Check the box to indicate if you have ever had a previous Canadian citizenship certificate. If yes, you must indicate the surname/last name and given name(s), certificate number and date citizenship was acquired.

I am applying for a replacement

Check the box to indicate whether you are:

• applying to update your certificate, or
• to replace it.

If you are applying to replace your certificate you must:

• indicate if it was stolen, lost or destroyed, and
• you must indicate if the theft or loss was reported to the police.

Note: You must provide details of theft, loss or destruction in the area provided.

Whether you are applying to replace or update your certificate you must return any Canadian citizenship certificates in your possession. Failure to do so will result in delays in processing your application.

Write your surname/last name and given name(s).

If you are applying to replace your certificate your name will be the same as what was on your previously issued certificate.

If this is the first time you are applying for a citizenship certificate, the name on your citizenship certificate will be the same as the one shown on your birth certificate or foreign passport.

If you want a different name on your certificate, you must provide us with satisfactory documentation. See legal name change section of this guide.

If you have used other names in the past, or are known by a name other than the one you listed above, indicate them in the space provided. (Other names can include your birth name, nicknames, call names, community name, etc.) You can use a separate piece of paper if required.

Date of birth

Write your date of birth.

If you are applying to replace your certificate your date of birth will be the same as what was on your previously issued certificate.

If this is the first time you are applying for a citizenship certificate, the date of birth on your citizenship certificate will be the same as the one shown on your birth certificate or foreign passport.

If you want a different date of birth on your certificate, you must provide us with satisfactory documentation. See date of birth correction section of this guide.

Check the box to indicate whether you are male or female. Proceed by including your height, and the colour of your eyes. Check the box to indicate your legal marital status.

Note: We need this information for our records. The colour of your eyes and height will be shown on your citizenship certificate.

If you are a woman and married before January 1, 1947.
Write:

• your husband’s surname/last name, given name(s) and his date and place of birth.
• the country you were married in and the date of your marriage.
• if your husband is a Canadian citizen, and if he is, provide the details.
• the number from your husband’s citizenship certificate, if he has one, and the date he acquired citizenship.

Check the box to indicate if you are a citizen of one or more countries other than Canada. If yes, include the country or countries, the date and how you obtained the citizenship.

Absences from Canada:
Check the box to indicate if you left Canada for 1 year or longer before 1977. If yes, provide the dates you were away, the country of destination and the reasons why you went to that country.

We may need to contact you by phone. List the phone number(s) where you can be reached.

Provide your current home address including your postal code.

If your mailing address is different from your home address, include your mailing address with your postal code.

Answer all questions on the information regarding your parents:

• Check the box to indicate the relationship of your parent(s) to you by selecting Natural or Adoptive.
• Print your parent(s) surname/last name, given name(s), date of birth and place of birth.
• Indicate where your parents were married (if applicable) and the date of the marriage.
• Indicate how your parent(s) obtained Canadian citizenship.
• Check the box to indicate if your parent(s) have left Canada for more than 1 year before 1977. If yes, provide the dates they were away and the country they visited.
• Check the box to indicate if your parent(s) are or were citizens of a country other than Canada. If yes, provide the details including the country, date and how the citizenship was obtained.
• Check the box to indicate if your parents were employed in Canada by a foreign government or international agency. If yes, provide details.
• Check the box to indicate if your parents were employed outside Canada by the Canadian armed forces, federal or provincial public service other than as a locally engaged person at the time of your birth. If yes, provide details.
• If your parents were born in Canada, check the box to indicate if one of his or her parents was employed by a foreign government or international agency. If yes, provide details.

Check the box to indicate if either your mother or your father was born outside Canada to a Canadian parent. If yes, provide applicant’s grandparents details by adding Surname/Last name, given name(s), country and date of birth.

Read the declaration. Sign and date the application form with the signature you currently use on other official document.

Your application will be returned to you if:

• the form is not signed and dated,
• stale-dated (dated more than 90 days before CIC receives it),
• post-dated (dated into the future).

Note: If the application is for a person under 14 years of age, it must be signed by a parent or guardian in the space provided.

Indicate whether you had assistance in completing this form, either from:

• an individual (including a family member, a friend, a volunteer, a consultant, a lawyer, etc.),
• a firm (company), or
• an organization.

If yes, the person who completed the form for you must:

• print their name and address,
• sign their name, and
• write the date the form was signed.