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Applicant's Guide:

Guide and Application Form for an Ex-Gratia payment to a person who was in a conjugal relationship with a now-deceased Chinese Head Tax Payer

Eligibility requirements for an ex-gratia payment to a living person who was in a conjugal relationship with a now-deceased Head Tax payer

Applications will be assessed against specific criteria to determine the eligibility of an applicant. To be eligible for a $20,000 ex‑gratia payment, the applicant must:

• have been in a conjugal relationship with a now-deceased person who, at the time of their death, met the following criteria:
  • paid the Head Tax, or on whose behalf the Head Tax was paid, in Canada or in the Dominion of Newfoundland; and
  • was a Canadian citizen, or permanent resident, or, in the opinion of the Minister of Canadian Heritage, had a long-standing connection to Canada;
• be a Canadian citizen, or permanent resident, or, in the opinion of the Minister of Canadian Heritage, have a long-standing connection to Canada; and
• have been alive on or after February 6, 2006.

All criteria must be met in order to be eligible for an ex-gratia payment.

Definition of an ex-gratia payment

An ex-gratia payment is a payment made voluntarily, for which there is no legal liability on the part of the Crown.

Signatures

Applications can be signed either by the applicant or by a person legally authorized to represent the applicant. Proof must be provided with the application form in the case of a person who is legally authorized to represent the applicant.

Supporting documents must be certified by a Commissioner for Oaths

You must submit a certified copy of each of your original documents of proof in support of your application form. Please do not provide original documents. An applicant cannot certify copies of their own documents.

Original documents must be presented to a Commissioner for Oaths who will certify that each document pertains to the applicant. A Commissioner for Oaths must certify the documents and include his or her name, profession, date and stamp or seal on the certified copy. They must also write in capital letters the following statement on the photocopy they are certifying:

I CERTIFY THAT THIS PHOTOCOPY IS A TRUE COPY OF THE ORIGINAL DOCUMENT, WHICH, TO THE BEST OF MY KNOWLEDGE, HAS NOT BEEN ALTERED IN ANY WAY.

The following, by virtue of their status, may receive oaths:

• court clerks and deputy clerks
• lawyers
• notaries
• mayors, clerks and secretary-treasurers in all municipalities, but only within the limits of their municipality
• justices of the peace

Documentation is required to assist the Department in processing your application. Failure to accurately provide any of the information or documentation requested in the application could result in a delay in processing your request for a payment.

Proof of conjugal relationship

Proof must be provided that the person was ordinarily residing with the Head Tax Payer in a conjugal relationship of some permanence that would be, as an indication, for at least a year.

One of the following could be an example of proof (list not exhaustive):

• Canadian marriage certificate
• Copy of the last will and testament of a Head Tax payer who has died indicating that the applicant is the spouse or the common law partner of the deceased
• Proof of recognition as the surviving spouse or common law partner under another federal, provincial or territorial program, such as the Canada Pension Plan (CPP)

Proof of identity

Acceptable documents for proof of identity (list not exhaustive)One or more documents should include photo identification, proof of family and given names, date of birth and current address

• Birth Certificate
• Old Age Security Card
• Passport
• Provincial driver's license
• Provincial health card
• Other Canadian identification card

Information on identity is required to process applications for an ex-gratia payment to a person, living on or after February 6, 2006, who was in a conjugal relationship with a now-deceased Head Tax payer. Documents that prove identity are required for both the applicant and the Head Tax payer.

Proof of Canadian citizenship or permanent residence documents

Acceptable documents required for proof of Canadian citizenship or permanent residence/ landed immigrant status (list not exhaustive)

Canadian citizenship
One of the following:

• Certificate of Naturalization (issued before January 1, 1947)
• Certificate of Canadian Citizenship (issued between January 1, 1947 and February 14, 1977)
• Registration of Birth Abroad Certificate (issued between January 1, 1947 and February 14, 1977)
• Canadian Passport

Permanent residence/landed immigrant status
One of the following:

• Immigration Record of Landing (form IMM1000)
• Confirmation of Permanent Residence (form IMM 5292)
• Permanent Resident Card (wallet-sized card) (issued June 2002 or later)
• Verification of admission/entry (certified copy of immigration record, issued by Citizenship and Immigration Canada)

If an applicant cannot provide documents to prove he or she is a Canadian citizen or permanent resident, a search of historical records of Citizenship and Immigration Canada and/or Library and Archives Canada will be undertaken, upon the consent of the applicant, to verify his or her personal information provided in the application (see consent #2 on page 11). If the applicant cannot provide documents to prove the Head Tax payer was a Canadian citizen or permanent resident, a search of personal information will be undertaken by the federal partners mentioned above and will be made in accordance with the Privacy Act.

If the applicant is not a permanent resident or a Canadian citizen, additional information will be required to determine if the applicant has a long-standing connection to Canada in order to be eligible for the payment. This also applies to a Head Tax payer who was not a permanent resident or a Canadian citizen. If this is the case, please contact the Department of Canadian Heritage at 1-888-776-8584.

Proof of Head Tax payment

Acceptable documents or information required for proof of Head Tax payment

• Certified copy of Head Tax certificate
• Head Tax certificate number
• Port of entry
• Ship of entry
• Date of entry

If an applicant cannot provide documents or information to prove that the Head Tax was paid, a search of historical records by Library and Archives Canada and Citizenship and Immigration Canada will be undertaken. Verification involving disclosure of personal information of the Head Tax payer will be made in accordance with the Privacy Act.

Proof of death

Acceptable documents required for proof of Head Tax payer's death (list not exhaustive)One of the following:

• Death certificate
• Obituary notices
• Provincial vital statistics

Documentary evidence that a Head Tax payer is now-deceased must be provided to substantiate the application by an applicant. Verification involving disclosure of personal information of the Head Tax payer will be made in accordance with the Canada Pension Plan (CPP).

Designated beneficiary

In the event the applicant is assessed as eligible to receive a payment but dies prior to the payment being made, a designated beneficiary, not the applicant's estate, will receive the payment. If no beneficiary has been designated in the application form or if the designated beneficiary has also died, no payment will be made.

Privacy statement

The information contained in this form is required for the purpose of issuing an ex-gratia payment to a person, living on or after February 6, 2006, who was in a conjugal relationship with a now-deceased Head Tax payer. Providing this information is voluntary and not required by law. However, if this information is not provided, an application cannot be processed and no ex-gratia payment can be issued.

In order for an ex-gratia payment to be processed and issued, Canadian Heritage will need to verify the veracity of the information submitted. The consent section must be signed to allow Library and Archives Canada and Citizenship and Immigration Canada to verify the personal information the applicant has provided (Consent #1, see page 11). Should an applicant be unable to provide some or all supporting documents regarding his or her personal information, a second consent is required to allow a records search by federal partners (Consent #2, see page 11). Concerning the identity and the existence of a conjugal relationship, this is a written request to the Minister of Human Resources and Social Development Canada to disclose personal information to Canadian Heritage as required by the provisions of the Old Age Security Act and Canada Pension Plan (Request, see p. 11).

Note that verification involving disclosure of personal information of the Head Tax payer will be made in accordance with the Privacy Act, Old Age Security Act (OASA) and Canada Pension Plan (CPP).

Affidavit

The applicant must take the application form to a Commissioner for Oaths to make oath or declare that the information on the application is true and accurate. Knowingly making a false or fraudulent application could result in criminal prosecution.

Application deadline

The application deadline is March 31, 2008. Where an application is submitted after March 31, 2008, the application may be accepted if the Minister of Canadian Heritage is satisfied that theapplicant was unable to submit the application before that date because of facts or circumstances beyond the control of the applicant.

Payment receipt

Eligible applicants will receive one cheque of $20,000, by mail.

To obtain an application form

Application guides and forms in both official languages (English and French) are available online or by contacting Canadian Heritage at 1-888-776-8584. Application guides and forms are also available at any of the 323 Service Canada centres throughout the country. For the Service Canada centre near you, contact the national 1-800-O-Canada call centre at 1-800-622-6232 or for online services, through servicecanada.gc.ca. Service Canada also offers TTY, or teletypewriter service (a telecommunications device for hearing-and speech-impaired persons), at 1-800-926-9105.

Application forms must be completed in English or in French. However, as a reference tool, application forms and guide are available in Chinese from Canadian Heritage (traditional and simplified).

Forms must be mailed to the following address:

Checklist
	Certified proof of applicant's family name(s) and given name(s), date of birth and current address
	Certified proof of applicant's Canadian citizenship or permanent residence status
	Certified proof of Head Tax payer's family name(s) and given name(s), date of birth and address before death
	Certified proof of Head Tax payer's Canadian citizenship or permanent residence status
	Certified death certificate of Head Tax payer
	Certified proof of Head Tax paid (if not available, then date of entry to Canada or the Dominion of Newfoundland, port of entry or ship of entry)
	Certified proof of conjugal relationship
	Signature of applicant or legal representative on privacy statement (Request, Consent #1 and Consent #2)
	Signature of applicant or legal representative on Affidavit
	Signature of Commissioner for Oaths to certify each document of proof
	Signature of Commissioner for Oaths to certify the Affidavit
	If applicable, certified proof that person is legal representative of applicant