Free CIT 0010E - Canada

Fillable Form
Citizenship and Immigration Canada Citoyenneté et Immigration Canada
PAGE 1 OF 4 PROTECTED WHEN COMPLETED - B

CONFIRMATION OF CANADIAN CITIZENSHIP OF THE ADOPTIVE PARENT(S)

PART 1

APPLICATION FOR CANADIAN CITIZENSHIP FOR A PERSON ADOPTED BY A CANADIAN CITIZEN (ON OR AFTER JANUARY 1, 1947) FOR OFFICIAL USE ONLY
Receipt no. File no. Return original document(s) Citizenship confirmed No Yes First generation limitation

FOSS client ID

Certificate no

GCMS client ID

Mission Signature
Year Month Day

Application ID Place (city/town) Date

Before you start completing this form, make enough photocopies for your needs. You can also print all or part of this form from our Web site at www.cic.gc.ca. If there is not enough space to provide all the necessary information, attach to this form a separate sheet of paper with further details. Print your name at the top of each additional sheet and indicate the form's title and the number of the question you are answering. BEFORE YOU START, READ THE APPLICATION GUIDE TYPE or PRINT in black or blue ink
1
I want service in English French Check

( ) one

2
A

APPLICANT'S INFORMATION
Who is applying on behalf of the adopted person for Canadian citizenship? The adoptive parent The adopted person (if aged 18 years or older) The legal guardian

Note: Adopted persons 18 years of age or older must fill in and sign their own application.
B

Name and addresses of the person applying for the adopted person's Canadian citizenship Given name(s) Last name (surname/family name)

C

Residential address No. & street

D

Apt./unit

Mailing address (if different from Section 2C) No. & street

Apt./unit

City/Town

Province/Territory

City/Town

Province/Territory

Postal code

Country

Postal code

Country

E

The address is also required in the local language where the applicant is living (for example: Arabic, Cyrillic, Chinese, Korean, Japanese characters or Chinese commercial/telegraphic code). Only if applicable.

F

Country code

Area code

No.

Country code

Area code

No.

Home telephone no.
Country code Area code No.

Cellular phone no.
Country code Area code No.

Business telephone no.

Facsimile no.

E-mail address

CIT 0010 (11-2009) E

This form is made available by Citizenship and Immigration Canada and is not to be sold to applicants. (DISPONIBLE EN FRANÇAIS - CIT 0010 F)

3
A

DETAILS OF ADOPTIVE PARENT(S)
ADOPTIVE PARENT
Last name (surname/family name) Given name(s)

PAGE 2 OF 4

ADOPTIVE PARENT

Other name(s) used (include birth name, maiden, previous married name(s), aliases and nicknames) Country and date of birth
B Day Month Year Day Month Year

Canadian citizenship information

Are you a Canadian citizen? No Yes If yes, how did you obtain Canadian citizenship?

Are you a Canadian citizen? No Yes If yes, how did you obtain Canadian citizenship?

Write details (for example: by birth, by naturalization, by birth from a Canadian parent outside Canada, etc.)

Write details (for example: by birth, by naturalization, by birth from a Canadian parent outside Canada, etc.)

C

Were you issued a Canadian citizenship certificate in the past?

No

Yes

No

Yes

If yes, certificate number: Name that appears on the certificate: Last name (surname/family name)

If yes, certificate number: Name that appears on the certificate: Last name (surname/family name)

Given name(s)

Given name(s)

D

Presence outside Canada before 1977

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

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

Yes To

If yes, write details. Destination (country)

If yes, write details. Destination (country)

M

Y

E

Dual citizenship

Are you or were you a citizen of a country other than Canada? No Country Date citizenship was obtained
Year Month Day

Are you or were you a citizen of a country other than Canada? No Country Date citizenship was obtained
Year Month Day

Yes

If yes, write details.

Yes

If yes, write details.

How was citizenship obtained?

How was citizenship obtained?

F

Parents of adoptive parent(s) citizenship

If you were born outside Canada, was one of your parents a Canadian citizen at the time of your birth?

If you were born outside Canada, was one of your parents a Canadian citizen at the time of your birth?

FATHER
No Yes If yes, provide details. No Yes

FATHER
If yes, provide details.

Surname/Last name Given name(s) Country and date of birth
Year Month Day Year Month Day

MOTHER
No Surname/Last name Given name(s) Country and date of birth
Year Month Day

MOTHER
No Maiden name Yes If yes, provide details.

Yes

If yes, provide details.

Maiden name

Year

Month

Day

CIT 0010 (11-2009) E

3

DETAILS OF ADOPTIVE PARENT(S) (continued)
ADOPTIVE PARENT ADOPTIVE PARENT
Parents of adoptive parent(s) employment details Have one of your parents been employed by a foreign government or international agency? No Yes If yes, write details.

PAGE 3 OF 4

G

Have one of your parents been employed by a foreign government or international agency? No Yes If yes, write details.

Name of the employer

Name of the employer

Employment start date

Year

Month

Day

Employment start date

Year

Month

Day

4
A

ADOPTION DETAILS
Has the adoption been completed? If no, No Yes Place (city/town) Region/Province Country

· Where will it be completed?

Year

Month

Day

If yes,

· When was it completed? · Which country issued the adoption order? · Age of adopted person at time of adoption Place (city/town) Region/Province Country

B

Is the adopted person a relative of one of the adoptive parent(s)? Where is the adopted person currently living (if known)?

No

Yes

If yes, what is the relationship? Region/Province Country

Place (city/town)

C

D

If the adopted person is currently living outside Canada, will the adopted person come to Canada to live as soon as Canadian citizenship is granted? If yes, write the name of the province or territory in which the adopted person will be living after their arrival in Canada.

No Province/Territory

Yes

5
A

PERSONAL DETAILS OF THE ADOPTED PERSON
Do you know the personal details of the adopted person? No If no, go to section 6. Yes I am the adopted person

B

Last name (surname/family name) at birth of the adopted person

Given name(s) at birth of the adopted person

C

Date of birth Sex

Day

Month

Year

Place of birth (city/town)

Country of birth

Country or countries of current citizenship

D

Female

Male

E

Do you know where the adopted person currently lives?

No

Yes

I am the adopted person (skip this section) Apt./Unit City/Town

If yes, include the address Province/Territory Postal code Country

No. & street

Name of the contact person/organization

F

Have you previously submitted a sponsorship or permanent residence application for this person?

No

Yes

If yes, write the approximate date

Year

Month

6

INDIVIDUAL, FIRM OR ORGANIZATION WHO ASSISTED IN THE COMPLETION OF THIS APPLICATION
(The applicant does not complete this section) No Yes If yes, have the individual, firm or organization complete the following section 6.

Did you receive assistance in completing this form Name of individual who assisted in completing this application form Address

Name of firm, organization

Signature of INDIVIDUAL

Date
Year Month Day

CIT 0010 (11-2009) E

7

DECLARATION AND SIGNATURE

PAGE 4 OF 4

I have read and understood the contents of this form. I declare that the information that I have provided in this form is true, complete and accurate. I understand that if I have made a false declaration or have otherwise provided false or misleading information or if I fail to declare all of the information material to the adopted person's application, the adopted person's application could be rejected or the adopted person could lose his or her Canadian citizenship. I understand that providing such false or misleading information, making a false declaration or failing to declare all information material to the adopted person's application could be an offence under the Citizenship Act. I hereby acknowledge that section 6 must be completed if an individual, firm or organization assisted me in the completion of this application. If section 6 is blank, I confirm that I completed this form myself without any help. Signature of adoptive parent/legal guardian or the adopted person (if 18 years of age or older)

(you must sign inside the white box in black ink only)
City
Year Month Day

Date

IMPORTANT NOTE: The application must be signed and dated before it is mailed. If your application is not signed and dated, it will be returned to you. You must make sure that all information you have entered is accurate and is up-to-date. Remember to make sure that you are eligible to apply on the day before you SIGN this application.

REMEMBER: You must submit one application form for each adopted person. 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 0010 (11-2009) E