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REQUEST FOR A CHANGE OF SEX OR GENDER IDENTIFIER

Note: Historical records, such as immigration record of landing, IMM 1000 or Confirmation of Permanent Residence document will not be amended unless a
clerical or administrative error was made by IRCC.

I, , born on in ,
(current legal name of applicant in full) (YYYY-MM-DD) (city, state/province, country)

request a change in sex or gender identifier from to

my Certificate of Canadian Citizenship

my Permanent Resident Card

my Temporary Resident Document (Visitor Visa, Temporary Resident Permit, Study Permit or Work Permit)

my document issued to a Protected Person

my Refugee Protection Claimant Document

By signing below, I acknowledge that my Immigration, Refugees and Citizenship Canada (IRCC) document may not be universally accepted for entry or exit by
border authorities of another country, especially if the sex or gender identifier is different from my other identification, including my passport or travel
document. It is my responsibility to check with the High Commission, Embassy or Consulate of all the countries that I intend to visit, transit through or where I
intend to reside to enquire about entry requirement that may affect me.

Name of applicant (current legal name in full) Signature of applicant Date (YYYY-MM-DD)

If co-signature of parent(s)/legal guardian(s) is required as per your application:

If a change of sex or gender identifier is being requested for an individual under 18 years of age, both the applicant and their parent or legal guardian will need
to sign and provide proof of parentage or legal guardianship, as stipulated within the appropriate jurisdiction.

Name of parent/legal guardian (current legal name in full) Signature of parent/legal guardian Date (YYYY-MM-DD)

Signed at:

city/town/village state/province country

IRM 0002 (03-2021) E (DISPONIBLE EN FRANÇAIS - IRM 0002 F)