Free CIT 0001E - Canada

Fillable Form
Citizenship and Immigration Canada Citoyenneté et Immigration Canada UCI no.

For official use only

PAGE 1 OF 5

Application for a Citizenship Certificate
(Proof of Citizenship)

Case ID Current Act Certificate no. Return original document(s) Former Act

Under Section 3

Approved

Note: If you are completing this application for Signature a child under 18 years of age, remember all questions are about the child.
Notify: Send certificate to:

Y

M

D

Please PRINT in ink or TYPE

Protected when completed

1 2

I want service in

English

French

Please check ( ) one No Yes
Date

Have you ever had a certificate of Canadian citizenship or naturalization? If yes, give information that appears on the certificate.
Surname/Last name Given name(s)

Certificate number

Year

Month

Day

I am applying for a replacement:

a) to update certificate (previous certificate enclosed) b) to replace a: stolen lost destroyed certificate.

Was the theft/loss reported to the police?

Yes Please give details of the theft/loss/destruction (when, where, how and what?)

No

Note: It is illegal to have more than one valid certificate of citizenship or naturalization. If you have any certificate of citizenship and naturalization or any pink transmission copy of a certificate, you have to send it back. If you find a lost certificate after you get your replacement certificate, you have to send it back to the Case Processing Centre in Sydney, Nova Scotia.

3

A

Name (exactly as it is shown on Last name (Surname/Family name) Given name(s) my birth certificate or previous certificate) B Request for a different name to Last name (Surname/Family name) Given name(s) appear on certifcate (subject to approval by Citizenship and Immigration Canada) Last name (Surname/Family name) C List any other names (include birth name, maiden, previous married name(s), aliases and Given name(s) nicknames). These names will not appear on your citizenship certificate A Birth details as shown on my birth certificate or previous certificate B Place and country of birth C Male OR Female Commonlaw Height
ft OR cm in
Day Month Year

4

Personal information Marital status

Sex Single

Colour of eyes Separated

Married

Widowed

Divorced

(AUSSI DISPONIBLE EN FRANÇAIS - CIT 0001 F)
CIT 0001 (04-2009) E

AVAILABLE ON CIC WEB SITE AT: http://www.cic.gc.ca

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5

If you are a woman and married before January 1, 1947, answer the following questions. If you married on or after January 1, 1947, this question does not apply to you. Go to part 6. Information on Husband's surname/last name your husband (Provide details of every marriage before 1947.) Given name(s)
Day Month Year

Husband's country of birth Country of marriage Is your husband a Canadian citizen? Number on husband's citizenship certificate (if applicable) Please use another piece of paper if you need more space to list other marriages. No Yes by birth or

Date of birth Date of marriage other
Year Month Day Year Month Day

Date

6

Other nationalities Are you a citizen of one or more countries other than Canada? If yes, list the country or countries, date and how you obtained this citizenship.

No

Yes

Absences from Canada Did you leave Canada for 1 year or longer before 1977?
FROM
Y M D Y

No

Yes

Give details below

TO
M D

DESTINATION What country did you go to?

REASON Why did you go to this country?

7

Telephone number(s)

Home ( Cell. (

) )

Work (

)

Ext.

Home address Postal code Mailing address (if different from home address)
CIT 0001 (04-2009) E

Postal code

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8a

Applicant's Parents Relationship to you

Answer all of the following questions: Natural Adoptive father father FATHER

Natural mother MOTHER Maiden name

Adoptive mother

Surname/Last name Given name(s) Country and date of birth Married in what country Additional information How did he obtain Canadian citizenship?
Day Month Year

Day Month Year

Year

Date of marriage

Month Day

How did she obtain Canadian citizenship?

Did he leave Canada for more than 1 year before 1977? No Yes
Y

Did she leave Canada for more than 1 year before 1977? No Yes
From
Y M Y

From

M

Y

To

M

Destination (Country)

To

M

Destination (Country)

Is he or was he a citizen of a country other than Canada? Give details (country, date and how No Yes citizenship was obtained)

Is she or was she a citizen of a country other than Canada? Give details (country, date and how No Yes citizenship was obtained)

Was he employed in Canada by a foreign government or international agency? No Yes Give details

Was she employed in Canada by a foreign government or international agency? No Yes

Give details

At the time of your birth, was he employed outside Canada by the Canadian Forces or a Canadian federal, provincial or territorial public service other than as a locally engaged person? No Yes Give details

At the time of your birth, was she employed outside Canada by the Canadian Forces or a Canadian federal, provincial or territorial public service other than as a locally engaged person? No Yes Give details

CIT 0001 (04-2009) E

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8a

Applicant's Parents (continued) If father was born in Canada, was one of his parents employed by a foreign government or international agency? No Yes Give details If mother was born in Canada, was one of her parents employed by a foreign government or international agency? No Yes Give details

8b

Applicant's Grandparents If applicant's father was born outside Canada, was one of his parents a Canadian citizen at the time of his birth? No Yes

If yes, provide details: FATHER Surname/Last name Given name(s) Country and date of birth
Day Month Year Day Month Year

MOTHER Maiden name

If applicant's mother was born outside Canada, was one of her parents a Canadian citizen at the time of her birth? No Yes

If yes, provide details: FATHER Surname/Last name Given name(s) Country and date of birth
Day Month Year Day Month Year

MOTHER Maiden name

9

Have you ever lived in Canada? No Yes If yes, on what date did you enter Canada to live?
OR

Year

Month

Day

Since birth

CIT 0001 (04-2009) E

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10

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 make a false declaration, or fail to disclose all information material to my application, my citizenship certificate could be taken away and I could be charged under the Citizenship Act. I hereby acknowledge that section 11 below must be completed if an individual, firm or organization assisted me in the completion of this application. If section 11 is blank, I confirm that I completed this form myself without any help.
Signature of applicant (you must sign inside the white box in black ink only)

Year

Month

Day

City

Date

If applicant is under 14 years of age, signature of parent/guardian:
Signature of parent/guardian (you must sign inside the white box in black ink only)

Year

Month

Day

City

Date

WHO ASSISTED IN THE COMPLETION OF THIS APPLICATION 11 INDIVIDUAL, FIRM OR ORGANIZATIONsection) (The applicant does not complete this

Did you receive assistance in completing this form? No Yes

If yes, have the individual, firm or organization complete the following section.
Name of individual who assisted in completing this application form Address
Date
Year Month Day

Name of firm, organization

Signature of INDIVIDUAL

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 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.
CIT 0001 (04-2009) E