Social Insurance Number Application (SIN)

Application Type

Type

Other - Specify Description

Applicant's Information

First Given Name

Other Given Name(s)

Family Name

Preferred Name

Date of Birth

Day Time Telephone Number

Evening Telephone Number

Language of Correspondence

Applicant's Gender

Applicant Gender

Check if the applicant is a twin, triplet, etc

Applicant's Birth Place

City, Town or Village

Country

Name of the Country

Province/Territory/State

Applicant's Family Name

Family Name at Birth

Other Family Name(s) Previously Used

Applicant's Parent

Given Name(s)

Family Name at Birth

Applicant's Parent

Given Name(s)

Family Name at Birth

Status

Is the Applicant Currently Residing in Canada?

NoYes

Applicant Status in Canada

Social Insurance Number

Did the Applicant ever have a SIN Number?

If Yes, Write the Nine Digit Number

Mailing Address

In care of (if different than the Applicant’s Name )

Apartment, suite or unit No.

Number and Street

City,Town or Village

Country

Name of the Country

Province/Territory/State

Postal/Zip Code

Privacy Statement

The personal information you provide is collected under the authority of the Employment Insurance Act (EIA) and the Department of Employment and Social Development Act (DESDA) for the purpose of assigning a Social Insurance Number (SIN) to you or your child. Participation is voluntary; however, refusal to provide your personal information will result in you or your child not receiving a SIN. The information you provide may be shared with federal departments and agencies that are authorized users of the SIN and in accordance with the Treasury Board Secretariat Directive on the Social Insurance Number for the administration of benefits and services; and/or with federal and provincial departments for the administration and enforcement of the legislation for which they are responsible. The information may also be used and/or disclosed for policy analysis, research and/or evaluation purposes, however, these additional uses and/or disclosures of your personal information will not result in an administrative decision being made about you. You have the right to the protection of, access to, and correction of personal information, which is described in the Personal Information Bank (ESDC PPU 390 Social Insurance Number Register).Instructions for obtaining this information is outlined in the following government publication entitledInformation about programs and information holdings.You have the right to file a complaint with the Privacy Commissioner of Canada regarding the institution’s handling of your personal information.

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Social Insurance Number Application (SIN)