Free CIT 0003E - Canada

Fillable Form
Citizenship and Immigration Canada Citoyenneté et Immigration Canada

For official use only
UCI no.

PAGE 1 OF 3

Application for Canadian Citizenship Minors (under 18 years of age) Under Paragraph 5(2)(a)
Before you start, read the instructions Please PRINT in ink or TYPE Protected when completed

Certificate no.

1 I want service in 2 Does the child have special needs?
person 4 a) Thethe childapplying for is the b) Is the child adopted?

English No Yes

OR French

Please check (

) one

If yes, explain:

3 Have you applied for the child to obtain Canadian citizenship before?
Parent No OR Guardian Yes

No

Yes

When? Year

Print your name
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).

For official use only

5 A Child's name (exactly as it
appears on the immigration document) B Name to appear on citizenship certificate (supporting documentation required)

Surname/Last name Given name(s)

Surname/Last name

Given name(s)

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)

C 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

6A

Birth details (as shown on the immigration document)

Day

Month

Year

Date
City, town, etc. Country

Place B Indicate the child's current citizenship C Personal information Marital status

Sex Single

Male Married

OR Female

Height

cm OR

ft

in

Colour of eyes Separated

Common-law

Widowed

Divorced

7

A Home address Postal code B Mailing address (if different from home address) C Telephone number(s) Home (

Postal code

)

Work (

)

Ext.

Cell (

)

CIT 0003 (04-2009) E

(AUSSI DISPONIBLE EN FRANÇAIS - CIT 0003 F) AVAILABLE ON CIC WEB SITE AT: http://www.cic.gc.ca

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8

CHILD'S PARENTS A Surname/Last name Given name(s) Other name(s) used B Country and date of birth C Was your parent(s) a Canadian citizen at the time of your birth D Proof of Canadian citizenship E Indicate whether you are the natural or adoptive mother and father F Did you leave Canada for more than 1 year before February 15th, 1977? (see instructions in the guide) No Yes

FATHER
Maiden name

MOTHER

Day Month

Year

Day Month

Year

No
Year

Yes
Year Month Day

Citizenship certificate number

Month Day Citizenship certificate number

Natural No
Y

Adoptive No

Natural Yes
M Y

Adoptive

Yes
M Y

From

To

M

Destination (Country)

Y

From

To

M

Destination (Country)

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.
Y

Year

Month

Day

Yes

No

If no, go to Section 10.
# of days absent days days days

FROM
M

TO
D Y M D

DESTINATION What country did the child go to?

REASON Why did the child go to this country?

Use another piece of paper if you need more space.

TOTAL

days

10

PROHIBITIONS UNDER THE CITIZENSHIP ACT

1. Is the child now: · an inmate of a penitentiary, jail, reformatory, or prison? · on probation? · on parole? 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? 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)?

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: Do not apply to the child Do apply to the child Provide details

CIT 0003 (04-2009) E

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11 SIGNATURE(S)

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.
PARENT'S/GUARDIAN'S signature (you must sign inside the white box in black ink only)

Year

Month

Day

City

Date

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)

Year

Month

Day

City

Date

12 INDIVIDUAL, FIRM OR ORGANIZATION WHO ASSISTED IN THE COMPLETION OF THIS APPLICATION
(The applicant does not complete this section) Name of individual who assisted in completing this application form: Name of firm, organization: Address:

Year

Month

Day

Signature of Individual

Date

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 0003 (04-2009) E