cit 0534 e : application to resume canadian citizenship ......page 1 of 7 cit 0534 (09-2016) e...
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PAGE 1 OF 7
CIT 0534 (09-2016) E
PROTECTED WHEN COMPLETED - B
This form is made available by Immigration, Refugees and Citizenship Canada and is not to be sold to applicants.
(DISPONIBLE EN FRANĂAIS - CIT 0534 F)
FOR OFFICIAL USE ONLY
APPLICATION TO RESUME CANADIAN CITIZENSHIP - CANADIAN ARMED FORCES Under subsection 11(1)
Receipt no.
UCI no. File no.
Loss
Certificate no.
NOTE: If you need more space to answer a question than is provided below, attach another sheet of paper and make sure to indicate the number of the question you are answering.
Refer to the guide for specific instructions. PRINT in ink or TYPE.
Claim
Date of loss
Loss confirmed by: Signature
(YYYY-MM-DD)
Date (YYYY-MM-DD)
For official use only 1 I want service in English French oneOR Check
2 I have special needs No Yes âș If yes, explain:
3 Have you applied to resume citizenship before?
No Yes âș Date
Have you ever had a certificate of Canadian citizenship?
No Yes âș If yes, give information that appears on the certificate.
Family name
Given name(s)
My certificate was/is: previously returned attached stolen lost destroyed
Was the theft/loss reported to police? No Yes
Note : 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.
âș Details
Certificate no.
Date (YYYY-MM-DD)
Date (YYYY-MM-DD)
4 A Name (exactly as it is shown on my immigration document)
Family name
Given name(s)
BLegal name change since the name provided in 4A
No Yes âș If yes, provide legal name change document. To:
Family name
Given name(s)
C Other names used (for example maiden name or name at birth)
Family name Given name(s)
Use another piece of paper if you need more space.
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CIT 0534 (09-2016) E
5 A Birth details
Date (YYYY-MM-DD)
Place
City, town, etc. Country
B Personal information Sex âș Male OR Female âș Height cmOR
ft in âș Colour of eyes
C Marital status Single Married Common-law Widowed Divorced Separated
6 A Home address
Postal code
B Mailing address(if different from home address) Postal code
C Telephone number(s) Home Work Ext. Cellular
E-mail address: (Indicating an e-mail address will authorize all correspondence, including file and personal information, to be sent to the e-mail address you specify.)
D How long have you lived at your home address? year(s) and month(s).
7 A List all countries of which you are a citizen. Include the dates you held this citizenship and how you obtained this citizenship.
FROM (YYYY-MM-DD)
TO (YYYY-MM-DD) 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, list absences from Canada for 1 year or longer before 1977.
FROM (YYYY-MM-DD)
TO (YYYY-MM-DD)
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?
No Yes âș If yes, indicate the date you became a permanent resident. âș(YYYY-MM-DD)
D When did you return to Canada if different from 7C? âș(YYYY-MM-DD)
E Do you have permanent resident status, or the equivalent, in any country other than Canada?
No Yes âș If yes, list the country (countries) and provide the date(s) you acquired this status.
COUNTRY DATE (YYYY-MM-DD)
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CIT 0534 (09-2016) E
F List all of your Canadian and overseas addresses in the two (2) years, immediately before the date of your application, including postal codes.
FROM (YYYY-MM-DD)
TO (YYYY-MM-DD) Apt. Street no. and name City/Town Province/State Country Postal
code
Use another piece of paper if you need more space.
G Service history in, or with, the Canadian Armed Forces in the two (2) years immediately before the date of your application. If you have multiple periods of service, include the details for all periods of service.
i) Are you, or were you, enrolled in the Canadian Armed Forces? No Yes âș If yes, provide the details below
ii) Are you, or were you, attached or seconded to the Canadian Armed Forces? No Yes âș If yes, provide the details below
Type of Service (enrolled, attached, seconded)
FROM (YYYY-MM-DD)
TO (YYYY-MM-DD) Number of Days of Service
Use another piece of paper if you need more space.
iii) Were you released from the Canadian Armed Forces?
No Yes âș If yes, provide the date of release.(YYYY-MM-DD)
âș Check the appropriate box to indicate the category of release.
Other Than Honorable Release (Item 1, Misconduct; Item 2, Unsatisfactory Service)
Honorable Release (Item 3, Medical; Item 4, Voluntary; Item 5, Service Completed)
H Income tax filing ***Complete this section if you are a permanent resident (you answered "YES" to question 7C)
Do you have a Social Insurance Number (SIN), Temporary Tax Number (TTN) and/or Individual Tax Number (ITN)? No Yes
âș If yes, provide the most recent number you used to file your income taxes so that we may verify compliance with the income tax filing requirement:
and complete the table below detailing your income tax filing history to help demonstrate that you meet any applicable requirement under the Income Tax Act to file a return in respect of the taxation year immediately before the year in which you are applying for citizenship:
Taxation Year (YYYY) Required to file Taxes filed
Yes No Yes No
With your consent to the to the sharing of your income tax filing history between IRCC and CRA, IRCC will use this information to determine if you meet the income tax filing requirement of the Citizenship Act. Note that if you do not provide your consent for that specific purpose, your application will be returned as incomplete and not processed. Note: You do not need to consent to the sharing of your income tax filing history between IRCC and CRA (in section 12) if you checked "NO".
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CIT 0534 (09-2016) E
8 PROHIBITIONS UNDER THE CITIZENSHIP ACT
A Are you now or have you ever been in the two (2) years immediately before the date of your application:
âą on probation in Canada? âș No Yes
âą on parole in Canada? âș No Yes
âą an inmate of a penitentiary, jail, reformatory, or prison in Canada? âș No Yes
B Are you now serving a sentence outside Canada for an offence? âș No Yes
C Are you now charged with, on trial for, or subject to or a party to an appeal relating to an offence under the Citizenship Act or an indictable offence in Canada? âș No Yes
D Are you now charged with, on trial for, or subject to or a party to an appeal relating to an offence committed outside Canada? âș No Yes
E Are you now, or have you ever been, under a removal order (have you been asked by Canadian officials to leave Canada)? âș No Yes
F Are you now under investigation for, charged with, on trial for, subject to or a party to an appeal relating to or have you ever been convicted of a war crime or a crime against humanity? âș No Yes
G In the past five (5) years, were you prohibited from being granted citizenship or taking the Oath of Citizenship because of misrepresentation or withholding material circumstances? âș No Yes
H In the past four (4) years, have you been convicted in Canada of an indictable offence under any Act of Parliament or an offence under the Citizenship Act? âș No Yes
I In the past four (4) years, have you been convicted outside Canada of an offence, regardless of whether you were pardoned or otherwise granted amnesty for the offence? âș No Yes
J While a permanent resident, have you:
âą been convicted in Canada of terrorism, high treason, treason, or spying offences? âș No Yes
âą been convicted outside Canada of terrorism? âș No Yes
âą served as a member of an armed force of a country or organized armed group and that country or group engaged in armed conflict with Canada? âș No Yes
I have read and understand the prohibitions under the Citizenship Act. If you have checked "YES" to any of the prohibitions listed above, provide details below. If applicable, attach court documents.
9 Have you ever lived in Canada
No Yes âș If yes, on what date did you enter Canada to live?(YYYY-MM-DD)
OR Since birth
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CIT 0534 (09-2016) E
10 APPLICANT'S PARENTS Answer all of the following questions (as applicable):
PARENT Relationship to you Natural parent Adoptive parent
Surname/Last name Given name(s)
Other names used (name at birth, maiden name)
Country of birth Date of birth (YYYY-MM-DD) Married in what country Date of marriage (YYYY-MM-DD)
Additional information
How did this parent obtain Canadian citizenship?
Did this parent leave Canada for more than 1 year before 1977? No Yes From (YYYY-MM)
To (YYYY-MM) Destination (Country)
Is this parent or was this parent a citizen of a country other than Canada? No Yes âș Give detailsCountry, date and how citizenship was obtained
Was this parent employed in Canada by a foreign government or international agency? No Yes âș Give details
If the parent was born in Canada, was one of your grandparents employed by a foreign government or international agency? No Yes âș Give details
PARENT Relationship to you Natural parent Adoptive parent
Surname/Last name Given name(s)
Other names used (name at birth, maiden name)
Country of birth Date of birth (YYYY-MM-DD) Married in what country Date of marriage (YYYY-MM-DD)
Additional information
How did this parent obtain Canadian citizenship?
Did this parent leave Canada for more than 1 year before 1977? No Yes
From (YYYY-MM)
To (YYYY-MM) Destination (Country)
Is this parent or was this parent a citizen of a country other than Canada? No Yes âș Give detailsCountry, date and how citizenship was obtained
Was this parent employed in Canada by a foreign government or international agency? No Yes âș Give details
If the parent was born in Canada, was one of your grandparents employed by a foreign government or international agency? No Yes âș Give details
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CIT 0534 (09-2016) E
11 CONSENT TO DISCLOSE PERSONAL INFORMATION
If you are not a resident of Canada, section 11 does not apply to you. Go to section 12.
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 Immigration, Refugees and Citizenship 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.
12 CONSENT TO DISCLOSE PERSONAL INFORMATIONA 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 IRCC to give your name, address, sex 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 QUĂBEC'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 IRCC 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.
C SERVICE HISTORY WITH THE CANADIAN ARMED FORCES
Request for authorization By selecting "YES" in the box below, and by signing this form, I hereby give my consent for IRCC to contact the Canadian Armed Forces (CAF) or the Department of National Defence (DND) to verify the details of my service in order to assist IRCC in determining my citizenship eligibility. I also hereby authorize the CAF or the DND to provide the details of my service to IRCC.
Yes No
D CANADA REVENUE AGENCY (Complete this section if you answered "YES" to Section 7, question H)
Note: If you do not provide consent, your application will not be considered complete according to the Citizenship Regulations. Consequently, your application will be returned and not be processed.
By selecting "YES" in the box below, and by signing this form, I hereby authorize IRCC to disclose my SIN, ITN, or TTN, as the case may be, to the CRA for the purpose of requesting my income tax filing history from the CRA and for the CRA to disclose my income tax filing history from the CRA's Income Tax and Benefit Return file to IRCC so as to allow it to assess my citizenship application against the fax filing requirement of paragraph 11 (1.1)(b) of the Citizenship Act.
Yes No
13 INTENTIONI intend, if granted citizenship, â to continue to reside in Canada â to enter into, or continue in, employment outside Canada in or with the Canadian Armed Forces, the federal public administration or the public service of a
province, otherwise than as a locally engaged person; or â to reside with my spouse or common-law partner, or parent, who is a Canadian citizen or permanent resident and is employed outside Canada in or with the
Canadian Armed Forces, the federal public administration or the public service of a province, otherwise than as a locally engaged person.
Yes
I have a mental disability and I am incapable of forming the intent referred to above. Note: You must submit supporting evidence.
No. Note: If you select "NO", your application will be returned to you as you do not meet the requirements for a grant of citizenship.
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CIT 0534 (09-2016) E
14 APPOINTMENT OF A REPRESENTATIVE
Are you appointing an individual, firm or organization as your representative? âș No Yes âș If yes, the Use of a Representative form (IMM 5476) must be completed and included with your application.
15 OPTIONAL
Completed Statutory Declaration - Request for a Change of Sex Designation form (CIT 0404).
Completed Support for a Change of Sex Designation on an IRCC Document form (CIT 0552).
16 SIGNATURE OF APPLICANTI agree to advise Immigration, Refugees and Citizenship Canada (IRCC) if any information on this form changes before I take the Oath of Citizenship. I understand the content 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 or someone on my behalf, makes a false representation, or commit fraud or conceal any material circumstances relevant to my application, I could be prohibited from becoming a citizen and reapplying for citizenship for 5 years, my citizenship could be revoked and I could be charged with an offence as provided for under the Citizenship Act or the Criminal Code. Note: IRCC may verify the authenticity and accuracy of any documents you have provided in support of your application to resume citizenship with the body that issued the
documents. I have indicated in Section 8 whether the prohibitions apply to me. I have indicated my future residence intentions in Section 13 of this form.
Signature of applicant you must sign inside the white box in black ink only
City Date
(YYYY-MM-DD)
IMPORTANT NOTE: Remember to make sure that you are eligible to apply for citizenship on the day before you SIGN this application.
FAILURE TO INCLUDE THE NECESSARY DOCUMENTATION (For example: 2 PIECES OF IDENTIFICATION)
WILL RESULT IN YOUR APPLICATION BEING RETURNED.
Protected Information Personal Information Bank CIC PPU 050
The information you provide on this form is collected under the authority of the Citizenship Act to determine whether your citizenship application may be approved. It will be stored in the Personal Information Bank (CIC PPU 050 entitled Application and Assessment for Canadian Citizenship). The information may be shared with other Canadian government institutions such as the Canada Border Services Agency (CBSA), the Royal Canadian Mounted Police (RCMP), the Canadian Security Intelligence Service (CSIS), and foreign governments in accordance with the Citizenship Regulations or subsection 8(2) of the Privacy Act. Information may also be disclosed to foreign governments, law enforcement bodies and detaining authorities with respect to the administration and enforcement of citizenship legislation where such sharing of information may not put the individual and/or his/her family at risk. Information may also be systematically validated by other Canadian government institutions under the terms of an agreement or arrangement for the purposes of validating status and identity to administer their programs. In accordance with the Privacy Act and the Access to Information Act, individuals have a right to protection of, access to and correction of their personal information. Details on these matters are available at the InfoSource Website at http://infosource.gc.ca. InfoSource is also available at public libraries across Canada.