Birth details as shown on my birth certificate or
Please check (9) one
(AUSSI DISPONIBLE EN FRANÇAIS - 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
I want service in
For official use only
a Citizenship Certificate
(Proof of Citizenship)
Under Section 3
CIT 0001 (04-2009) E
PAGE 1 OF 5
Protected when completed
Please PRINT in ink or TYPE
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.
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
If you are completing this application for
a child under 18 years of age, remember
all questions are about the child.
Was the theft/loss reported to the police?
Please give details of the theft/loss/destruction (when, where, how and what?)
I am applying for a replacement:
a) to update certificate
(previous certificate enclosed)
b) to replace a:
Send certificate to:
Marital status Single