Free CIT 0480E - Canada

Citizenship and Immigration Canada

Citoyenneté et Immigration Canada

PROTECTED WHEN COMPLETED -

A

CANADIAN CITIZENSHIP CERTIFICATE PREPARATION FORM
If the adopted person is granted Canadian citizenship, this form will be used to produce the adopted person's Canadian citizenship certificate. FOR OFFICIAL USE ONLY
Certificate Certificate Number Adopted person's ID Adoptive parent's ID
Affix label here

English

French

1

Where would you like the adopted person's citizenship certificate mailed to?
Canadian address of adoptive parent(s), legal guardian or applicant Visa office responsible for your area Authorized representative

Important
Applicants 14 years of age and older must sign in the white signature strip below each photo. For applicants under 14 years of age, leave the signature strip blank. Put one photo in a small envelope and send it with this form to the address indicated below. Put the second identical photo in a small envelope and send it with Part 2 of your application to the address identified on the decision letter. Do not staple the photo to the forms.

2

Full name of the adopted person as per the adoption order or the legal change of name document.
This name will appear on the citizenship certificate Surname / Last name Given Name(s)

3

Date of birth
Day Month Year

4

Sex
Male Female

5

Height
cm OR ft in

6

Colour of eyes

7

Signature
Signature of the adoptive parent or the legal guardian or the applicant (if 18 years of age and older)

Place (town, city)

Date

Year

Month

Day

Place (town, city)

Children (14 years of age and older) must also sign this form
Date Year Month Day

Return this completed form in the envelope that was provided to you by the Case Processing Centre at the following address:

Case Processing Centre - Sydney - Adoptions P.O. Box 10030 SYDNEY NS, B1P 7C1, CANADA

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 0480 (09-2009) E

(DISPONIBLE EN FRANÇAIS - CIT 0480 F)