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Address change request
Use this form to change your address and telephone number(s).
You can also update your address and telephone number(s) over the Internet using the
Change my address online service of My Account at
or via
the MyCRA application at
Information about you
Social insurance number
First name and initial
Last name
Year
Month Day
Date of birth:
Current mailing address we have on file
Apt no – Street no Street name
PO box
RR
City
Province/Territory
Postal code
Country, state, zip code (if outside Canada)
New mailing address
Apt no – Street no Street name
PO box
RR
City
Province/Territory
Postal code
Country, state, zip code (if outside Canada)
Effective date
Year
Month Day
Telephone numbers
Home
Work
Other
Complete the following section if your home address is different from your mailing address
Current home address we have on file (if different from above)
PO box
RR
Apt no – Street no Street name
City
Province/Territory
Postal code
Country, state, zip code (if outside Canada)
New home address (if different from above)
Apt no – Street no Street name
PO box
RR
City
Province/Territory
Postal code
Country, state, zip code (if outside Canada)
Date of move
Year
Month Day
Certification
I certify that the information given on this form is correct.
Year
Month Day
Sign here
Date
Privacy Act, notice details on page 2 of this form.
(Vous pouvez obtenir ce formulaire en français à ou en composant le 1-800-959-7383.)
RC325 E (17)