Application for Grant of Citizenship for Stateless Persons Born to a Canadian Parent (Subsection 5(5)) (CIT 0497)

Would you like to receive service (correspondence, interview) in English or French?

Check the box to indicate if you have any special needs. If yes, explain.

Special needs are described as:

• wheelchair access
• sign language interpretation
• personal assistance (for example, you will be accompanied by a care attendant, an interpreter, a seeing eye dog, a sighted guide, etc.)

Write your last name (surname/family name) and given name(s) exactly as they appear on your immigration document or birth certificate. Your immigration documents include your:

• Record of landing (IMM 1000)
• Confirmation of Permanent Residence (IMM 5292 or IMM 5688)
• Permanent Resident Card (PRC)
• Temporary Resident Permit

Did you have a legal change of name or are you requesting a different name on your citizenship certificate?

If yes:

• see the name change section in the application guide and
• write the last name (surname/family name) and given name(s) you request to appear on your citizenship certificate.

Write if you:

• have used another name in the past (such as your birth name, married name), or
• are known by a name other than the one you listed above (such as a nickname or community name).

Write your date and place of birth, including the city or town and country.

Did you acquire citizenship from the country where you were born? If you check no, explain.

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

Important information: Your family and given name, date of birth and gender will appear on your citizenship certificate.

Write your current home address, complete with:

• street address
• city or town
• province
• postal code

If your mailing address is different from your home address, write your complete mailing address.

If you provide the mailing address of your representative in this section, you must also complete the Use of a Representative Form (IMM 5476) (opens in new tab) .

List the telephone number(s) where you can be reached.

Indicate your e-mail address using this format (if applicable): name@provider.net

If you provide your e-mail address, we may correspond with you about your citizenship application via e-mail if necessary.

If you provide the email address of your representative, you must also complete the Use of a Representative Form (IMM 5476) (opens in new tab) .

Answer all questions on the information regarding your parents:

• Indicate the relationship of your parent(s) to you by checking “Natural” or “Adoptive”.
• Write your parent(s)’ surname/last name, given name(s), other names used, date of birth and country of birth.
• Indicate where your parents were married (if applicable), and the date of the marriage.
• Check the box to indicate how your parent(s) obtained Canadian citizenship.
• Provide your parent(s) Canadian citizenship certificate number (if available)
• Check the box to indicate if your parents are or were a citizen or national of a country other than Canada. If yes, provide the details showing the country, date and how citizenship was obtained and/or recognized.
• Check the box to indicate if, at the time of your birth, your parent(s) were employed in Canada by a foreign government or international agency. If yes, provide details.
• Check the box to indicate if, at the time of your birth, your Canadian parent(s) were employed outside Canada in or with the Canadian Armed Forces or the federal public administration or the public service of a province or territory otherwise than as a locally engaged person.

Answer all questions on the information regarding your grandparents:

• Check the box to indicate if one of your grandparents was a Canadian citizen at the time of your Canadian parents’ birth or adoption.
• Check the box to indicate if, at the time of your parents’ birth or adoption, one of your grandparents was employed outside Canada in or with the Canadian Armed Forces, the federal public administration or the public service of a province or territory otherwise than as a locally engaged person.
• If you answered yes to either question, provide your grandparents’ details in the table provided.
• Complete the check boxes (and provide details if applicable) concerning your other grandparents.

Write the date you first came to Canada to live.

Write all your addresses in Canada for the last four (4) years. If you were residing, employed or attending school outside Canada, you must also list all foreign addresses.

Write your work and education history (inside and outside Canada) in the last four years, including the city and country, starting with your most recent. If you were not of school age, unemployed, retired, homemaker, etc. Indicate this under “Work/Education” and indicate the time period.  Do not exclude any period of time during the past four years.  Do not leave this section blank.  If you do, your application will be returned to you.

Enter absences from Canada and calculate your physical presence by completing question A to E in the section “Calculation of time towards physical presence.”

Answer all of the questions by checking YES or NO to the prohibitions. For any yes responses provide details and if applicable, attach court documents.

Check either Yes or No to indicate whether or not you authorize IRCC to give your name, residential and mailing address, gender, date of birth, Unique Client Identifier (UCI) and the date your citizenship was granted to Elections Canada in order to add you to the National Register of Electors (the Register).

When you become a Canadian citizen and are 18 years of age or older, you have the right to vote in federal elections and referendums. Elections Canada maintains the Register and uses it during a federal election or referendum to produce voters lists and to communicate with eligible voters.

The Canada Elections Act also allows Elections Canada to provide voter information to provincial and territorial election agencies for uses permitted under their respective legislations and to provide voter information (name, address, and gender only) to members of Parliament, registered political parties and candidates at election time. The UCI and the date your citizenship was granted will only be used by Elections Canada for administrative purposes, and will not be shared by Elections Canada except as required by law.

If you check Yes, IRCC will provide your name, residential and mailing address, gender, date of birth, UCI and the date your citizenship was granted to Elections Canada in order to add you to the Register, but only after you become a Canadian citizen. If you check No, IRCC will not provide your information to Elections Canada.

You will still have the right to vote in federal elections and referendums, but you will have to take the necessary steps to be added to the list.

More information about the Register and its uses is available at Election Canada. You can also call Elections Canada at 1-800-463-6868.

If you are18 years or older and reside in Québec, indicate whether you authorize IRCC to provide your name, residential address and the date at which you started to reside at that address, gender, date of birth, your Unique Client Identifier (UCI) and the date your citizenship was granted to the Chief Electoral Officer of Québec so that your name can be added to the Permanent List of Electors (voters) if you become a Canadian citizen.

Your application for citizenship will in no way be affected by your answer to this question.

The Election Act allows the Chief Electoral Officer of Québec to:

• provide voter information to provincial political parties and members of the National Assembly as well as municipal and school boards to compile and update lists of electors (voters) for municipal and school elections, and
• notify the elector in writing that their name has been entered on the permanent list of electors, requesting that the elector correct or complete the information which concerns him/her, where required.

The Chief Electoral Officer of Québec receives the UCI for administrative purposes only, while the date your citizenship was granted allows him/her to validate that you qualify as an elector based on the electoral laws it administers. This information is subject to no other use or communication.

If you do not provide this authorization, you will still be able to vote, but you will have to go to the revision office and present two supporting documents to register your name on the list of electors to be able to vote in a provincial, municipal or school election.

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.

Note: Your application will be returned to you if:

• You have appointed an individual, firm or organization as your representative and did not submit the Use of a Representative Form (IMM 5476) (opens in new tab)  with your application or this form was submitted incomplete.
• You appoint a compensated representative who is not a member of the following designated bodies:
  • Immigration consultants who are members in good standing of the College of Immigration and Citizenship Consultants (CICC)
  • Lawyers and paralegals who are members in good standing of a Canadian provincial or territorial law society and students-at-law under their supervision; or
  • Notaries who are members in good standing of the Chambre des notaries du Québec and students-at-law under their supervision.

The parent or legal guardian(s) or applicants 18 years of age or older must sign the application, using the same signature they currently use on other official documents. Enter the place (city, town or village) and date beside the signature. Sign and date the application on the same day.

Note: Your application will be returned to you if the application form is:

• not signed and dated,
• stale-dated (dated more than 90 days before we receive it), or
• post-dated (dated into the future).