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A-509 Request for Change Application Form

A-509 Request for Change Application Form

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Request for Change Application Form

Request for Change
Any changes to a name must have the supporting documentation for example, a Marriage Certificate or Birth Certificate
A change to ethnicity must be accompanied by supporting documentation for example, a Beneficiary Enrollment Card/Letter

A: Reason for Change (To avoid delays, complete sections A through C and D if applicable. For more information refer to sections F through J on the reverse side)

Change of Address

B: Change to Personal Information
(Must be a permanent resident) * In the "Ethnicity" box, enter one of the following numbers: 1 - Inuit 2 - Registered Indian 3 - All Others

If you entered #1 or #2 in the "ethnicity" box, please see Section H

Is the change due to one of the following?
C: Change to Mailing Address & Contact Numbers (will not accept General Delivery address for Iqaluit)
D: Temporary Address Outside of Nunavut (See Section I For required documents)
Reason for Temporary Absence from Nunavut

Steps

  • Request for Change Application Form
  • Declaration
  • Information
  • Preview
  • Complete
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