Registration and Secure Certificate of Indian Status (in-Canada SCIS) Guarantor Declaration

PDF Version - Fill & Print   (81 Kb, 2 Pages)

PDF Version   (61 Kb, 2 Pages)

The PDF Version - Fill & Print is the recommended format which allows applicants to complete this form electronically.

 


PROTECTED B

Privacy Act Statement

The personal information provided in this document is collected under the authority of the Indian Act to determine the applicant's entitlement to inclusion in the Indian Register and, if applicable, in a Band List maintained by the department of Indian Affairs and Northern development (DIAND), and to obtain an in-Canada format of a Secure Certificate of Indian Status (in-Canada SCIS). The applicant has the right to the protection of and access to his or her personal information under the Privacy Act. The personal information will be retained indefinitely by DIAND. Details of the collection, use, disclosure and retention of personal information are described in the Personal Information Bank INA PPU 110.

General Information

A guarantor is a person other than the applicant (the adult who is applying or the parent/legal guardian who is applying on behalf of a child or dependent adult) who confirms the identity of the applicant.

The guarantor:

  • must perform the following tasks free of charge:
    • Complete and sign the Guarantor Declaration form (83-120E).

    • Write "This is a true likeness of (the name of applicant or child or dependent adult)" on the back of ONE (1) of the two up-to-date passport-style photographs. The guarantor must also sign and date the back of the photograph (as applicable).

    • Sign and date a copy of the front and back of the documents that support the applicant's identity (as applicable).

  • must be 18 years of age or older.

  • must have known the applicant personally for at least TWO (2) years. To know an applicant personally means that the guarantor is able to confirm aspects of the applicant's personal attributes such as name, approximate age, place of birth, physical description and some personal history such as place of residence.

  • must be accessible for INAC to contact.

  • must be residing in Canada or the United States.

If an eligible guarantor who has known the applicant for at least TWO (2) years cannot be located, the applicant must complete a Statutory Declaration in Lieu of Guarantor (83-119E) and provide TWO (2) references who are not relatives. The Registration and Secure Certificate of Indian Status (in-Canada SCIS) Statutory Declaration in Lieu of Guarantor must be completed before a Commissioner for Oaths, Notary Public or Lawyer.

The guarantor must be someone from the following list:

  • Indian Registrar or an Indian Registry Administrator

  • Elected chief or councillor of the applicant's or child/dependent adult's band

  • Dentist, medical doctor, optometrist, pharmacist or chiropractor

  • Judge, magistrate or police officer (reserve, municipal, provincial, territorial or RCMP)

  • Lawyer

  • Mayor

  • Minister of a religion authorized under a provincial or territorial law to perform marriages

  • Notary public

  • Postmaster/Postmistress

  • Principal of a primary or secondary school

  • Professional accountant

  • Professional engineer

  • Senior administrator or teacher in a community college or university

  • Registered social worker

  • Veterinarian

Family members as guarantors

Family members may act as guarantors if they are 18 years of age or older, residing in Canada or the United States, are available to be contacted by INAC for verification, AND meet the criteria above.

Please note that a parent or legal guardian applying for Registration and in-Canada SCIS on behalf of a child or dependent adult cannot act as a guarantor for the child or dependent adult.


NOTICE TO ALL APPLICANTS

The in-Canada SCIS remains at all times the property of the Government of Canada and must be used only by the person in whose name it is issued. Any false or misleading statements on this form or relating to any document in support of this application, including concealment of any material fact, selling the in-Canada SCIS or permitting any other individual or agency to use the in-Canada SCIS may lead to criminal prosecution and is cause for revocation of the in-Canada SCIS and refusal of any future SCIS issuance.

Applicant Information

(Complete in block letters using black or dark blue ink and in the presence of the guarantor)

Note: For purposes of this guarantor declaration, the applicant is the adult applying for registration or the parent/legal guardian applying on behalf of a child (15 years of age or younger) or dependent adult.

Complete the following only if Guarantor Declaration is in support of a Child/Dependent Adult Application:

Guarantor Information and Declaration

3. Address of Permanent Residence:
 (See list above)
 years. (minimum of 2 years)

Instructions for Guarantors: Write "This is a true likeness of (the name of applicant or child or dependent adult)" on the back of ONE (1) of the two photographs. The guarantor must also sign and date the back of the photograph AND sign and date a copy of the front and back of the documents that support the applicant's identity (as applicable).

I solemnly declare that I am at least 18 years of age and that I have known the applicant identified above personally for at least TWO (2) years. I have signed the back of one photo and confirm that the image is a true likeness of the applicant, child or dependent adult, if required. I have signed a copy of each document to support the applicant's identity confirming that I have seen the original(s). I declare that any false or misleading statement on this Guarantor Declaration or relating to any document in support of this application, including concealment of any material fact, may lead to refusal or revocation of a SCIS and be grounds for criminal prosecution.

 

INTER 83-120E 2011-01-31