IN-CANADA Secure Certificate of Indian Status (SCIS) Parent or Legal Guardian Application For Applicants Fifteen (15) Years of Age or Younger or a Dependent Adult

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Protected B (When Completed)

Privacy Act Statement

Personal information provided in this document is collected by Aboriginal Affairs and Northern Development Canada (AANDC) under the authority of the Indian Act . Individuals have the right to the protection of and access to their personal information under the Privacy Act . The information provided is voluntary. Failure to provide sufficient information may render the application invalid or may result in processing delays. Information provided is subject to routine verifications, including verifications against the Indian Register. AANDC may, for the purpose of receiving and processing applications, collect personal information from Indian Registry Administrators. Furthermore, personal information will be disclosed to a third party for the purpose of printing the SCIS . In the performance of these duties, personal information will be processed and used in accordance with the provisions of the Privacy Act . Further details on the collection, use and disclosure of personal information are described under the Personal Information Bank INA PPU 110 .

Helpful Tips for Completing a SCIS Application for a Child or Dependent Adult

  • Complete all sections and sign the application. Failure to complete all the sections of this form and submit all necessary documentation will result in the application being refused and returned to you.
  • Child’s or Dependent Adult’s Information (Section A)
    If the child’s or dependent adult’s name in Section A differs from that on their birth certificate, the following original documents may be required: adoption order, legal name change, marriage certificate, other court orders. If the name differs from that in the Indian Register, a change to the child’s or dependent adult’s information in the Indian Registry System must be processed by an Indian Registry Administrator or at an AANDC Regional Office prior to applying for the SCIS.
  • Proof of Birth (Section B)
    The child’s or dependent adult’s original birth certificate must be submitted. The birth certificate accompanying a child’s application must show the names of the parent(s). Please note: If the child or dependent adult was born in Manitoba, Manitoba Division/District Registrar birth certificates are not accepted. If the dependent adult was born in the province of Quebec, only birth certificates issued on or after January 1,1994, by the Directeur de l’état civil will be accepted. If the dependent adult is 65 years of age or older, a baptismal certificate issued by a church is acceptable.
  • Previous Secure Certificate of Indian Status (SCIS) (Section C – replacement or renewal applications only)
    If the child or dependent adult has been previously issued a SCIS, it must be presented regardless of its validity. If the child’s or dependent adult’s SCIS has been lost, stolen, damaged or destroyed, a Statutory Declaration (83-113E), completed and signed in the presence of a Commissioner for oaths, Notary Public or Lawyer, must also be submitted.
  • Documents to support your identity as the applicant on behalf
    of the child or dependent adult
    (Section F)
    Provide one (1) valid government issued identity document with your name, photo and signature. Where the name on the identity document presented differs from the name listed on the birth certificate or custody order provided, name-linking documents (e.g., marriage certificate) will be required. Where a legal guardian is applying on behalf of a child or dependent adult, please enclose a copy of the Order of Trusteeship or Guardianship.
  • Activation Code (Section H)
    Select a four digit numeric activation code. You will be required to write the activation code twice. IMPORTANT: Please be sure to tear off your portion of the activation code. Upon receipt of the child’s or dependent adult’s SCIS , you will be required to activate their SCIS via telephone using the selected activation code.
  • Photographs
    Two (2) unaltered, identical, commercial grade, passport style photographs of the child or dependent adult are required to be submitted with the child’s or dependent adult’s application. See the Photographs section for SCIS photo specifications.
  • Mail-in applications
    If you are applying on behalf of the child or dependent adult for a SCIS by mail, a Guarantor Declaration (83-111E) must be signed and completed. The guarantor must also sign the back of one (1) passport style photograph of the child/dependent adult and a photocopy (both sides) of each document to support your identity as the applicant. An original birth certificate and any name-linking documents must be included and will be returned to you by mail after they have been processed. Applications are to be mailed to:
    SCIS National Processing Unit, 10 Wellington Street, Gatineau, QC K1A 0H4 .

Further information regarding the Secure Certificate of Indian Status is available by telephoning toll-free 1-800-567-9604, e-mailing InfoPubs@aandc-aadnc.gc.ca or viewing the AANDC website

 

Photographs

Important: Two (2) unaltered, identical, commercial grade, passport style photographs are required to be submitted with the child’s/dependent adult’s application.

Size and paper

  • The length of the face on the photographs from chin to crown (natural top) of head must be between 31 mm (1 1/4 in.) and 36 mm (1 7/16 in.).
  • Photographs must measure 50 mm x 70 mm in size (2 inches wide x 2 3/4 inches long).
  • Photographs must be a close-up of the head and shoulders so that the face covers approximately 25% of the photograph.
  • Photographs must be printed on plain, high quality photographic paper. Heavyweight paper is not acceptable.
  • Colour or black and white photographs are acceptable.

Image information

  • The photographs provided will be printed on the SCIS .
  • Photographs must be taken against a plain white or light-coloured background so that the applicant’s features are clearly distinguishable against the background.
  • Shadows are unacceptable. Lighting must be uniform to avoid shadows across the face or shoulders, around the ears or in the background.
  • There must be no reflection or glare on the face or glasses.
  • The applicant must show a neutral facial expression (no smiling, mouth closed).
  • Eyes must be open and clearly visible. Glasses, including tinted prescription glasses, are acceptable as long as the eyes are clearly visible and there is no glare in the glasses.
  • Sunglasses are unacceptable.
  • Photographs must show a full head without any head covering, unless worn for religious or medical reasons. However, both edges of the face must be clearly visible.
  • Photographs must show a full front view of the applicant's face and top of the applicant's shoulders must be squared to the camera (the image of the applicant's face and shoulders must be centred in the photograph).
  • Photographs must be clear, sharp and in focus.
  • Photographs must be original and not taken from an existing photograph.
  • Photographs must have been taken within the last 12 months.

Photographer

  • The name of the photographer or studio, the address and the date the photograph was taken (not the date the photograph was printed) must be provided directly on the back of one photograph.
  • Ensure your guarantor signs the back of one (1) photo, if you are submitting your application by mail.

Please Note – U.S. passport specifications are not the same and do not meet SCIS photo specifications.

Notice To All Applicants

The SCIS remains at all times the property of the Government of Canada and must only be used 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 a SCIS or permitting any other individual or agency to use your SCIS may lead to criminal prosecution and is cause for revocation of the SCIS and refusal of future SCIS issuance.

Reason for application: (Please check one)

  _  Initial SCIS
  _  Replacement SCIS
  _  Renewal SCIS

 

A Child's or Dependent Adult's Information

(Complete in block letters using black or dark blue ink)

1. Family Name (Last name)


2. Given Name(s)


3. Alias


4. Family Name (Last Name) at Birth (If different from above, name-linking documents must be provided)


5. Date of Birth (YYYYMMDD)



6. Sex

  _ M   _ F
7. Indian Registration No.

 


8. Band Name


9. Is this application for a Dependent Adult?

  _ Yes   _ No

If Yes , please include a copy of the Order of Trusteeship or Guardianship with the application.

10. Mailing Address (Address where the SCIS will be sent) Number/Street/Apartment/P.O.Box



City/Town



Province/Territory/
State



Postal/ZIP Code




 

B Proof of Birth

Please check one

  _ Original birth certificate issued by a Vital Statistics Agency in a Canadian Province or Territory

OR

  _ Original birth certificate issued by a U.S. State/County/City/Township

OR

  _ Original birth certificate issued by a non-U.S. or non-Canadian jurisdiction

OR

  _ Original baptismal certificate issued by a church, if dependent adult is 65 years of age or older

 

C Child's or Dependent Adult's Secure Certificate of Indian Status (SCIS)

(Complete if the child or dependent adult has been previously issued a SCIS regardless of its validity.)

1. Serial No.


2. Renewal Date (YYYYMMDD)


Note:If the child’s or dependent adult’s SCIS, regardless of its validity is lost, stolen, damaged or destroyed, a SCIS Statutory Declaration Concerning a Lost, Stolen, Damaged or Destroyed SCIS (83-113E) must also be completed.

 

D Custody of Child

1. Is the child subject to an adoption case?

  _ Yes   _ No
2. Are there any separation agreements, court orders or legal proceedings pertaining to the custody of the child?

  _ Yes   _ No




If Yes, include all related legal documentation pertaining to the adoption case or to the custody of the child.




 

E Applicant (Parent or Legal Guardian) Information

1. Family Name (Last Name)


2. Given Name(s)


3. Sex


  _ M   _ F

4. Indian Registration No. (if applicable)




5. Relationship to Child or Dependent Adult (e.g. Parent, Legal Guardian)



6. Mailing Address (If different than
indicated in Section A)

Number/Street/Apartment/P.O.Box
City/Town




Province/Territory
/State




Postal/ZIP Code





7. Telephone No. (Daytime)

(      )


8. Telephone No. (Evening)

(      )


 

F Documents to Support Parent's/Legal Guardian's Identity

Document Type



Document No.



Expiry Date
(YYYYMMDD)


Name of Bearer as it appears on document


Note: If the name on the identity document provided differs from the name on the birth certificate or legal document provided, name-linking documents (e.g. marriage certificate) will be required.

 

G Declaration

REMINDER: Complete all sections and sign the application. Failure to complete all the sections of this form and submit all necessary documentation will result in the application being refused and returned to you.
I solemnly declare that I am the parent or legal guardian of the child or dependent adult and that the photos enclosed are a true likeness of the child or dependent adult. I solemnly declare any documents provided to support the child's or dependent adult's application are unaltered and that all of the statements made in this application are true. I solemnly declare that I have read and understood the Privacy Act Statement and the Notice to All Applicants.
Signature of Applicant (Parent or Legal Guardian)

X
Date (YYYYMMDD)



 

H Activation Code

Please select a four (4) digit numeric activation code and record the same code in both of the sections provided (below).

Note: This is the code that you will use to activate your SCIS upon receipt.

 

 



INTER 83-131E 2012-10-01 7540-20-006-5043


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SCIS ACTIVATION CODE (Tear-Off along the Dotted Line)

Instructions on how to activate your SCIS using this four (4) digit activation code will accompany your SCIS .

Tear this section and keep it safe.
SCIS Activation Code: