Form SC ISP-3210 "Consent to Exchange Information With Citizenship and Immigration Canada" - Canada

Form SC ISP-3210 or the "Consent To Exchange Information With Citizenship And Immigration Canada" is a form issued by the Service Canada.

The form was last revised in June 30, 2016 and is available for digital filing. Download an up-to-date fillable Form SC ISP-3210 in PDF-format down below or look it up on the Service Canada Forms website.

ADVERTISEMENT
ADVERTISEMENT

Download Form SC ISP-3210 "Consent to Exchange Information With Citizenship and Immigration Canada" - Canada

681 times
Rate (4.3 / 5) 46 votes
Service
PROTECTED B (when completed)
Canada
Consent to Exchange Information with Citizenship
and Immigration Canada
Service Canada requires proof of your immigration into Canada and your legal status to complete your
application for a pension or supplementary benefit under the Old Age Security (OAS) program. You are
required to provide proof of your:
- Date(s) of arrival in Canada; and/or
- Legal status in Canada.
If you do not have the required Citizenship and Immigration documentation, you have two options:
1. Complete this consent form: With your consent, this form allows us to collect your information and
provide it to Citizenship and Immigration Canada (CIC) in order to obtain immigration or citizenship
information on your behalf. The signed consent form and response from CIC will be added to your file and
used to determine your eligibility and entitlement to an OAS pension and/or benefits and administer the
OAS Program. Completing and returning this form may expedite the application process.
This consent form will be valid for two years from when it is received by Service Canada and must be
received within one year of your signing it. You may withdraw your consent at any time, but you must do
so in writing. The consent form is no longer valid in the event of your death.
2. Contact CIC directly to request documentation. CIC requires you to pay a fee. Please see CIC's
website (www.cic.gc.ca/english/index.asp) for further information.
Protect your privacy
The information provided on this form is collected by Service Canada with your consent and under the
authority of the OAS Act and Department of Employment and Social Development Act and will be used to
administer your pension and/or benefits under the OAS program. The information will be provided to CIC in
order to obtain proof of your date(s) of arrival and/or legal status in Canada. CIC may use and disclose
information obtained from Service Canada in the administration and enforcement of the Immigration and
Refugee Protection (IRP) Act and the Citizenship Act.
Your personal information is administered and protected in accordance with the Department of Employment
and Social Development Act, the OAS Act, the IRP Act, the Privacy Act and any other applicable law. You (or
your authorized representative) have the right to the protection of, and access to, your personal information. It
will be retained in Personal Information Banks (entitled ESDC PPU 116, PPU 053 Permanent Resident Data
System, PPU 054 Temporary Worker Records and Case File, PPU 051 Foreign Student Records and Case
File, and CIC PPU 050 Application and Assessment for Canadian Citizenship). Instructions for obtaining this
information are outlined in the government publication entitled Info Source which is available at the following
web site address: http://www.infosource.gc.ca. Info Source may also be accessed on-line at any Service
Canada Centre.
If you have any questions about the Old Age Security pension, contact Service Canada:
English :
1-800-277-9914
French :
1-800-277-9915
TTY :
1-800-255-4786
Internet:
www.servicecanada.gc.ca
From all other countries: 613-957-1954 (we accept collect calls)
Service Canada delivers Employment and Social Development Canada
programs and services for the Government of Canada.
Disponible en français
SC ISP-3210 (2016-06-30) E
of 3
Service
PROTECTED B (when completed)
Canada
Consent to Exchange Information with Citizenship
and Immigration Canada
Service Canada requires proof of your immigration into Canada and your legal status to complete your
application for a pension or supplementary benefit under the Old Age Security (OAS) program. You are
required to provide proof of your:
- Date(s) of arrival in Canada; and/or
- Legal status in Canada.
If you do not have the required Citizenship and Immigration documentation, you have two options:
1. Complete this consent form: With your consent, this form allows us to collect your information and
provide it to Citizenship and Immigration Canada (CIC) in order to obtain immigration or citizenship
information on your behalf. The signed consent form and response from CIC will be added to your file and
used to determine your eligibility and entitlement to an OAS pension and/or benefits and administer the
OAS Program. Completing and returning this form may expedite the application process.
This consent form will be valid for two years from when it is received by Service Canada and must be
received within one year of your signing it. You may withdraw your consent at any time, but you must do
so in writing. The consent form is no longer valid in the event of your death.
2. Contact CIC directly to request documentation. CIC requires you to pay a fee. Please see CIC's
website (www.cic.gc.ca/english/index.asp) for further information.
Protect your privacy
The information provided on this form is collected by Service Canada with your consent and under the
authority of the OAS Act and Department of Employment and Social Development Act and will be used to
administer your pension and/or benefits under the OAS program. The information will be provided to CIC in
order to obtain proof of your date(s) of arrival and/or legal status in Canada. CIC may use and disclose
information obtained from Service Canada in the administration and enforcement of the Immigration and
Refugee Protection (IRP) Act and the Citizenship Act.
Your personal information is administered and protected in accordance with the Department of Employment
and Social Development Act, the OAS Act, the IRP Act, the Privacy Act and any other applicable law. You (or
your authorized representative) have the right to the protection of, and access to, your personal information. It
will be retained in Personal Information Banks (entitled ESDC PPU 116, PPU 053 Permanent Resident Data
System, PPU 054 Temporary Worker Records and Case File, PPU 051 Foreign Student Records and Case
File, and CIC PPU 050 Application and Assessment for Canadian Citizenship). Instructions for obtaining this
information are outlined in the government publication entitled Info Source which is available at the following
web site address: http://www.infosource.gc.ca. Info Source may also be accessed on-line at any Service
Canada Centre.
If you have any questions about the Old Age Security pension, contact Service Canada:
English :
1-800-277-9914
French :
1-800-277-9915
TTY :
1-800-255-4786
Internet:
www.servicecanada.gc.ca
From all other countries: 613-957-1954 (we accept collect calls)
Service Canada delivers Employment and Social Development Canada
programs and services for the Government of Canada.
Disponible en français
SC ISP-3210 (2016-06-30) E
of 3
Service
PROTECTED B (when completed)
Canada
Consent to Exchange Information with Citizenship
and Immigration Canada
PART A - CURRENT PERSONAL DETAILS
(Please note that all fields are mandatory. If you do not have the
information requested, please state “unknown” in the space provided.)
3. Sex
1. Current Surname
2. Current Given name(s)
Male
Female
4. Date of Birth (YYYY-MM-DD) 5. Place of Birth - City
Province / State
Country
6. Are you
Permanent Resident 7. Language of correspondence
Canadian Citizen
English
French
8. Mailing address
No.
Street Name
Apt. No.
P.O. Box
R.R.
City / Town or Village
Province / Territory
Country
Postal Code
9. Current Passport No.
10. Date of Issue (YYYY-MM-DD)
11. Expiry Date (YYYY-MM-DD)
PART B - DETAILS ON ENTRY
(Please note that all fields are mandatory. If you do not have the information
requested, please state “unknown” in the space provided.)
1. Citizenship & Immigration Canada Unique Client Identifier or Client ID number
2. Surname (Family name) on entry was
3. Given name(s) on entry
4. Marital status on entry
5. If you were married on entry, was your
spouse a Canadian citizen or permanent
Never Married
Married
Widowed
resident?
Separated
Divorced
Yes
No
Common-law partner
6. Passport number on Entry, if known 7. Date of Issue (YYYY-MM-DD) 8. Expiry Date (YYYY-MM-DD)
9. Date of Entry in Canada
10. a) Canadian port of entry
10. b) Immigration document - Place of Issue
(YYYY-MM-DD)
11. Did you enter Canada as a
Visitor
Student
Worker
Permanent Resident
Unknown
Other (specify)
Service Canada delivers Employment and Social Development Canada
programs and services for the Government of Canada.
SC ISP-3210 (2016-06-30) E
of 3
PROTECTED B (when completed)
12. List all names you have ever used.
Other name(s)
Date of Birth
Surname (Family Name)
Given name(s)
(Middle name, maiden
name, alias, initials, etc.)
YYYY-MM-DD
PART C - IF YOU ENTERED CANADA AS A PERMANENT RESIDENT PRIOR TO 1973, COMPLETE THE
FOLLOWING SECTION
(If you are completing this section, please note that all fields are mandatory. If you
do not have the information requested, please state “unknown” in the space provided.)
1. Provide the full names and date of birth of the person(s) who accompanied you on arrival in Canada.
(e.g., middle name, maiden name, English name or alias.)
Other name(s)
Date of Birth
Surname (Family Name)
Given name(s)
(Middle name, maiden
name, alias, initials, etc.)
YYYY-MM-DD
2. Were either of your parents born Canadian Citizens?
Yes
No
3. What are the names and dates of birth of your parents?
Other name(s)
Date of Birth
Surname (Family Name)
Given name(s)
(Middle name, maiden
name, alias, initials, etc.)
YYYY-MM-DD
PART D - PROVISION OF CONSENT
I acknowledge I have read and understand the contents of this form. I hereby provide my consent allowing
Service Canada to collect the above information, provide it to Citizenship and Immigration Canada (CIC), and
obtain information from CIC that will be used to determine my eligibility and entitlement to an OAS pension
and/or benefits and administer the OAS Program. My consent also allows CIC to use and disclose the
information for the purposes of the administration and enforcement of the Immigration and Refugee Protection
Act and the Citizenship Act.
Date of Signature (YYYY-MM-DD)
Signature
SC ISP-3210 (2016-06-30) E
of 3
Page of 4