Application to Renounce Canadian Citizenship – R7.1 (for certain persons who acquired citizenship under amendments to the Citizenship Act in 2009 or 2015) (CIT 0496)

Section 1

Question 1

Indicate whether you would like service in English or French.

Section 2

Question 2

Check the box to indicate if you ever had a certificate of Canadian citizenship or naturalization. If yes, write your certificate number (if you have one).

Note: You must return any Canadian citizenship certificates in your possession. Failure to do so will result in delays in processing your application.

Section 3

Question 3A

Write down your last name (surname/family name) and given name(s).

Question 3B

If you have used other names in the past, or are known by a name other than the one you listed above, write them in the space provided.

Other names can include your:

• birth name,
• nicknames,
• community names, etc.

Note: You can use a separate piece of paper if required.

Section 4

Question 4A

Write your date of birth exactly as it appears on your birth certificate or citizenship certificate. Indicate the place and country where you were born.

Question 4B

Check the box to indicate whether you are a F Female, M Male or X Another gender. Include your height, the colour of your eyes, and your legal marital status.

Section 5

Question 5A

Provide your current home address including your postal code.

Question 5B

If your mailing address is different from your home address, include your mailing address with your postal code.

If the mailing address is that of a representative, you must indicate their mailing address(es) in this section and complete the IMM 5476 form.

Question 5C

List the phone number(s) and email where you can be reached.

If the email address is that of a representative, you must indicate their e-mail address in this section and complete the IMM 5476 form (opens in new tab) .

If applicable, write your e-mail address using a format similar to the following: name@provider.net

Note: By indicating your e-mail address, you are hereby authorizing us to transmit all correspondence, including your file and personal information to this specific e-mail address.

Section 6

Question 6A

Check the box to indicate if you are a citizen or a national of a country other than Canada. If yes, indicate the name of the country.

If no, and you are not a citizen of another country, write the name of the country of which you will become a citizen if your application to renounce Canadian citizenship is approved. Attach proof.

Question 6B

Indicate the reason(s) you wish to renounce your Canadian citizenship.

Section 7

If you are a woman and married before January 1, 1947:

• Write your spouse’s surname/last name, given name(s), country and date of birth.
• Write the country in which you were married and the date of your marriage.
• Check the box to indicate if your spouse is a Canadian citizen. If yes, check the box to indicate if it was by “birth” or “other”. If you select “other”, provide the details.
• If your spouse has a citizenship certificate, write the certificate number and the date your spouse acquired citizenship.

Section 8

You must indicate if you left Canada for 1 year or longer before 1977. If yes, provide the dates you were away, the country of destination and the reason you went to that country.

Section 9

Check the box to indicate if you have ever lived in Canada. If yes, indicate either since birth or the date you first entered to live.

Section 10

• Check the box to indicate the relationship of your parents to you by selecting Natural or Adoptive.
• Print your parents surname/last name, other names used, given name(s), date of birth and country of birth.
• Indicate where your parents were married (if applicable), and the date of the marriage.
• Indicate how your parents obtained Canadian citizenship.
• Check the box to indicate whether your parents left Canada for more than one (1) year before 1977. If yes, provide the dates they were away and the country they visited.
• Check the box to indicate if your parents are or were citizens of a country other than Canada. If yes, provide the details including the country, date and how the citizenship was obtained.
• Check the box to indicate if at the time of your birth, your parents were employed in Canada by a foreign government or international agency. If yes, provide details.
• If your parents were born in Canada, check the box to indicate if one of your grandparents was employed by a foreign government or international agency. If yes, provide details.

Section 11

If you appoint an individual, firm or organization as your representative, you must complete the Use of a Representative Form (IMM 5476) (opens in new tab) . Note that once you appoint a representative, all correspondence from us regarding your application will be directed to them and not to you.

Section 12

Make sure to read the declaration. Then sign the application with the signature you currently use on other official documents and include the place and date.