1

A) Child's name (exactly as it appears on the immigration document)

B) Indicate the reason why you are asking for a different name to appear on this child certificate (subject to approval by Citizenship and Immigration Canada). See instructions in Step 1. Gather Documents about Quebec issued documents.

C ) List any other names the child has used in the past or now uses (i.e. alias, birth name, nickname) These names will not appear on the child's certificate of citizenship

A Child's name (exactly as it appears on the immigration document)

2
3
4
5

Note: Guardians can apply but one of the natural or adoptive parents must be a Canadian citizen or applying to become a Canadian citizen. You must provide a birth certificate, adoption order or a legal document showing guardianship (see instructions about Quebec issued documents in the section on documents).

6

A Birth details as shown on the immigration document)

C) Personal information

7
8 DETAILS OF CHILD'S PARENTS
D) Proof of Canadian citizenship
D) Proof of Canadian citizenship
9
If yes, give details of the time the child spent away from Canada.
LANGUAGE EVIDENCE

Declaration

ARATION Do solemnly declare that the information that I have given in the foregoing the questionnaire is truthful, complete and correct, and I make this solemn declaration consciously believing it to be true and knowing that it is of the same force and effect as if made under oath.

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