EBBI Citizenship Assessment — Client Intake (Blank)

How to fill this out: Write dates as Day / Month / Year (e.g. 04 / 07 / 2026). Where a question does not apply, write N/A. Print clearly in block letters. Return by mail, in person, or scan and email to admin@explorebeyondborders.ca. Expected response: 2–3 business days.

1. Which Situation Applies?

Note: This form is for Permanent Residents applying for citizenship (Grant) or former citizens seeking resumption only. If you believe you may be eligible for citizenship through a Canadian parent or grandparent (citizenship by descent), please contact EBBI directly at admin@explorebeyondborders.ca, (647) 780-4069, WhatsApp, or Facebook Messenger to discuss your situation individually, rather than using this form.

Select all that apply

I am a Permanent Resident applying for citizenship for the first time (Grant)I was previously a Canadian citizen and am seeking to resume my citizenship

2. Personal Information

Last Name

First Name

Date of Birth (D/M/Y)

UCI (Unique Client Identifier) Number

Email Address

Phone Number

Date You Became a Permanent Resident (D/M/Y)

3. Physical Presence History

Citizenship requires 1,095 days of physical presence in Canada within the 5 years before you apply. The questions below help EBBI calculate this accurately on your behalf — we do not expect you to do this math yourself. Time spent in any of these situations does not count toward physical presence and may affect eligibility timing. Time outside Canada as a Crown servant or their family member can count at full value toward physical presence, as an exception to normal rules.

Did you spend any time in Canada as a temporary resident (work permit, study permit, or as a protected person) BEFORE becoming a Permanent Resident?

YesNo - I became a PR directly

If yes, approximate start date of that temporary status period (D/M/Y)

If yes, approximate end date (when you became a PR) (D/M/Y)

Please list all trips OUTSIDE Canada since becoming a Permanent Resident, with approximate dates. Include the most recent 5 years at minimum — more history is helpful if you have it.

Have you ever served time in prison, been on parole, or been on probation in Canada? NoYes

If yes, briefly describe (dates, circumstances)

Were you, or your spouse/parent, ever a Crown servant (e.g. Canadian Armed Forces, federal public service) posted outside Canada during this period? NoYes

4. Other Eligibility Factors

Applicants aged 18-54 must demonstrate language ability (English or French) and pass a citizenship knowledge test. These requirements may not apply outside this age range.

Have you filed Canadian income tax returns for at least 3 of the last 5 tax years (if required to file under Canadian tax law)?

YesNoNot required to file (please explain below)Not sure

If "Not Required" or "Not Sure," please explain

Your current age

Have you taken an approved English or French language test, or do you have other proof of language ability (e.g. study in an English/French program)?

Yes - language test takenYes - other proof (school, work, etc.)No - not yetNot applicable (outside 18-54 age range)

Are you currently under any review, investigation, or proceeding related to immigration or fraud concerns? NoYes

If yes, briefly describe

5. Document Status

Check all documents you currently have ready.

Documents ready — check all that apply

PR Card (current or expired)Valid passportConfirmation of Permanent Residence (COPR)Detailed travel history / passport stampsNotices of Assessment / tax filing recordsLanguage test results (if applicable)

Additional Information / Anything Else We Should Know

Client Declaration

I declare that the information provided is true, complete, and accurate to the best of my knowledge. This form is for assessment only, does not constitute legal advice, and does not guarantee any immigration outcome. I have read the Privacy Policy and Legal Notice at explorebeyondborders.ca. I authorize EBBI to share this information with supervising counsel, Atty. George M. Garvida.

☐ I have read and agree to the above declaration

Full name (print)

Signature

Date (D/M/Y)

For EBBI Staff Use Only

Received by

Date received (D/M/Y)

Reference code assigned

Pathway flagged

Online option: explorebeyondborders.ca/immigration-citizenship-assessment.html · Legal Notice: explorebeyondborders.ca/legal-disclaimer.html