3

4
Birth details as shown on my birth certificate or
previous certificate
Date
destroyed
Note:
1
Please check () one
(AUSSI DISPONIBLE EN FRANAIS - CIT 0001 F)
AVAILABLE ON CIC WEB SITE AT: http://www.cic.gc.ca
Name (exactly as it is shown on
my birth certificate or previous
certificate)
2
I want service in
cm
Sex
For official use only
Application for
a Citizenship Certificate
(Proof of Citizenship)
Under Section 3
CIT 0001 (11-2012) E
PAGE 1 OF 6
Protected when completed
Please PRINT in ink or TYPE
English French
List any other names (include birth name,
maiden, previous married name(s), aliases and
nicknames). These names will not appear on
your citizenship certificate
Have you ever had a certificate of Canadian citizenship or naturalization?
If yes, give information that appears on the certificate.
No Yes
Note: It is illegal to have more than one valid certificate of citizenship or naturalization. If you have any certificate of
citizenship and naturalization or any pink transmission copy of a certificate, you have to send it back. If you find a
lost certificate after you get your replacement certificate, you have to send it back to the Case Processing Centre
in Sydney, Nova Scotia.
Place and country of birth
Personal information OR Female Height
OR
ft in
Colour
of eyes
Male
If you are completing this application for
a child under 18 years of age, remember
all questions are about the child.
Citizenship and
Immigration Canada
Citoyennet et
Immigration Canada
Surname/Last name Given name(s) Certificate number
Day Month Year
Was the theft/loss reported to the police?
Please give details of the theft/loss/destruction (when, where, how and what?)
No
I am applying for a replacement: a) to update certificate
(previous certificate enclosed)
lost
Yes
certificate. b) to replace a: stolen
A
B
C
Signature
UCI no.
Case ID
Current Act
Certificate no.
Return original
document(s)
Former Act
Approved
Marital status Single Married Widowed Divorced Separated
Common-
law
M D Y
A
B
C
Request for a different name to
appear on certificate
(subject to approval by Citizenship
and Immigration Canada)
Last name (Surname/Family name) Given name(s)
Last name (Surname/Family name)
Given name(s)
Last name (Surname/Family name) Given name(s)
Day Month Year
Notify:
Send certificate to:
CIT 0001 (11-2012) E
7
Other nationalities
Are you a citizen of one or more countries other than Canada?
If yes, list the country or countries, date and how you obtained this citizenship.
6
Please use another piece of paper if you need more space to list other marriages.
5
Absences from Canada
Did you leave Canada for 1 year or longer before 1977?
PAGE 2 OF 6
If you are a woman and married before January 1, 1947, answer the following questions. If you married on or after
January 1, 1947, this question does not apply to you. Go to part 6.
Information on
your husband
(Provide details of every
marriage before 1947.)
Husband's surname/last name
Given name(s)
Husband's country of birth
Date of
birth
Country of marriage
Date of
marriage
Number on husband's citizenship
certificate (if applicable)
Date
Is your husband a
Canadian citizen?
No Yes by birth or other
TO
Give details
below
M
DESTINATION
What country did you go to? D Y D M Y
FROM REASON
Why did you go to this country?
No Yes
No Yes
Telephone number(s)

Home address
Mailing address
(if different from home
address)
Postal code
Postal code
Year Month Day
Year Month Day
Year Month Day
E-mail address
(if applicable)
Cell ( ) Work ( ) Ext.
Home ( )
CIT 0001 (11-2012) E
8a
Applicant's Parents
PAGE 3 OF 6
Natural
father
Adoptive
father
Natural
mother
Adoptive
mother
Maiden name
FATHER MOTHER
Date of marriage
How did he obtain Canadian citizenship? How did she obtain Canadian citizenship?
Was he employed in Canada by a foreign
government or international agency?
Was she employed in Canada by a foreign
government or international agency?
No Yes
Give details
No Yes
Give details
At the time of your birth, was he employed
outside Canada by the Canadian Forces or
a Canadian federal, provincial or territorial
public service other than as a locally
engaged person?
At the time of your birth, was she employed
outside Canada by the Canadian Forces or
a Canadian federal, provincial or territorial
public service other than as a locally
engaged person?
No Yes
Give details
No Yes
Give details
Is he or was he a citizen of a country other
than Canada?
Is she or was she a citizen of a country
other than Canada?
Give details
(country, date and how
citizenship was obtained)
Give details
(country, date and how
citizenship was obtained)
Answer all of the following questions:
No Yes No Yes
Additional information
Surname/Last name
Given name(s)
Country and date of birth
Married in what country
Relationship to you
Day Month Year
No Yes No Yes
Did he leave Canada for more than 1 year
before 1977?
Did she leave Canada for more than 1 year
before 1977?
Destination (Country) Destination (Country)
From To From To
M Y M Y M Y M Y
Day Month Year Day Month Year
CIT 0001 (11-2012) E
If father was born in Canada, was one of
his parents employed by a foreign
government or international agency?
If mother was born in Canada, was one of
her parents employed by a foreign
government or international agency?
No Yes
Give details
No Yes
Give details
8a
Applicant's Parents (continued)
8b
Applicant's Grandparents
If applicant's father was born outside Canada, was one of his parents a
Canadian citizen at the time of his birth?
If yes, provide details:
Maiden name
FATHER MOTHER
Surname/Last name
Given name(s)
If applicant's mother was born outside Canada, was one of her parents a
Canadian citizen at the time of her birth?
If yes, provide details:
Maiden name
FATHER MOTHER
Surname/Last name
Given name(s)
9
Have you ever lived in Canada?
No Yes If yes, on what date did you enter Canada to live?
PAGE 4 OF 6
Country and date of birth
Country and date of birth
No Yes
No Yes
OR
Since birth
Month Day Year
Day Month Year Day Month Year
Day Month Year Day Month Year
CIT 0001 (11-2012) E
PAGE 5 OF 6
10
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 make a false declaration, or fail to
disclose all information material to my application, my citizenship certificate could be taken away and I could be
charged under the Citizenship Act.
I hereby acknowledge that section 11 below must be completed if an individual, firm or organization assisted me
in the completion of this application. If section 11 is blank, I confirm that I completed this form myself without
any help.
If applicant is under 14 years of age, signature of parent/guardian:
REMEMBER:
If you are sending more than one application, send all of them together in one envelope. The applications
will be processed together.
Signature of parent/guardian
(you must sign inside the white box in black ink only)
Date
Day Month Year
City
Signature of applicant
(you must sign inside the white box in black ink only)
Date
Day Month Year
City
11
INDIVIDUAL, FIRM OR ORGANIZATION WHO ASSISTED IN THE COMPLETION OF THIS APPLICATION
(The applicant does not complete this section)
Did you receive assistance in completing this form?
If yes, have the individual, firm or organization complete the following section.
No Yes
Year Month Day
Signature of
INDIVIDUAL
Date
Name of individual who assisted in completing this application form Name of firm, organization
Address
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.
Protected Information
Personal Information Bank CIC PPU 050
CIT 0001 (11-2012) E
DOCUMENT CHECKLIST
APPLICATION FOR A CITIZENSHIP CERTIFICATE UNDER SECTION 3 - PROOF OF CITIZENSHIP
PAGE 6 OF 6
Send the following documents with your application. Check each box once you enclose the item.
Application for a Citizenship Certificate (CIT 0001), fully completed, signed and dated. See section "Step 2.
Complete the Application" in the instruction guide to know how to complete the form.
Identify and check which scenario that describes your situation. You must read the section "Step 1. Gather
Documents" in the instruction guide to determine which documents you must submit based on your situation.
Two (2) pieces of personal identification, one of which must have your photo on it. If there is information on both
sides of your personal identification documents, provide a photocopy of both sides. See section "Step 1. Gather
Documents" in the instruction guide for examples.
Two (2) citizenship photos. See the page.
Fees. Copy 2 of the Receipt form showing the amount paid. See section "Step 3. Pay the Fees" in the
instruction guide for the acceptable methods of payment.
If this applies to you:
If your application is for a replacement of your citizenship certificate, you must return all original Canadian
citizenship/naturalization certificates previously issued to you and any pink transmission copies that you still
have. See section "Before you apply" in the instruction guide.
5. You were a British subject who lived in Canada
for 20 years immediately before 1947
6. You were a British subject who lived in Canada
as a permanent resident for at least 5 years (but less
than 20 years) before 1947
7. You were a woman who married a Canadian
before 1947 and who also entered Canada as a
permanent resident before 1947
8. You are a woman, Canadian-born or a British
subject, who lost her British subject status upon or
during marriage before 1947
1. You have a certificate of registration of birth abroad
(RBA), a citizenship certificate, or you are applying to
replace your certificate
2. You have never had a citizenship certificate and
you were born in Canada
3. You were born outside Canada to a Canadian
parent on or after January 1, 1947
4. You were born outside Canada to a Canadian
parent before January 1, 1947
Original translation of any documents that are not in English or French and an affidavit from the translator.
See section "Step 1. Gather Documents" in the instruction guide.
Date of birth correction or a name change: see section "Step 1. Gather Documents" in the instruction guide
to know which documents to include.
Mail your fully completed application form and all required documents to:
Inside Canada
By regular mail: Case Processing Centre - Sydney-Proofs
Box 10000
Sydney, Nova Scotia
B1P 7C1
By courier: Case Processing Centre - Sydney-Proofs
47-49 Dorchester
Sydney, Nova Scotia
B1P 5Z2
Outside Canada
See section "Step 4. Mail the Application" in the instruction guide.
(Include this completed Document Checklist with your application package.)
Failure to provide a fully completed application form or the necessary documents of will result in the return of
your application. If you are sending more than one application (for example, family members), and one of the
applications is incomplete, all the applications will be returned to you.
If the application is for your first citizenship certificate, provide originals or clear and legible certified copies of your
documents.
If this application is for a replacement of your citizenship certificate, provide clear and legible photocopies of your
documents.
Citizenship Photograph Specifications
Step 2.
Complete the Application
Step 1. Gather
Documents
Step 1. Gather
Documents
Step 3. Pay the Fees
Before you apply
Step 1. Gather Documents
Step 1. Gather Documents
Step 4. Mail the Application