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PAGE 1 OF 8

CIT 0002 (10-2016) EPROTECTED WHEN COMPLETED -

B This form is made available by Immigration, Refugees and Citizenship Can ada and is not to be sold to applicants. (DISPONIBLE EN FRANÇAIS - CIT 0002 F)

APPLICATION FOR CANADIAN

CITIZENSHIP - ADULTS

(18 years of age and older)

UNDER SUBSECTION 5(1)

FOR OFFICIAL USE ONLY

UCI no.

Certificate no.

FOR OFFICIAL USE ONLY

Space reserved

for applicant's label IMPORTANT INFORMATION: REFER TO THE GUIDE FOR SPECIFIC INSTRUCTIONS.

PLEASE PRINT IN INK

OR TYPE.

1. A Language you prefer for service:

EnglishFrench

B I have special needs that require accommodation No

Yes ŹIf yes, please explain:

2. I have applied for Canadian citizenship before

No

Yes Ź When?

Year

3. A Name (

exactly as it is shown on my immigration document)

Last name

(surname/family name)

Given name(s)

B Your current name, if different from above.

Note: you must provide supporting documents for any change in y our name. Consult "Step 1. Gather documents" in the instruction guide.

Given name(s)

Last name

(surname/family name)

C List any other names used including name at birth, maiden name, previous married name(s), aliases and

nicknames. These names will not appear on your citizenship cer tificate.

Given name(s)

Last name

(surname/family name)

Provide details:

Sex Ź

4. A Birth details as shown on my immigration document

Date (YYYY-MM-DD) Place

Country

Town/City

B Personal information

MaleFemaleHeight

ŹcmORftinColour of eyesŹ

Marital status

Never marriedMarriedCommon-lawWidowedDivorcedLegally separated

5. A Home address (residence)

No. and street Apt. no.

City/VillageProvince

CountryPostal code

No. and streetApt. no.

City/VillageProvince

CountryPostal codeB Mailing address (if different from home address) If you need more space to answer a question than is provided below, atta ch another sheet of paper and make sure to include the number of the question you are answer ing. http://bit.ly/fill_out_with_RCIC

PAGE 2 OF 8

CIT 0002 (10-2016) E

5. C Telephone number(s)

Home

Area code and number

WorkArea code and number

Cell

Area code and number

D How long have you lived at your home address?

year(s)month(s) E Email address, if applicable (If you provide us with your email address, we may correspond with you about your application via email)

6. A When did you become a permanent resident (landed immigrant) of C

anada? (YYYY-MM-DD) B When did you first come to live in Canada if different from "A"? (YYYY-MM-DD)

C Are you a citizen of any other country(ies)?

NoYes ŹIf yes, list the country(ies).

If no, explain why these documents are not in your possession in the box below. Note: if your passport validity was extended, include a photocopy of the page(s) containing the extension stamp(s). D You must include photocopies of the biographical pages of any pas sports or travel documents you held in the six (6) years immediately b efore the date of your application, or since you became a permanent resident if this h appened less than six years ago ("the relevant period").

Do you have all of the required photocopies?

No ŹYes

E Are there any gaps in time in the validity period of your passpor ts or travel documents during the past (6) years, or since you became a permanent resident, whichever is more recent?

NoYes Ź

If yes, explain why your passports or travel documents do not cover the entire period of time in the box below. If you do not provide an explanation for any period when you did not hav e a valid passport, your application will be returned to you. http://bit.ly/fill_out_with_RCIC

PAGE 3 OF 8

CIT 0002 (10-2016) E

F Do you have permanent resident status or the equivalent in any co untry other than Canada?

NoYes Ź

If yes, list the country(ies) and provide the

dates you acquired this status.

Country

Date (YYYY-MM-DD) G Addresses in the past six (6) years immediately before the date of your application or since you became a permanent resident, whichever is more recent ("the relevant period") List all your Canadian and overseas addresses in the relevant period, in cluding the postal codes. If you were residing, employed or attending sc hool outside Canada during this time, you must also indicate all your foreign addresses. If you miss any period of time during the relevant period, your applicat ion will be returned to you. From (YYYY-MM-DD) To (YYYY-MM-DD) Apt. no.

Street no. and nameCity/TownProvince/StateCountry

Postal

code H Work and education history in the six (6) years immediately bef ore the date of your application or since you became a permanent residen t, if you became a permanent resident within the past six years ("the relevant period" C) You must complete the section below. If you leave this section blan k, your application will be returned to you. If you need more space, us e an additional sheet of paper. If you answered yes to questions A and/or B, list your work and/or educatio n history (inside and outside Canada) in the relevant period, includin g the city and country, starting with your most recent. If you answered no to questions A and/or B, you must indicate the reason you were not employed (i.e. you were unemploye d, retired, homemaker, etc.) and the dates of your unemployment under "Work/Education. Do not exclude any period of time during the relevant period. From (YYYY-MM)To (YYYY-MM) Work/EducationEmployer or school attendedCity, Country A) Were you working during the relevant period?YesNo

B) Were you attending an educational institution or participating in English/French language training during the relevant period?

YesNo http://bit.ly/fill_out_with_RCIC

PAGE 4 OF 8

CIT 0002 (10-2016) E

I Minor's education history in the six (6) years immediately bef ore the date of your application or since you became a permanent residen t, whichever is more recent (if applicable). Complete the information below for all children who were under the age o f 18 in the six (6) years immediately before the date of your applicat ion or since you became a permanent resident, whichever is more recent, including those who are al ready Canadian citizens (if applicable). If you need more space, use a n additional sheet of paper. NOTE: LISTING A MINOR CHILD'S SCHOOL ATTENDANCE IS NOT AN APPLICATION FOR CIT IZENSHIP FOR THE CHILD. IF YOU WISH TO APPLY FOR YOUR CHILDREN, YOU MUST COMPLETE AN "APPLICATION FOR CANADIAN CITIZENSHIP - M

INOR" FOR EACH CHILD (UNDER 18 YEARS OF AGE).

CHILD Family name/SurnameGiven name(s)Country of birthDate of birth (YYYY-MM-DD) From (YYYY-MM)To (YYYY-MM)Institution/School

Attended/Home schooled

City, Country

Child is

not at school age CHILD Family name/SurnameGiven name(s)Country of birthDate of birth (YYYY-MM-DD) From (YYYY-MM)To (YYYY-MM)Institution/School

Attended/Home schooled

City, Country

Child is

not at school age

J Income tax information

Do you have a Social Insurance Number (SIN), Temporary Tax Number (TT

N), and/or Individual Tax Number (ITN)?

A)

Yes Ź

No, I declare that I do not have a SIN, an ITN or a TTN and was not requ ired to file income taxes for any of the past six (6) taxation years. If yes, provide the most recent 9-digit number you used to file your income taxes so that we may verify compliance with the income tax filing requirements: Complete the table below detailing your income tax filling history to he lp demonstrate that you meet any

applicable requirement under the Income Tax Act to file a return in respect of four (4) taxation years that are fully

or partially within the six (6) years immediately before the date of y our application.

Taxation yearRequired to fileTaxes filed

YesNoYesNo

YesNoYesNo

YesNoYesNo

YesNoYesNo

YesNoYesNo

YesNoYesNo

With your consent to the sharing of your income tax filing history betwe en 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 a nd not be processed. Note that with your consent this information may also be used in the assessment of whether you meet the p hysical presence requirements. See Section 9E. B) Note: You do not need to consent to the sharing of your income tax filing hist ory between IRCC and CRA in part 9 if you checked "NO". http://bit.ly/fill_out_with_RCIC

PAGE 5 OF 8

CIT 0002 (10-2016) E

K Physical presence calculation

The Online Physical Presence Calculator is the preferred method to calcu late your physical presence in Canada. The printout from the Internet must be included with your application. If you experience diffi culty with the Online Physical Presence Calculator, please submit a How to Calculate Physical Presence form (CIT 0407) with your application.

L Residence outside Canada

In the six (6) years immediately before the date of your application, or since you became a permanent resident, whichever is most recent: A) Did you reside outside Canada with your Canadian spouse or common-law partner who was employed 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? YesNo B) Were you 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? YesNo C) Did you reside outside Canada with your spouse, common-law partner, or parent who:

· was a permanent resident, and

· was employed in or with the Canadian Armed Forces, the federal public ad ministration or the public service of a province, otherwise than as a locally engaged person? YesNo

If you have answered yes to any of the above questions, complete the Residence outside Canada form (CIT 0177) and submit it with your application.

M In the past four (4) years, were you present in a country, other than

Canada, for a total of 183 days or more?

NoYes Ź

If you have checked "YES", indicate each country in the box below. You must provide police certificates for each country where you have be en present for 183 days or more. If you cannot get a police certificate fr om a country, provide details in the box below.

7. LANGUAGE EVIDENCE. See section 7 - "Step 2. Complete the application"

and section 2 - "Step 1. Gather documents" in the instruction guide.

A If you are 18 to 64 years of age you must submit acceptable proof that demonstrates that you have adequate knowle

dge of English or French. Please check the appropriate box to indicate which of the following forms of proof you ar e submitting with your application: Results of a IRCC-approved third-party language test; or Diploma, certificate or transcript of a secondary or post-secondary educ ation completed in English or French, in Canada or abroad; or Evidence of achieving CLB/NCLC 4 in a government-funded language trainin g program If you successfully completed LINC or CLIC (Language Instruction for Ne wcomers to Canada), classes during the period from January 2008 to Octo ber 2012 but did not receive a certificate*

* IRCC has previously collected information about the results of your LINC or CLIC language training for statistical purpose but IRCC would like to obtain and use this

information for purposes of verifying your language results. By signing the consent form section 9F of this application, you authorize IRCC to use the information that

has been already collected to verify whether you have adequate knowledge of English of French. C I have a disorder, disability or condition that is cognitive, psychiatri c or psychological in nature which prevents me from submitting proof of language with my application.

Note: You must submit supporting evidence.

NoYes Ź If yes, you must submit supporting evidence of your disorder, disabil ity or condition. B See section 7 - "Step 2. Complete the application" and section 2

- "Step 1. Gather documents" in the instruction guide. I am deaf, which prevents me from submitting the proof of language descr

ibed in 7A with my application. Note: If you check yes, you must submit supporting evidence with your application. NoYes

PAGE 6 OF 8

CIT 0002 (10-2016) E

A Are you now or have you ever been in the six (6) years immediately before the date of your application, or since you became a p

ermanent resident, whichever is most recent

8. PROHIBITIONS UNDER THE

CITIZENSHIP ACT

NoYes• on probation in Canada?

NoYes• on parole in Canada?

NoYes• an inmate of a penitentiary, jail, reformatory, or prison in Canada? B Are you now serving a sentence outside Canada for an offence? NoYes 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? NoYes 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? NoYes E Are you now, or have you ever been, under a removal order (have you been asked by Canadian officials to leave Canada)? NoYes 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? NoYes G In the past five (5) years, were you prohibited from being gra nted citizenship or taking the Oath of Citizenship because of misrepresentation or withholding material circumstances? NoYes H In the past four (4) years, have you been convicted in Canad a of an indictable offence under any Act of Parliament or an offence under the Citizenship Act? NoYes I In the past four (4) years, have you been convicted outside C anada of an offence, regardless of whether you were pardoned or otherwise granted amnesty for the offence? NoYes

J While a permanent resident, have you:

• been convicted in Canada of terrorism, high treason, treason, or spying offences? NoYes • been convicted outside Canada of terrorism? NoYes • 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? YesNo I have read and understand the prohibitions under the Citizenship Act. If you have checked "YES" to any of the questions listed above, provide details below. If applicable, attach court documents to avoid unnecessar y delays. http://bit.ly/fill_out_with_RCIC

PAGE 7 OF 8

CIT 0002 (10-2016) E

A CONGRATULATORY LETTER

9. CONSENT TO DISCLOSE PERSONAL INFORMATION

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