Registration and Secure Certificate of Indian Status (in-Canada SCIS) Statutory Declaration in Lieu of Guarantor
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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.
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.
This form must be completed and signed before a Commissioner for Oaths, Notary Public or Lawyer.
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