PDF Version - Fill and Print (778 Kb, 1 Page)
The PDF Version - Fill & Print is the recommended format which allows applicants to complete this form electronically.
IMPORTANT ► To apply for the Certificate of Indian Status (CIS), you must first be a registered Indian as defined in the Indian Act.
Privacy Act Statement
The information you provide on this document is collected under the authority of the Privacy Act for the purpose of issuing a Certificate of Indian Status and will be stored in personal information bank no. INA/P-PU-110. Personal information that you provide is protected under the provisions of the Privacy Act.
How to Apply
You may apply in person to any of the 450 Indian Registry Administrators located in most band offices in Canada, or to any 1315096908344 office. If you need to apply by mail it must go to an AANDC Regional Office..
Applicants must provide proof of their identity to obtain a CIS. Please contact your band office or an AANDC Regional Office to obtain information on identification and other requirements.
If the above applicant is under 12 years of age the parent/guardian must complete the following:
Declaration of Applicant
I read the Privacy Act Statement above. I willingly provide my signature and photo for recording on the CIS and I certify the accuracy of the information I have provided in this application.
Applicant Mailing Address (optional)
To be completed only if the applicant wishes the CIS to be mailed, rather than picked up.
For Office Use Only
INTER 83-009E 2012-04-01