Free CIT 0301E - Canada

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

PROTECTED WHEN COMPLETED - B
PAGE 1 OF 6

FOR OFFICIAL USE ONLY

APPLICATION TO RESUME CANADIAN CITIZENSHIP Under Subsection 11(1)

UCI no. Claim Date of loss Loss confirmed by: Signature

File no.

Loss

Y

M

D

NOTE: The information you provide should not be limited by the space allowed to answer a question. If you need more space, attach another sheet of paper. Indicate the number of the question you are answering. Refer to the guide for specific instructions. Please PRINT in ink or TYPE.

Date
Y M D

Certificate no.

For official use only

1 2 3

I want service in

English

OR
Yes

French If yes, explain:

Please check

( ) one

I have special needs

No

Year

Month

Day

Have you applied to resume citizenship before? Have you ever had a certificate of Canadian citizenship?

No

Yes

Date

No Family name

Yes

If yes, give information that appears on the certificate.

Given name(s)

Certificate no.

Date
Year Month Day

My certificate was/is: Was the theft/loss reported to police? Note :

previously returned No Yes

attached

stolen

lost

destroyed

Details

It is illegal to have more than one valid certificate of citizenship or naturalization. If you have any certificate of citizenship or naturalization or any pink transmission copy of a certificate, you have to send it back.

4A

Name (If applying within Canada use name exactly as shown on immigration document. If applying from outside Canada, please see appendix A.) Family name

Given name(s)

B

Legal name change since the name provided in 4A

Family name No Yes If yes, provide legal name change document. To: Given name(s)

C

Other names used (example maiden name or name at birth)

Family name

D

Given name(s)

Name you want on citizenship certificate (documentation required)

Family name

Given name(s)

Use another piece of paper if you need more space.

(AUSSI DISPONIBLE EN FRANÇAIS - CIT 0301 F)
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AVAILABLE ON CIC WEB SITE AT: http://www.cic.gc.ca

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5

City, town, etc.

Country

A B C

Birth details Personal information Marital status

Date Sex

Day

Month

Year

Place Female Height Common-law
cm

Male Single

OR

OR

ft

in

Colour of eyes Divorced Separated

Married

Widowed

6

A

Home address Postal code

B

Mailing address (if different from home address) Postal code Home ( ) year(s) and Work ( month(s) ) Ext. Cellular ( )

C D

Telephone number(s) I have lived at this address

7

A

Are you a citizen of any other countries? No
FROM M

Yes
TO D Y

If yes, please list the date(s), country (countries) and how you obtained this citizenship.

Y

M

D

What country?

How did you obtain this citizenship?

Use another piece of paper if you need more space.

B

If you received a Canadian citizenship certificate before February 15, 1977 OR you have never had a Canadian citizenship certificate please list absences from Canada for 1 year or longer before 1977.
Y FROM M TO D Y M D

DESTINATION What country did you go to?

REASON Why did you go to this country?

Use another piece of paper if you need more space.

C

Are you a permanent resident of Canada? Yes No If yes, indicate the date you became a permanent resident.
Year Month Day

D E

When did you return to Canada if different from 7C?

Year

Month

Day

Did you obtain permanent residence in another country since becoming a permanent resident of Canada? No Yes If yes, please list the country (countries).

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F

Have you left Canada in the last year? No
FROM M

Yes
TO D Y M

If yes, please list all of your trips outside Canada (including vacations and all trips to the United States) in the last year. TOTAL # DAYS

Y

D

DESTINATION

REASON FOR ABSENCE

Use another piece of paper if you need more space.

TOTAL

G

List all of your addresses (including foreign addresses) in the last year.
FROM Y TO M Y M

ADDRESS

CITY, PROVINCE, COUNTRY

Use another piece of paper if you need more space.

8

PROHIBITIONS UNDER THE CITIZENSHIP ACT
1. Are you now or have you ever been in the last year: · an inmate of a penitentiary, jail, reformatory, or prison? · on probation? · on parole? 2. In the past 3 years, have you been convicted of an indictable offence (crime) in Canada or an offence under the Citizenship Act? 3. Are you now charged with an offence (crime) or an offence under the Citizenship Act? 4. Are you now, or have you ever been, under a removal order (have you been asked by Canadian officials to leave Canada)? 5. Are you now under investigation for, or charged with, a war crime or a crime against humanity or have you ever been convicted of a war crime or a crime against humanity? 6. In the past 5 years, have you had Canadian citizenship which has been taken away (revoked)? I have read and understand the prohibitions under the Citizenship Act. I declare that these prohibitions: Do not apply to me. Do apply to me. Provide details:

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

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10

APPLICANT'S PARENTS
Answer all of the following questions: Relationship to you Natural father FATHER Maiden name Family name Adoptive father Natural mother MOTHER Adoptive mother

Given name(s)
Day Month Year Day Month Year

Country and date of birth
Year Month Day

Married in what country How did he obtain Canadian citizenship?

Date of marriage How did she obtain Canadian citizenship?

Additional information

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

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

Yes To
M

Yes To
M

Destination (Country)

Destination (Country)

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

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

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

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11

If you are a woman and married before January 1, 1947, answer the following questions. If you married for the first time on or after January 1, 1947, this question does not apply to you. Go to Section 12.

Information on your husband (Provide details of every marriage before 1947.)

Husband's family name

Given name(s)

Husband's country of birth

Date of birth

Day

Month

Year

Country of marriage

Date of marriage

Year

Month

Day

Is your husband a Canadian citizen? Number on husband's citizenship certificate (if applicable)

No

Yes

by birth

OR

other
Year Month Day

Date

Please use another piece of paper if you need more space to list other marriages.

12

CONSENT TO DISCLOSE PERSONAL INFORMATION
If you are not a resident of Canada, section 13 does not apply to you. Go to section 13. CONGRATULATORY LETTER:
Request for authorization Federal Members of Parliament (M.P.s) send a letter of congratulations to new citizens in their ridings. Do you authorize Citizenship and Immigration Canada to forward your name, address, sex and preferred official language to your Member of Parliament? No other information will be forwarded. Yes

No

This information will be disclosed once your Canadian citizenship is resumed.

13

CONSENT TO DISCLOSE PERSONAL INFORMATION A
NATIONAL REGISTER OF ELECTORS:
Request for authorization Canadian citizens who are 18 years of age or older have the right to vote in federal elections and referendums. Elections Canada needs your authorization to add your name to the National Register of Electors which is used to produce the voters lists for federal elections and referendums. Do you authorize Citizenship and Immigration Canada to give your name, address, gender and date of birth to Elections Canada, after you obtain your citizenship, so that Elections Canada can include this information in the National Register of Electors?

Yes

No

Whether you answer "yes" or "no" is completely your choice. Your information will be used only for purposes permitted under the Canada Elections Act, which include sharing the information with provincial and territorial election agencies, members of Parliament and political parties, as well as candidates at election time. Your answer will not affect your citizenship application. More information about the Register and its uses is available at www.elections.ca. You can also call Elections Canada at 1-800-463-6868.

B

QUÉBEC'S PERMANENT LIST OF ELECTORS:
Do you reside in Québec? Yes No

Request for authorization To make sure that you are on the list of electors for provincial, municipal or school elections, the Chief Electoral Officer of Québec needs to add your name to Québec's Permanent list of electors. Do you authorize Citizenship and Immigration Canada to forward your name, address, sex and date of birth to the Chief Electoral Officer of Québec so that this information can be added to the permanent list? Yes No

No information will be forwarded until you resume Canadian citizenship. By law this information will be used for electoral purposes only.

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14

SIGNATURE OF APPLICANT
I agree to advise Citizenship and Immigration Canada if any information on this form changes before the processing of my application is complete. 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 me. I understand that if I make a false declaration, or fail to disclose all information material to my application, I could lose my Canadian citizenship and be charged under the Citizenship Act. I have indicated in Section 9 whether the prohibitions apply to me. Signature of applicant (you must sign inside the white box in black ink only)

Year

Month

Day

City
IMPORTANT NOTE:

Date

Remember to make sure that you are eligible to apply for citizenship on the day before you SIGN this application.

15

INDIVIDUAL, FIRM OR ORGANIZATION WHO ASSISTED IN THE COMPLETION OF THIS APPLICATION
Did you receive assistance in completing this form? Yes No If yes, have the individual, firm or organization complete the following section 15.

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.

FAILURE TO INCLUDE THE NECESSARY DOCUMENTATION (e.g. 2 PIECES OF IDENTIFICATION) WILL RESULT IN DELAYS IN PROCESSING YOUR APPLICATION.

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.
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