PROTECTED WHEN COMPLETED - B
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For official use only
Receipt no.
Client ID
APPLICATION TO
RENOUNCE CANADIAN
CITIZENSHIP
Under subsection 9(1)
File no.
Claim: (Section of Act)
Certificate no.
Return original
document(s)
Signature
Approved
Date (YYYY-MM-DD)
Notify:
Send certificate to:
Before you start, read the instructions
Please PRINT in ink or TYPE
For official use only
1
I want service in
2
Have you applied to renounce
citizenship before?
3
Have you ever had a
certificate of Canadian
citizenship or
naturalization?
OR
English
French
No
No
Yes
Please check
►
Yes
►
✔ One
(YYYY-MM-DD)
Date
If yes, give information that appears on the certificate.
Surname/Last name
Given name(s)
Certificate no.
My certificate of
Canadian citizenship is:
Was the theft/loss
reported to police?
Date (YYYY-MM-DD)
enclosed
No
stolen
Yes
►
lost
destroyed
Details
Note: It is illegal to have a certificate of citizenship or naturalization once you have renounced your Canadian
citizenship. If you have any certificate of citizenship or naturalization or any pink transmission copy of a
certificate, you have to send it back. Once your application to renounce Canadian citizenship is approved, you
will receive a certificate of renunciation of Canadian citizenship.
4
A
Name (exactly as is shown on
my citizenship or birth certificate)
Surname/Last name
Given name(s)
B
Legal name change
No
Yes
►
If yes, provide legal
name change document.
To:
Surname/Last name
Given name(s)
C
Other names used (example
maiden name or name at birth)
Surname/Last name
Given name(s)
Use another piece of paper if you need more space.
5
D
Name you want on certificate of
renunciation (documentation
required)
A
I am a citizen or a national of a country other than Canada.
IF NO, I will become a citizen of
B
Surname/Last name
Given name(s)
►
No
Yes
►
Name of country and attach proof.
once I renounce my Canadian citizenship (attach proof).
I hereby declare that I wish to renounce my Canadian citizenship for the following reasons:
CIT 0302 (06-2015) E
(DISPONIBLE EN FRANÇAIS - CIT 0302 F)
AVAILABLE ON CIC WEB SITE AT: http://www.cic.gc.ca
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6
I live outside Canada
A
No
►
Yes
(attach proof)
Home address
Postal code
B
Mailing address
(If different from
home address)
7
Postal code
C
Telephone number(s)
D
E-mail address
(if applicable)
A
Birth details
B
Personal information Sex
Home
Work
City, town, etc.
(YYYY-MM-DD)
Date
Ext.
Cell
Country
Place
►
Male
Marital status
►
OR Female
►
Single
Height
cm
Married
OR
ft
►
in
Widowed
Colour
of eyes
Divorced
Separated
IF YOU RECEIVED A CITIZENSHIP CERTIFICATE ON OR AFTER FEBRUARY 15, 1977, GO TO SECTION 12.
8
If you are a woman and married before January 1, 1947, answer the following questions.
If you married for the first time on or after January 1, 1947, this question does not apply to you. Go to Section 9.
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
Is your husband a Canadian citizen?
No
►
Yes
by birth
or
other
Number on husband's citizenship certificate
(if applicable)
(YYYY-MM-DD)
(YYYY-MM-DD)
►
►
Date
(YYYY-MM-DD)
Please use another piece of paper if you need more space to list other marriages.
9
If you received a certificate before February 15, 1977 OR have never had a certificate, please list absences from Canada of 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?
Please use another piece of paper if you need more space.
10
►
A
Are you claiming Canadian citizenship by birth outside Canada to a Canadian parent?
B
Did you enter Canada?
►
No
Yes
►
If yes, on what date did you enter Canada?
C
Were you a British subject living in
Canada before 1947?
►
No
Yes
►
If yes, on what date did you enter Canada?
CIT 0302 (06-2015) E
No
Yes
(YYYY-MM-DD)
(YYYY-MM-DD)
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11
APPLICANT'S PARENTS
Answer all of the following questions:
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)
Country of marriage
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
From
(YYYY-MM)
Yes
To
(YYYY-MM)
No
Yes
►
Give details
Was this parent employed in Canada by a foreign government or
international agency?
No
Yes
►
Give details
If the parent was born in Canada, was one of your grandparents employed
by a foreign government or international agency?
No
Yes
►
Give details
Is this parent or was this parent a citizen of a country other than Canada?
Destination (Country)
(country, date and how citizenship was obtained)
OTHER PARENT
Relationship to you
Natural parent
Adoptive parent
Surname at birth
Given name(s)
Other names used (name at birth, maiden name)
Country of birth
Date of birth (YYYY-MM-DD)
Country of marriage
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
From
(YYYY-MM)
Yes
To
(YYYY-MM)
No
Yes
►
Give details
Was this parent employed in Canada by a foreign government or
international agency?
No
Yes
►
Give details
If the parent was born in Canada, was one of your grandparents employed
by a foreign government or international agency?
No
Yes
►
Give details
Is this parent or was this parent a citizen of a country other than Canada?
(country, date and how citizenship was obtained)
CIT 0302 (06-2015) E
Destination (Country)
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12
APPOINTMENT OF A REPRESENTATIVE
Are you appointing an individual, firm or organization as your representative?
►
Yes
No
If yes, the Use of a Representative form (IMM 5476) must be completed and included with your application.
13
SIGNATURE OF APPLICANT
I agree to advise Citizenship and Immigration Canada (CIC) if any information on this form changes before the processing of my application is complete.
I understand the content of this form and the significance of renouncing my Canadian citizenship. I declare that the information provided is true, correct
and complete, and that the photograph enclosed is a true likeness of me. I understand that if I, or someone on my behalf, make a false representation,
commit fraud or conceal any material circumstances relevant to my application, my application could be denied, my certificate of renunciation could be
taken away, and I could be charged with an offence as provided for under the Citizenship Act or the Criminal Code.
Date (YYYY-MM-DD)
Signature of APPLICANT
Place
REMEMBER:
If you are sending more than one application, send all of them together in one envelope.
The applications will be processed together.
FAILURE TO INCLUDE THE NECESSARY DOCUMENTATION
WILL RESULT IN YOUR APPLICATION BEING RETURNED.
Protected Information
Personal Information Bank SSC/P-PU-050
Information in this form is collected under the Citizenship Act to determine eligibility fro the grant of Canadian citizenship and to maintain a record of persons to whom citizenship
certificates were issued. Under the Privacy Act, you have the right to access, request correction of or have a notation attached to the information concerning yourself.
CIT 0302 (06-2015) E
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DOCUMENT CHECKLIST
APPLICATION TO RENOUNCE CANADIAN CITIZENSHIP UNDER SUBSECTION 9(1)
Send the following documents with your application. Check
þ each box once you enclose the item.
Failure to provide a fully completed application form or the necessary documents 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.
Note: You must provide the English or French translation of all documents that are in another language and an affidavit from the person who completed
the translation.
FORM
Application to Renounce Canadian Citizenship under Subsection 9(1) - (CIT 0302), fully completed, signed and dated.
IDENTITY DOCUMENTS
Provide the following documents to prove you are a Canadian citizen:
Certified copy of your birth certificate or, if unobtainable, other evidence that establishes your date and place of birth; and
Original of your Canadian citizenship certificate (if applicable).
Provide the following supporting documents:
Certified copy of the proof that you are a citizen of a country other than Canada OR that you will become a citizen of a country other than Canada, if
your application to renounce Canadian citizenship is approved (e.g., foreign citizenship document, letter from a foreign government stating that you will
become a citizen once you renounce your Canadian citizenship); and
Certified copy of the proof that you live outside of Canada (e.g., resident card from a foreign country, letter from a foreign government stating that you
reside there, employment records showing employment in a foreign country); and
Certified copies of two (2) additional pieces of personal identification, such as a passport, a driver's licence and a health insurance card, one of which
must have your photo on it.
PHOTO
One (1) citizenship photo as per the Citizenship Photo Specifications.
FEE
$100 processing fee.
MAILING ADDRESS
Be sure that you have addressed the envelope, attached sufficient postage and send to:
Case Processing Centre - Sydney
Renunciation
P.O. Box 10000
Sydney, Nova Scotia
B1P 7C1
(Include this completed Document Checklist with your application package.)
CIT 0302 (06-2015) E