Free CIT 0058E - Canada

Fillable Form
Citizenship and Immigration Canada Citoyenneté et Immigration Canada
PAGE 1 OF 2

Application for a Search of Citizenship Records
Please PRINT in ink or TYPE Protected when completed OR French Please check ( ) one

1 I want service in
A B C D
Surname/Last name

English

2 Information on the person whose record you are asking for
Given name(s) List other names used (e.g. maiden name, alias, etc.)
Day Month

Date of birth

Year

Place and country of birth

Date of entry into Canada
Year Month Day

Name on certificate of Canadian citizenship or naturalization (if known)

Canadian citizenship certificate no. (if known)

Date certificate was issued (if known)
Year Month Day

IF the above person entered Canada before 1915, complete this section

E

Father's surname/last name

Father's first name(s)

When the father became a Canadian citizen, a) where was he living?
Day

Father's date of birth
Month Year

b) what was his job?

3 Information on the person asking for the search
Surname/Last name Given name(s)

Mailing address
Street no. Street Apt. no.

City/Town

Province

Postal Code

Telephone (home)
Area Code Telephone no.

Telephone (work)
Area Code Telephone no. Extension

4 Authorization for the release of information
A Are you the person named in Section 2?
Yes No Go to Section 5 Go to next question

B Does the person named in Section 2 consent to this search?
Yes I am the person named in Section 2 and I authorize the release of information to the person making this application.
Signature

Date
Year Month Day

No
CIT 0058 (04-2009) E

Go to next question
(AUSSI DISPONIBLE EN FRANÇAIS - CIT 0058 F)
AVAILABLE ON CIC WEB SITE AT: http://www.cic.gc.ca

PAGE 2 OF 2

4 Authorization for the release of information (continued)
C Is the person named in Section 2 deceased?
Yes No Date of death Go to next question
Year Month Day

Provide proof of death
(clear and legible photocopy of death certificate)

D What is your relationship to the person named in Section 2?
Provide proof (clear and legible photocopy of birth certificate, marriage certificate, etc.)

do you need this information? (to give to a foreign government, 5 Whymust give a valid reason(s) for requesting this information. for employment, etc.) You

Signature of applicant (you must sign inside the white box in black ink only)

Year

Month

Day

City

Date

REMEMBER: If you are sending more than one application, send all of them together in one envelope. The applications will be processed together. Failure to include the necessary documentation (e.g. 2 pieces of identification) will result in delays in processing your application. FOR DEPARTMENTAL USE ONLY
Documents: Office
Year Month Day

NR

PR

Receipt no. $ .00

Receipt date
Year Month Day

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 0058 (04-2009) E