Fillable Sc Isp-3210 - Canadian Citizenship Application Form printable pdf download

Service

PROTECTED B (when completed)

Canada

Consent to Exchange Information with Citizenship

and Immigration Canada

Service Canada requires proof of your immigration into Canada and your legal status to complete your

application for a pension or supplementary benefit under the Old Age Security (OAS) program. You are

required to provide proof of your:

- Date(s) of arrival in Canada; and/or

- Legal status in Canada.

If you do not have the required Citizenship and Immigration documentation, you have two options:

1. Complete this consent form: With your consent, this form allows us to collect your information and

provide it to Citizenship and Immigration Canada (CIC) in order to obtain immigration or citizenship

information on your behalf. The signed consent form and response from CIC will be added to your file and

used to determine your eligibility and entitlement to an OAS pension and/or benefits and administer the

OAS Program. Completing and returning this form may expedite the application process.

This consent form will be valid for two years from when it is received by Service Canada and must be

received within one year of your signing it. You may withdraw your consent at any time, but you must do

so in writing. The consent form is no longer valid in the event of your death.

2. Contact CIC directly to request documentation. CIC requires you to pay a fee. Please see CIC's

website ( ) for further information.

Protect your privacy

The information provided on this form is collected by Service Canada with your consent and under the

authority of the OAS Act and Department of Employment and Social Development Act and will be used to

administer your pension and/or benefits under the OAS program. The information will be provided to CIC in

order to obtain proof of your date(s) of arrival and/or legal status in Canada. CIC may use and disclose

information obtained from Service Canada in the administration and enforcement of the Immigration and

Refugee Protection (IRP) Act and the Citizenship Act.

Your personal information is administered and protected in accordance with the Department of Employment

and Social Development Act, the OAS Act, the IRP Act, the Privacy Act and any other applicable law. You (or

your authorized representative) have the right to the protection of, and access to, your personal information. It

will be retained in Personal Information Banks (entitled ESDC PPU 116, PPU 053 Permanent Resident Data

System, PPU 054 Temporary Worker Records and Case File, PPU 051 Foreign Student Records and Case

File, and CIC PPU 050 Application and Assessment for Canadian Citizenship). Instructions for obtaining this

information are outlined in the government publication entitled Info Source which is available at the following

web site address: Info Source may also be accessed on-line at any Service

Canada Centre.

If you have any questions about the Old Age Security pension, contact Service Canada:

English :

1-800-277-9914

French :

1-800-277-9915

TTY :

1-800-255-4786

Internet:

From all other countries: 613-990-2244 (we accept collect calls)

Service Canada delivers Employment and Social Development Canada

programs and services for the Government of Canada.

Disponible en français

SC ISP-3210 (2015-07-21) E

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Sc Isp-3210 - Canadian Citizenship Application Form

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