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H (if different from above) Your first name, initial and last name FOR OFFICE USE ONLY 4. Date of birth (YYYY-MM-DD) Age established Important: You do not need to provide proof of birth with your application. However, the Old Age Security program has the right to request proof of birth at any time, when deemed necessary. 5. Country of birth (if born in Canada, indicate province 6. Preferred language for correspondence or territory) English French 7A. Home address No., Street, Apt. No.,.

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