounds for criminal prosecution.

PROOF OF CANADIAN CITIZENSHIP ­ ADDITIONAL INFORMATION

INFORMATION PROTECTED

This form must be completed by those born outside of Canada between February 15, 1977 and April 16, 1981 inclusively, to a Canadian parent. It must be fully completed, signed and submitted with your passport application. You do NOT need to complete this form if: · you are presenting a certificate of Canadian citizenship issued after January 1, 2007; OR · one of your parents was born in Canada; OR · you received Canadian citizenship after being adopted by a Canadian parent. PRINT OR TYPE IN CAPITAL LETTERS using black or dark blue ink

1
Surname (last name)

Applicant's Personal Information
Given name(s)

Name as it appears on the certificate of Canadian citizenship, if different
Surname (last name) Given name(s)

Date of birth
Year Month Day

Place of birth
City Province/territory/state (if applicable) Country

2

Additional Information on Canadian Citizenship

If you do not know the answers to the following questions, contact Citizenship and Immigration Canada at 1-888-242-2100 (in Canada only) or visit their website at www.cic.gc.ca. 1. Before you were born, was one of your parents granted Canadian citizenship following immigration to canada?

H H

No No

H H

Yes Yes

2. Was one of your Canadian parents born outside Canada before February 15, 1977, AND was his or her birth abroad registered with Canadian Citizenship and Immigration authorities before February 15, 1977?
If you answered Yes to question 1 OR 2, If you answered No to questions 1 AND 2, proceed to questions 3 and 4.

complete and sign the declaration below and attach the present form to your passport application.

3. Is one of your parents a Canadian citizen because he or she was born outside Canada between January 1, 1947, and February 14, 1977 (inclusively) AND, although eligible to be registered as a Canadian citizen at birth, was not registered until after February 14, 1977? 4. Is one of your parents a Canadian citizen because he or she was born outside Canada after February 14, 1977, to a Canadian parent?
If you answered No to questions 3 AND 4, If you answered Yes to question 3 OR 4,

H

No

H

Yes

H

No

H

Yes

complete and sign the declaration below and attach the present form to your passport application. you may be subject to loss of Canadian citizenship pursuant to section 8 of the Citizenship Act. If so, you will automatically lose your Canadian citizenship on your 28th birthday unless you take steps to retain it. If it is confirmed that you are subject to section 8 of the Citizenship Act and your 28th birthday has already passed, no passport will be issued to you. If it is confirmed that you are subject to section 8 of the Citizenship Act and your 28th birthday is within five years, the validity of any passport issued to you will be limited to the day before your 28th birthday. For more information on retention of Canadian citizenship, contact Citizenship and Immigration Canada at 1-888-242-2100 or visit their website at www.cic.gc.ca. Proceed to question 5 and complete and sign the declaration below and attach the present form to your passport application.

5. Have you applied to Citizenship and Immigration Canada to retain your Canadian citizenship?

H
3

No

H

Yes

Date applied
Year Month Day

Reference number (if known)
Français au verso PPTC 001 (09-04)

DECLARATION ­ I solemnly declare that the information provided on this form is true, correct and complete, and I give my consent to Citizenship and Immigration Canada to provide confidential citizenship status information concerning me to Passport Canada. I declare that I have read and understood the WARNING above.

Declaration of Applicant (to be completed by all applicants required

to provide additional information on their Canadian citizenship)

Date
Year Month Day

Signed at
City Province/territory/state Signature