Free CIT 0302E - Canada

Citizenship and Immigration Canada

Citoyenneté et Immigration Canada Receipt no. Client ID

For official use only

PAGE 1 OF 4

File no.

APPLICATION TO RENOUNCE CANADIAN CITIZENSHIP Under Subsection 9(1)

Claim: (Section of Act) Certificate no. Return original document(s) Signature Notify: Send certificate to: Approved
D Date M Y

Before you start, read the instructions Please PRINT in ink or TYPE

Protected when completed OR
No Yes French Yes Please check ( Date

For official use only

1 I want service in English applied to 2 Have you citizenship before? renounce No 3 Havea you ever had certificate
of Canadian citizenship or naturalization?

') one
Day Month Year

If yes, give information that appears on the certificate.

Surname/Last name

Given name(s)

Certificate no.

Date
Day Month Year

My certificate of Canadian citizenship is: Was the theft/loss reported to police? No

enclosed Yes

stolen Details

lost

destroyed

Note : It is illegal to have a certificate of citizenship or naturalization once you have renounced your Canadian citizenship. If you have any certificate of citizenship or naturalization or any pink transmission copy of a certificate, you have to send it back. Once your application to renounce Canadian citizenship is approved, you will receive a certificate of renunciation of Canadian citizenship.

(exactly 4 A Nameshown on as is my citizenship or birth certificate)

Surname/Last name

Given name(s)

Surname/Last name

B Legal name
change

No

Yes

If yes, provide legal name change document.

To:
Given name(s)

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

Surname/Last name

D Name you want
on certificate of renunciation (documentation required)

Surname/Last name

Given name(s)

Given name(s)

Use another piece of paper if you need more space.

5A

I am a citizen or a national of a country other than Canada. IF NO I will become a citizen of

No

Yes

Name of country and attach proof.

once I renounce my Canadian citizenship. (attach proof)

B I hereby declare that I wish to renounce my Canadian citizenship for the following reasons:

(AUSSI DISPONIBLE EN FRANÇAIS - CIT 0302 F)
CIT 0302 (04-2002) E

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

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6

I live outside Canada

No

Yes

(attach proof)

A Home address
Postal code

B Mailing address
(if different from home address) Postal code Home (
Day Month

C Telephone number(s)

)
Year

Work (
City, town, etc.

)
Country

Ext.

7

A Birth details Date B Personal
information Marital status Single Sex Male OR Female

Place Height Married cm OR Widowed ft in Divorced Colour of eyes Separated

IF YOU RECEIVED A CERTIFICATE ON OR AFTER FEBRUARY 15, 1977, GO TO SECTION 12.

8

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 9. Information on your husband (Provide details of every marriage before 1947.) Husband's country of birth Country of marriage Is your husband a Canadian citizen? No Yes by birth or Husband's surname/last name Given name(s)
Day Month Year

Date of birth
Day Month Year

Date of marriage other
Day Month Year

Number on husband's citizenship certificate (if applicable)

Date

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

9

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

TO
Y

DESTINATION What country did you go to?

REASON Why did you go to this country?

Please use another piece of paper if you need more space.

10 A Are you claiming Canadian citizenship by birth outside Canada to a Canadian parent?
B Did you enter Canada? C Were you a British subject living in Canada before 1947?
CIT 0302 (04-2002) E

No
Day Month

Yes
Year

No

Yes

If yes, on what date did you enter Canada? If yes, on what date did you enter Canada?

No

Yes

Day

Month

Year

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11 APPLICANT'S
PARENTS Relationship to you

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

Natural mother Maiden name

Adoptive mother 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 Day Month

Year Year

Date of marriage

How did she obtain Canadian citizenship?

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

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

Yes
Y M

From

To

Y

Destination (Country)

M

From

To

Y

Destination (Country)

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

Is she or was she a citizen of a country other than Canada? Give details No Yes (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 If mother was born in Canada, was one of his parents employed by a foreign her parents employed by a foreign government or international agency? government or international agency? No Yes Give details No Yes Give details

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12 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 photograph enclosed is 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 certificate of renunciation could be taken away and my renunciation deemed to have no effect and I could be charged under the Citizenship Act.

Signature of APPLICANT

Day

Month

Year

Place

Date

WHO ASSISTED IN THE COMPLETION OF THIS APPLICATION 13 INDIVIDUAL, FIRM OR ORGANIZATIONsection) (The applicant does not complete this
Name of individual who assisted in completing this application form: Name of firm, organization Address

Day

Month

Year

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 WILL RESULT IN DELAYS IN PROCESSING YOUR APPLICATION.

Protected Information Personal Information Bank SSC/P-PU-050
Information in this form is collected under the Citizenship Act to determine eligibility for the grant of Canadian citizenship and to maintain a record of persons to whom citizenship certificates were issued. Under the Privacy Act, you have the right to access, request correction of or have a notation attached to the information concerning yourself.

CIT 0302 (04-2002) E