canadian passport abroad f04k5m

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Adult and Child Canadian Passport Application Pack for Applicants Abroad

1

Welcome to the Adult and Child Canadian PassportApplication Pack Abroad!

This application is both for adults (over 16) and children (under 16) whoare Canadian Citizens applying from abroad (outside USA and Bermuda)

How To Use This Kit:

Step 1: Read the instructions provided to you.Step 2: Fill out the Canadian Passport Application form.Step 3: Submit your form with documents and fee.


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2

Index:

How do I qualify for a Canadian passport 3

Proof of Canadian Citizenship 4

Proof of your ID 5

Photo requirements 6

Provide a guarantor 7

Pay the Fee 8

Where do I apply? 9

Processing time 10

Upon receipt of your Passport 11

Appendix A

Application Form Adult

Appendix B

Application Form Child

Appendix C

Proof of Canadian Citizenship Form PPTC 001

Appendix D

Statutory declaration concerning a lost, stolen, found, damaged orinaccessible passport PPTC 203

Appendix E

Declaration in Lieu of Guarantor form PPTC 132


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3

How do I qualify for Canadian Passport?

In order to qualify, you need to be an adult (over 16) or child (under 16) tobe able to prove your ID and your Canadian citizenship. You also need topresent two photographs, find a guarantor and pay the appropriate fee. AnyCanadian passport or other travel document issued within the last five (5)years should also be submitted with your application.

Note: If your passport was lost, stolen or is inaccessible to you, please also

fill out Appendix D

Please read on for more detailed information.


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4

Proof of Canadian Citizenship

You must present an original proof of citizenship. If you were born inCanada, this can be either a Canadian certificate of birth or Certificate ofCanadian citizenship. If you were born outside Canada, you must provideone of the four Canadian citizenship documents below:

Certificate of Canadian citizenshipCertificate of Naturalization in CanadaCertificate of Retention of Canadian citizenshipCertificate of Registration of Birth Abroad

All original documents will be returned to you. Photocopies are notAccepted

Note 1: Since November 26, 2001, only the following identity documentsare accepted as proof of Canadian citizenship for Canadians born in theProvince of Quebec.

a birth certificate issued after January 1, 1994, byle Directeur de l'tatcivilin the Province of Quebeca Certificate of Canadian Citizenship

Since February 2009, Manitoba Division Registrar Certificates nolonger constitute an acceptable proof of Canadian citizenship for passportissuance purposes. Only the following identity documents are accepted asproof of Canadian citizenship for Canadians born in the Province ofManitoba:

a birth certificate issued by the Manitoba Vital Statistics Agencya Certificate of Canadian Citizenship

Note 2: If you were born outside of Canada between February 15, 1977 andApril 16, 1981 inclusively, to a Canadian parent, fill out form PPTC 001included in this application pack.


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5

Proof of your ID

Additionaly to your Proof of Citizenship, you have to present at least one (1)additional document issued by a federal, provincial or municipal authoritywith your name and signature. For example:

Provincial driver's licence Provincial health care card Other provincial identification card Other federal identification card Certificate of Indian Status

Alien Registration Card Old Age Security card Federal, provincial/state or municipal employee identification card Canadian passport

You may submit original documents. They will be returned to you. Ifsubmitting a photocopy of the document(s), you must photocopy bothfront and back and have the guarantor sign and date every copy.

For children under 16, no ID proof is required.


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6

Photo Requirements

Please include two (2) identical passport photos taken within the pasttwelve (12) months with your application. These photos must not exceed a

size of 50mm wide x 70 mm (2 x 2.75) long. The name of thephotographer or studio, date, and address along with the guarantorsstatement must be provided on the backside of one (1) photo. A guarantormust sign the photograph as such: I certify this to be a true likeness of(your name).


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7

Provide a guarantor

A guarantor must be someone who is a Canadian citizen, has a Canadianpassport and who has known you for at least two (2) years. Someone whose

passport has been expired for less than one-year can still serve as aguarantor. In the case of a child, have known you (parent or legalguardian) personally for at least two (2) years and have knowledge of thechild. Your guarantor must be at least 18 years of age and must havereceived their passport after turning 16. It is expected that your guarantorshould be able to provide a description of you (physical and historical). Yourguarantor must include his/her passport number in the application, beavailable to Passport Canada for verification and reside in Canada, the USAor Bermuda.Your guarantor must be one of the following:

Dentist Judge Practising lawyer Magistrate Mayor Medical doctor Notary public Police officer Signing officer of a bank

Please note that if you are the parent or legal guardian applyingfor a passport for your child, you cannot act as guarantor.

If you cant find a guarantor: If you do not know of anyone who meets thecriteria for a guarantor, then the applicant must complete a Declaration inLieu of Guarantor form PPTC 132 (Appendix E)

The "Statutory Declaration in Lieu of Guarantor" form must be sworn

to or declaredbefore, and signed by, a person authorized by law to

administer an oath or a solemn declaration. If completed outside Canada, a

qualified official includes a Canadian or British diplomatic or consular

representative, or a qualified local official.


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8

Pay the fee

The fee for the Simplified Canadian Passport Application is $100 for a 24page passport and $105 for a 48 page Passport.

For children under three years old, the 24 page passport fee is $20 and the48 page passport fee is $22.

For children aged 3-15, the fees are $35 and $37 respectively.

We recommend that you request a 48 page passport if you plan to travelabroad extensively. Otherwise just request the 24 page Passport.

You may pay:

Cash Certified cheque, traveller's cheque or international money order

(postal or bank) made payable to the Canadian Embassy, HighCommission or Consulate, as the case may be

Note: The fees are in Canadian dollars. Payment must be made in localcurrency.

Methods of payment for passports at Canadian Government Offices abroadmay vary based on local banking regulations. It is advisable to confirmacceptable methods of payment with the Canadian Government Officewhere you will be submitting your passport application.


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9

Where do I apply?

All applications must be made at a local Canadian Embassy, HighCommission or Consulate.

Cheque or money order must be made out the Canadian Office processingyour application. For a list ofCanadian offices abroadvisit:

http://www.voyage.gc.ca/main/foreign/fordest/foreign_clientview-en.asp(English)http://www.voyage.gc.ca/main/foreign/fordest/foreign_view_client-fr.asp(French)
http://www.voyage.gc.ca/main/foreign/fordest/foreign_clientview-en.asphttp://www.voyage.gc.ca/main/foreign/fordest/foreign_view_client-fr.asphttp://www.voyage.gc.ca/main/foreign/fordest/foreign_view_client-fr.asphttp://www.voyage.gc.ca/main/foreign/fordest/foreign_clientview-en.asp


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10

Processing Time

Canada Passport Service processing times may change depending on thevolume of applications received and are not guaranteed. Complexity of

routine verifications and security checks may lead to longer processingtimes. Generally, these are the processing times as of April 2010:

Application submitted in person 2 weeks

Application submitted by mail 4 weeks


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11

Upon receipt of your Passport

Your passport will be sent to you by mail. Please verify the accuracy of the

information in the passport, especially your personal information. If thereare any errors, contact Passport Canada immediately.

Signature

You are required to sign your name in ink in the space provided onpage 3.Children 11 years of age or over must sign their own passports.Parents must not sign the passport of a child who cannot sign.

Address

Complete the section provided on page 4.

Contact information

Enter on page 4 the name of a person to be contacted in case of emergencyand keep it up to date. We recommend that you name someone who wouldnot normally travel with you.


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Fee

PPTC040A(09-04)M02

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Entitlement to a Canadian Passport

Processing Times

Requirements Checklist

C$100(includes the passport fee (C$75) and consular service fee (C$25))

Note: This fee is subject to change.

The fee is in Canadian funds and should be converted intolocal funds.

Important Every person who requests a passport servicemust pay the applicable fee. This fee is non-refundable.

Methods of payment

Cash

Certified cheque or money order (postal or bank) payable to

the Canadian Embassy, High Commission or Consulate as

the case may be

Administrative fees and any applicable interest will be applied

to all dishonoured payments.

Our goal is to have the passport ready in 15 working daysupon receipt of a complete application. Visit our website at

www.passportcanada.gc.ca for any changes to processing

times.

If you require a passport in exceptional circumstances, contact

the nearest Canadian government office that provides passport

services.

Where to Apply

Your application should be submitted to the nearest Canadian

government office that provides passport services in the

country in which you are residing or visiting. For a list of

Canadian government offices abroad, visit our website at

www.passportcanada.gc.ca or consult your local telephone

directory.

The following are Canadian government offices:

Canadian Embassies

Canadian High Commissions

Canadian Consulates (except those headed by HonoraryConsuls).

A Canadian passport is the only reliable and universally

accepted travel and identification document for Canadians

who travel abroad.

Issued to Canadian citizens only, a Canadian passport

reflects the identity of the applicant as determined by

documentary evidence of citizenship and documents to

support identity.

Children under 16 years of age must have an individual

passport (use form PPTC 042 "Child Passport Application").

All THREE (3) pages of the application form completedand signed within the last 12 months

TWO (2) identical passport photos taken within the last12 months

Application form and one of the photos certified by

your guarantor

Proof of Canadian citizenship (no copies or certified copies)

Documents to support identity

Any Canadian passport or travel document issued to

you within the last FIVE (5) years

The fee

Additional documents or information may be requested

in support of this application.

ADULT PASSPORT APPLICATIONfor Canadians 16 years of age or over (Abroad)

GENERAL INFORMATION AND INSTRUCTIONS

Aussi disponible en franais

Failure to complete all the required sections of this form will result in your application being rejected.


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Contact Us

General information is available 24 hours a day, 365 days a year. Specific information is available during regular office hours.

INFORMATION ON PASSPORTS AND FEES

Canadian Government Office Locations

INFORMATION ON TRAVEL CONDITIONS AND REQUIREMENTS

PPTC040A(09-04)M02

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Website:..............................................................................www.passportcanada.gc.ca

The nearest Canadian government officeproviding passport services:..........................................................(Consult your local telephone directory.)

Passport Canada:...........................................................................................................819-997-8338

TTY (For persons who are deaf or hard of hearing)

Montral, Canada:....................................................................................................514-283-5197

Website:.......................... ........................................... .....................www.voyage.gc.ca

For the location of the nearest Canadian government office providing passport services, we suggest you visit our website or consult

your local telephone directory.

To obtain the most recent version of this form, visit our website.

Application forms are also available in Braille, on diskette or in large print for persons with a visual impairment.


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INSTRUCTIONS

SignatureUnacceptable

SignatureInner LimitsAcceptable

PPTC040A(09-04)M02

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2 Declaration of Guarantor

Previous Canadian Passport3

NAME TO APPEAR IN PASSPORTWrite the name you want to appear in the passport. If this name is different from the name on your documentary evidence ofcitizenship, the original of the documentation listed below may be required:

Marriage certificate

Legal change of name (original document from issuing authority)

Additional documentation will be required to verify your identity as well as the name to appear in the passport (see instructionno. 5 "Documents to Support Identity").

SURNAME (LAST NAME) AT BIRTH/FORMER SURNAME (FORMER LAST NAME)Complete only if different from the surname (last name) to appear in the passport (for Passport Canada information only; will notappear in the passport).

PLACE OF BIRTHYour place of birth must be provided on the application form. If you do not wish the place of birth to appear in the passport, submit awritten request. Be sure to contact the consulate or embassy of every country you plan to visit to ensure that you will be admitted ifthe passport does not include your place of birth.

SIGNATUREYou MUST sign your usual signature on allTHREE (3) pages. Your signature in section 1will appear in the passport. Therefore, yoursignature MUST NOT exceed the inner limits ofthe signature box.

A guarantor is a person other than yourself who confirms your identity. Your guarantor must perform free of charge the followingTHREE (3) tasks:

1. Complete and sign the "Declaration of Guarantor" section. (Ensure you have completed and signed the form before submittingit to your guarantor.)

2. Write "I certify this to be a true likeness of (your name)" on the back of ONE (1) of your photos, and sign.

3. If applicable, sign and date a copy of each document to support your identity (see instruction no. 5 "Documents to SupportIdentity").

Your guarantor:

must have known you personally for at least TWO (2) years*;

must be included in ONE (1) of the following groups:

dentist, medical doctor notary public

judge, magistrate, police officer practising lawyer, notary

mayor signing officer of a bank

The list above is not a recognition or endorsement by Passport Canada of professional status or superior qualifications.

must live within the jurisdiction of the Canadian government office providing passport services;

must sign the "Declaration of Guarantor" section on your application form;

must sign the statement on the back of ONE (1) of your photos; and

must be accessible to Passport Canada for verification.

If you have not known an eligible guarantor for at least TWO (2) years, complete a "Statutory Declaration in Lieu of Guarantor" formPPTC 132, available from any Canadian government office providing passport services. This form must be completed at your expensebefore a person authorized by law to administer an oath or solemn affirmation. This may delay the processing time of thepassport.

Enclose any Canadian passport or travel document issued to you within the last FIVE (5) years. If your current passport expiresmore than 12 months from the date you submit your application, provide a written explanation for why you are applying atthis time. Should Passport Canada not be satisfied that you have a valid reason for applying early, your application for a newpassport may be refused.

A person's name may appear in only ONE (1) valid Canadian passport, Certificate of Identity or Travel Document.

If the valid passport has been lost, stolen, damaged, destroyed or is inaccessible, complete a "Statutory Declaration" formPPTC 203, available from any Canadian government office providing passport services or at www.passportcanada.gc.caA Canadian passport, once reported lost or stolen, is no longer valid and is not to be used for any travel.

To know an applicant personally means that the guarantor is able to confirm aspects of the applicants personalattributes such as name, approximate age, place of birth, physical description and some personal history such as

occupation and place of residence.

*

1 Personal Information


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Proof of Canadian Citizenship4

PPTC040A(09-04)M02

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Provide ONE (1) of the documents listed in section 4 of the application form (copies or certified copies are not accepted).

It will be returned to you. Additional information may be requested to confirm your citizenship.

If you are a woman who, before 1947, married a man who was not a British subject, contact Passport Canada.

CERTIFICATE OF BIRTH IN CANADAYou may obtain a birth certificate from the Vital Statistics authorities of your province or territory of birth.

If you were born in Quebec

Only birth certificates issued on or after January 1, 1994, by the Directeur de l'tat civilin the province of Quebec are accepted.

CERTIFICATE OF CANADIAN CITIZENSHIP

Large commemorative documents of citizenship issued after February 14, 1977, are not accepted. If you require a certificate ofCanadian citizenship, contact the nearest Canadian government office. You may also visit the Citizenship and Immigration Canada

website at www.cic.gc.ca

Photo Specifications

SIZE AND PAPER The photos must measure 50 mm X 70 mm in size.

Heavy weight paper is unacceptable.

Photos must be printed on plain, high quality photographic paper.PHOTOGRAPHER AND GUARANTOR Photos must be taken by a commercial photographer.

The name of the photographer or studio, the address and the date

the photo was taken (not the date the photo was printed) must be

provided directly on the back of one photo (see illustration).

The guarantor must clearly write on the back of ONE (1) photo:

I certify this to be a true likeness of (applicants name).

Documents to Support Identity

At least ONE (1) document to support your identity and the name to appear in the passport must be submitted with your applicationform. Further documentation may be required.Documents to support your identity must be valid, must be issued by a federal, provincial, territorial or municipal authority inCanada, or local equivalent, and must include the bearer's name and signature. For example:

5

Provincial, territorial or localdriver's licence

Provincial health care card

Certificate of Indian Status

Other federal, provincial, territorial ormunicipal identification card

Valid Canadian passport or Canadian passportexpired for a period of less than one year

Federal, provincial, territorial or municipalemployee identification card

Old Age Security card

You may submit original documents. They will be returned to you. If you are submitting copies (both sides), your guarantormust sign and date the copies to indicate that the originals have been seen.If you are submitting copies but are using form PPTC 132, "Statutory Declaration in Lieu of Guarantor", the same official whosigns the "Declaration" must also sign and date the copies of the documents you are providing to support your identity to indicatethat the originals have been seen. If you have no documents to support your identity, call the nearest Canadian government officeproviding passport services.

Your passport application will be rejected if your photos do not meetthe following specifications:

IMAGE INFORMATION Photos must be taken with uniform lighting and not show

shadows or flash reflection on the face and head. Photos with

shadows on the face or background are unacceptable.

Photos must show a full front view of the face with both edges

of the face showing clearly. The face and shoulders must be

centred in the photo and squared to the camera.

Eyes must be open and clearly visible. Glasses, including tinted

ones with prescription, may be worn as long as the eyes are

clearly visible. Sunglasses are unacceptable.

Facial expression must be neutral (not frowning or smiling)

with the mouth closed.

The image must be clear, sharp and in focus.

Photos must be taken against a plain, uniform, white orlight-coloured background.

Photos must reflect/represent natural skin tones.

The length from chin to crown of head (natural top of head)

must be between 31 mm and 36 mm.

Hats or head coverings are not permitted except when worn for

religious reasons and only if the full facial features are clearly visible.

Black and white or colour photos are acceptable.

Photos must be originals, not taken from any existing photo, and

must have been taken within the last 12 months.

QUANTITY AND FORMAT TWO (2) identical unaltered photos produced from the same film or

from the same electronic file capturing the digital image.


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Complete and sign allTHREE (3) pages of the application form.

ADULT PASSPORT APPLICATIONfor Canadians 16 years of age or over

(Abroad)

Aussidisponibleenfranais

PPTC040(09-04)M02

To obtain the most recent version of this form, visit our website at www.passportcanada.gc.ca

Protection of Information

Personal information provided on this application form is protected and used in accordance with the provisions of the Privacy

Act(Personal Information Bank No. FAI PPU 030). This information is collected under the Canadian PassportOrderto determine the

applicants current and ongoing entitlement to a Canadian passport, to administer passport services and to provide information to the

Consular Affairs Bureau of Foreign Affairs and International Trade Canada in the event that the applicant require assistance while

travelling abroad. The information provided, including the applicants photo, is subject to routine verifications and security queries. To

further strengthen Canadian passport security, the photo is stored on an alphanumeric template and incorporated into the passport as a

digital image.

Passport Canada may use the services of third parties to receive passport applications submitted in person and to process the return of

incomplete passport applications. In the performance of these services, personal information will be protected and used in accordance

with the provisions of the Privacy Act.

Passport Canada may contact the applicant to solicit feedback about passport services.

Signature of guarantor

Signature (seeinstructionNo.1)

INFORMATION

PROTECTEDADULT PASSPORT APPLICATIONfor Canadians 16 years of age or over (Abroad)

Given name(s)(see instruction No.1)

Date of birth

Address of permanent residence

Place of birthYear Month Day

Occupation (see instruction No.2) Name of firm/organization

City Province/Territory (if applicable) Country

Surname(lastname)atbirth (see instruction No.1) Formersurname(formerlastname)(see instruction No.1)

Surname(lastname)ofspouse (see instruction No.1)

PRINT ORTYPEINCAPITAL LETTERS using black ordark blue ink.

Daytime telephone number

Year Month Day

Date Signed at

Evening telephone numberDaytime telephone number

Business address

Date Signed atYear Month Day

City Country

City Country

Eye colour

Given name(s)Surname (last name)

Evening telephone number

Sex Female

Male

Mailing address (if different from above)

Number Street Apartment City Country Postal code

Haircolour Height Weight

Cell.number or email address(optional)

I have known

the applicant for

Number of years

Number Street City Country Postal code


Marital status

( )

( ) ( ) ( )

( ) ( )

Cell.number

Ifpassportrequestedinspousalsurname(lastname),enter

Yearofmarriage

Surname(lastname)

Void if signature touches border

Personal Information

Month Day

Date of travel

Unknown

1


PPTC040(09-04)M02

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COMPLETENEXTPAGE

WARNINGtoall applicantsand guarantors Anyfalseormis leadingstatementonthis formorrelatingtoanydocumentinsupportofthi sappl i cation,includingconcealmentofanymater ial fact,mayleadtorefusalorrevocationofapassportandbegroundsforcriminalprosecution.


DECLARATIONIsolemnlydeclarethatIamaCanadianci tizen,thatthephotosenclosedareatruel i kenessofmeandthatal l ofthestatementsmadeinthisappl icationaretrue.Idec larethatIhavereadandunderstoodtheWARNINGtoallapplicantsand guarantorsabove.

DECLARATION I solemnly declare that I have known theapplicant identified above personally for at least TWO (2)years.I have certified on the back of ONE (1) photo that theimage is a true likeness of t he applicant.If applicable,I have signed a copy of each document to support theapplicants identity confirming that I have seen theoriginal(s).I declare that I have read and understood theWARNING to all applicants and guarantors above.

Declaration of Guarantor(to be completed by the guarantor only if the applicant has completed and signed this application form)2 Page2of3

COMPLETENEXTPAGE

Previous Canadian Passport

PPTC040(09-04)M02

Would you like the passport to be returned to you? No Yes

In the last FIVE (5) years, has a Canadian passport, Certificate of Identity or Travel Document been issued to you?

If yes, include it with your application.

Number Date of issue Place of issue

If the passport issued to you in the last FIVE(5) years has been lost, stolen, damaged, destroyed or is inaccessible, you mustinclude with this application form a completed "Statutory Decla ration" form PPTC 203, available from any Canadian governmentoffice providing passport services or at www.passportcanada.gc.ca

Year Month Day

DECLARATION I solemnly declare that the statements made in this application are true.

Signature of applicant Signed at

Date

City Country

Year Month Day

Providethefollowinginformation.Include signedcopies (bothsides)ororiginaldocuments (seeinstructionNo. 5).

Type of document Document number

Type of document D oc um en t n um be r N am e o f b ea re r a s i t a pp ea rs o n t he d oc um en t

Name of bearer as it appears on the document

Year Month DayDate of expiry (if applicable)


Documents to Support Identity5

3

Registration number Date of issue

Country Effective date

Year Month Day


Certificate number Date of issue


A

To be completed by ALLapplicants.Did you acquire citizensh ip of another country before JANUARY 1, 1947?

B To be completed if you were bornin Canada.Provide ONE (1) of the two documents listed below (no copies):

C To be completed if you were bornoutside of Canada.1) Provide ONE (1) of the four documents listed below (no copies):

5

5

Certificate of registration of birth abroad (issued by the Registrar ofCanadian Citizenship)

Certificate of retention of Canadian citizenship (issued beforeFebruary 15, 1977)

2) To be completed if you were born outside of Canada between February 15, 1977 and April 16, 1981 inclusively. (You do notneed to complete this section if you are presenting a certificate of Canadian citizenship issued after January 1, 2007.)

a) Are you a naturalized Canadian? (i.e.Did you receiveCanadian citizenship following immigration to Canada?)

b) Was one of your parents born in Canada?

c) Complete and submit form PPTC 001 Proof of Canadian Citizenship Additional Informat ionwhi ch you can obtain atwww.passportcanada.gc.ca or at any Canadian government office providing passport services.

No

Yes(specify)

No Yes(specify) By birth

By naturalization

Birth certificate in Canada (see instruction No.4)

Certificate of Canadian citizenship (see instruction No.4)

Certificate of Canadian citizenship (see instruction No.4)

Certificate of naturalization

Y es G o t o se ct i on

Y es G o t o se ct i on

No Continuetoquestionb)

N o C on t in ue t oc)

Declaration of Applicant

Emergency Contact(optional)

Given name(s)1.Surname (last name)

2. Surname (last name) Given name(s)

Re lati onsh ip Ad dres s

Number Street Apartment City Country

Address

Number Street Apartment City

State number of years


Country

D ay ti me ph on e E ve ni ng ph on e

E ve ni ng ph on e C el l. n um be r o r e ma il ad dr es s(optional) Has known me for

Cell.number or email address(optional) Has known me for

( ) ( )

( ) ( )

( )

Providethefollowinginformationwithrespectto TWO(2) personswhoareneitheryourrelativesnoryourguarantorandwhohaveknownyouforatleast TWO(2) years.Theymaybecontactedtoconfirmyouridentity.

Werecommendthatyouprovidethenameofsomeonewhowould not normallytravelwithyou.Thisinformationishelpfulifyouhaveanaccidentorbecomeill whiletravellingoutsideofCanada.

PPTC040(09-04)M02

References

Relationship to applicant Daytime phone

( )

Evening phone

( )

Cell.number

Relationship

Address


Given name(s)

Surname (last name)

Daytime phone



Signature of applicant Signed atYear Month Day

Date

City Country

Page3

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ENSUREALLTHREE

(3)

PAGESARECOMPLETED

1.

2.To

Year MonthFrom

Year Month

N um be r S tr ee t A pa rt me nt Ci ty P ro vi nc e/ Te rr it or y/ St at e C ou nt ry

N um be r S tr ee t A pa rt me nt Ci ty P ro vi nc e/ Te rr it or y/ St at e C ou nt ry

In the last TWO (2) years,

Addresses in the last TWO (2) years if different from current address. (If insufficient space, attach a separate sheet.)

my employers were and/or I was attending educationalinstitutions as follows:

Employer/school or other Address Daytime phone Date (From) Date (To)Natureofemployment/studies

ToYear Month

FromYear Month

AdditionalPersonalInformation

Mother's maiden nameProvide your mother's surname (last name) at the time of her birth.

A Addresses in the last TWO (2) years

B Occupationinthe last TWO(2) years (If insufficient space, attach a separate sheet. If you are, for example, a homemaker or are retired,indicate this in the Employer/schoolor othercolumn.)

C

Same as current address.


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Signature (see instruction No. 1)

INFORMATION

PROTECTEDADULT PASSPORT APPLICATIONfor Canadians 16 years of age or over (Abroad)

Given name(s)(see instruction No. 1)

Date of birth


Place of birthYear Month Day

Occupation (see instruction No. 2) Name of firm/organization


Surname (last name) at birth(see instruction No. 1) Former surname (former last name)(see instruction No. 1)

Surname (last name) of spouse(see instruction No. 1)

PRINT OR TYPE IN CAPITAL LETTERS using black or dark blue ink.


Year Month DayDate Signed at

Evening telephone numberDaytime telephone number

Business address


City Country

City Country

Eye colour



Sex Female

Male



Hair colour Height Weight

Cell. number or email address (optional)

I have known

the applicant for

Number of years

Number Street City Country Postal code


Marital status

( )

( ) ( ) ( )

( ) ( )

Cell. number

If passport requested in spousal

surname (last name), enter

Year of marriage

Surname (last name)


Declaration of Guarantor(to be completed by the guarantor only if the applicant has completed and signed this application form)

Personal InformationMonth Day

Date of travel

Unknown

1

2


PPTC040(09-04)M02

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COMPLETENEXTPAGE

WARNING to all applicants and guarantors Any false or misleading statement on this form or relating to any document in supportof this application, including concealment of any material fact, may lead to refusal or revocation of a passport and be grounds forcriminal prosecution.


DECLARATION I solemnly declare that I am a Canadian citizen, that the photosenclosed are a true likeness of me and that all of the statements made in thisapplication are true. I declare that I have read and understood the WARNING toall applicants and guarantors above.

DECLARATION I solemnly declare that I have known theapplicant identified above personally for at least TWO (2)years. I have certified on the back of ONE (1) photo that theimage is a true likeness of the applicant. If applicable,I have signed a copy of each document to support theapplicants identity confirming that I have seen theoriginal(s). I declare that I have read and understood theWARNING to all applicants and guarantors above.


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COMPLETENEXTPAGE

Previous Canadian Passport

PPTC040(09-04)M02

Would you like the passport to be returned to you? No Yes

In the last FIVE (5) years, has a Canadian passport, Cer tificate of Identity or Travel Document been issued to you?

If yes, include it with your application.

Number Date of issue Place of issue

If the passport issued to you in the last FIVE (5) years has been lost, stolen, damaged, destroyed or is inaccessible, you mustinclude with this application form a completed "Statutory Declaration" form PPTC 203, available from any Canadian governmentoffice providing passport services or at www.passportcanada.gc.ca

Year Month Day


Signature of applicant Signed atDate

City Country

Year Month Day


Provide the following information. Include signed copies (both sides)or original documents (see instruction No. 5).

Type of document Document number

Type of document Document number Name of bearer as it appears on the document

Name of bearer as it appears on the document



Documents to Support Identity5

3


Country Effective date

Year Month Day




A To be completed by ALLapplicants. Did you acquire citizenship of another country before JANUARY 1, 1947?

B To be completed if you were bornin Canada. Provide ONE (1) of the two documents listed below (no copies):

C To be completed if you were bornoutside of Canada.1) Provide ONE (1) of the four documents listed below (no copies):

5

5

Certificate of registration of birth abroad (issued by the Registrar ofCanadian Citizenship)

Certificate of retention of Canadian citizenship (issued beforeFebruary 15, 1977)

2) To be completed if you were born outside of Canada between February 15, 1977 and April 16, 1981 inclusively . (You do notneed to complete this section if you are presenting a certificate of Canadian citizenship issued after January 1, 2007.)

a) Are you a naturalized Canadian? (i.e. Did you receiveCanadian citizenship following immigration to Canada?)

b) Was one of your parents born in Canada?

c) Complete and submit form PPTC 001 Proof of Canadian Citizenship Additional Information which you can obtain atwww.passportcanada.gc.ca or at any Canadian government office providing passport services.

No

Yes (specify)

No Yes (specify) By birth

By naturalization

Birth certificate in Canada (see instruction No. 4)

Certificate of Canadian citizenship (see instruction No. 4)

Certificate of Canadian citizenship (see instruction No. 4)

Certificate of naturalization

Yes Go to section

Yes Go to section

No Continue to question b)

No Continue to c)


19/30

Emergency Contact(optional)

Given name(s)1. Surname (last name)

2. Surname (last name) Given name(s)

Relationship Address

Number Street Apartment City Country

Address

Number Street Apartment City



Country

Daytime phone Evening phone

Evening phone Cell. number or email address(optional) Has known me for

Cell. number or email address(optional) Has known me for

( ) ( )

( ) ( )

( )

Provide the following information with respect to TWO (2) persons who are neither your relatives nor your guarantor and who haveknown you for at least TWO (2) years. They may be contacted to confirm your identity.

We recommend that you provide the name of someone who would not normally travel with you. This information is helpful ifyou have an accident or become ill while travelling outside of Canada.

PPTC040(09-04)M02

References

Relationship to applicant Daytime phone

( )

Evening phone

( )

Cell. number

Relationship

Address



Daytime phone



Signature of applicant Signed atYear Month Day

Date

City Country

Page

3

of3

ENSUREALLTHREE

(3)

PAGESARECOMPLETED

1.

2.To Year MonthFrom Year Month

Number Street Apartment City Province/Territory/State Country

Number Street Apartment City Province/Territory/State Country

In the last TWO (2) years,

Addresses in the last TWO (2) years if different from current address. (If insufficient space, attach a separate sheet.)

my employers were and/or I was attending educational institutions as follows:

Employer/school or other Address Daytime phone Date (From) Date (To)Nature of employment/studies

To Year MonthFrom Year Month

Additional Personal Information

Mother's maiden nameProvide your mother's surname (last name) at the time of her birth.

A Addresses in the last TWO (2) years

B Occupation in the last TWO (2) years(If insufficient space, attach a separate sheet. If you are, for example, a homemaker or are retired,indicate this in the Employer/school or other column.)

C

Same as current address.


20/30

Where to Apply

PPTC042A(09-04)M02

Page1of4

CHILD PASSPORT APPLICATIONfor Canadians under 16 years of age (Abroad)

GENERAL INFORMATION AND INSTRUCTIONS

Entitlement to a Canadian Passport

Fees

Requirements Checklist

A Canadian passport is the only reliable and universallyaccepted travel and identification document for Canadians

who travel abroad.

Canadian passports are issued to Canadian citizens only.

If applying for an individual passport for a child under 16 years

of age, use this application form (PPTC 042) to apply.

Our goal is to have the passport ready in 15 working daysupon receipt of a complete application. Visit our website at

www.passportcanada.gc.ca for any changes to processing times.

If you require a passport in exceptional circumstances, contact

the nearest Canadian government office that provides passport

services.

One of the parents

The custodial parent in cases of separation or divorce

The legal guardian

The application should be submitted to the nearest Canadiangovernment office that provides passport services in thecountry in which you are residing or visiting. For a list ofCanadian government offices abroad, visit our website at

www.passportcanada.gc.ca or consult your local telephone

directory.

The following are Canadian government offices:

Canadian Embassies

Canadian High Commissions

Canadian Consulates (except those headed by HonoraryConsuls).

For a child aged 3 to 15 years C$35

under 3 years C$20

Note: These fees are subject to change.

The fee is in Canadian funds and should be converted into

local funds.

Important Every person who requests a passport service

must pay the applicable fee. This fee is non-refundable.

Methods of payment

Cash

Certified cheque or money order (postal or bank) payable to

the Canadian Embassy, High Commission or Consulate as

the case may be

Administrative fees and any applicable interest will be appliedto all dishonoured payments.

For a child aged:

3 to 15 years, the maximum period of validity is 5 years.

Under 3 years, the maximum period of validity is 3 years.

Note: Children who have been issued a passport in their first12 months may be issued a one-time replacement passport,

free of charge, valid for the balance of the three-year validity

period of the original passport. Full application requirements

must be met. To ensure the photo is a current and true likeness

of the child, it must be taken within one month of the date the

application is submitted.

BOTH pages of the application form completed and signedwithin the last 12 months

TWO (2) identical passport photos of the child (See "PhotoSpecifications")

Application form and one of the photos certified byyour guarantor

Proof of Canadian citizenship (no copies or certifiedcopies)

Any valid Canadian passport or travel document issued tothe child

All documents that refer to custody or mobility of, oraccess to, the child

The fee

Additional documents or information may be requested insupport of this application.

Aussi disponible en franais


Processing Times

Who May Apply for a Passport on Behalf of a Child?

Periods of Validity for Passports Issued to Children


21/30

Contact Us

General information is available 24 hours a day, 365 days a year. Specific information is available during regular office hours.

INFORMATION ON PASSPORTS AND FEES

For the location of the nearest Canadian government office providing passport services, we suggest you visit our website orconsult your local telephone directory.

INFORMATION ON TRAVEL CONDITIONS AND REQUIREMENTS

PPTC042A(09-04)M02

Page2of4

Canadian Government Office Locations

Website:................................................................................www.passportcanada.gc.ca

The nearest Canadian government officeproviding passport services:.............................................................(Consult your local telephone directory.)

Passport Canada:.............................................................................................................819-997-8338

TTY (For persons who are deaf or hard of hearing)

Montral, Canada:......................................................................................................514-283-5197

To obtain the most recent version of this form, visit our website.

Application forms are also available in Braille, on diskette or in large print for persons with a visual impairment.

Website:................................ ........................................... .................www.voyage.gc.ca


22/30

INSTRUCTIONS

SignatureUnacceptable

SignatureInner LimitsAcceptable

Information on Applicant2

Proof of Canadian Citizenship

Previous Canadian Passport3

4

PPTC042A(09-04)M02

Page3of4

NAME TO APPEAR IN PASSPORTWrite the child's name as you want it to appear in the passport. If this name is different from the name on the child's documentaryevidence of citizenship, the child's legal change of name document (original document from issuing authority) may be required.Additional documents may be requested to verify the child's identity.

SURNAME (LAST NAME) AT BIRTH/FORMER SURNAME (FORMER LAST NAME)Complete only if different from the surname (last name) to appear in the passport (for Passport Canada information only; will notappear in the passport).

PLACE OF BIRTHThe place of birth must be provided on the application form. If you do not wish the place of birth to appear in the passport, submit awritten request. Be sure to contact the consulate or embassy of every country you plan to visit to ensure that the child will beadmitted if the passport does not include the place of birth.

SIGNATUREChildren 11 years of age or over MUST signtheir usual signature. The childs signature insection 1 will appear in the passport. Therefore,the signature MUST NOT exceed the inner limitsof the signature box.

Both parents are requested to participate in obtaining passport services for their child and to sign the application form. The otherparent may be contacted. To avoid possible delays, we strongly recommend that you provide a long-form bir th certificate showinginformation on both parents. Where a legal guardian is the applicant, the other legal guardian as the case may be is also requestedto participate.

CUSTODY, SEPARATION AND DIVORCEWhere a court order or agreement exists referring to custody of the child, only the person with custodial rights may apply. All documentsthat refer to custody or mobility of, or access to, the child must be provided. If a divorce has been granted, a copy of the divorce

judgement or order must also be provided. Where joint custody provisions exist, either parent may apply.

RELATIONSHIP WITH OTHER PARENTIndicate your current relationship with the other parent: single, common law, married, separated, divorced, widowed. Indicate date ofmarriage to the other parent, if applicable. Additional information or documentation may be requested.

For further information, contact any Canadian government office providing passport services.

Enclose any valid Canadian passport or travel document issued to the child. If the childs current passport expires more than 12months from the date of submission of the application, provide a written explanation for why you are applying at this time. ShouldPassport Canada not be satisfied that you have a valid reason for applying early, your application for a new passport may berefused.

If the valid passport has been lost, stolen, damaged, destroyed or is inaccessible, complete a "Statutory Declaration" formPPTC 203, available from any Canadian government office providing passport services or at www.passportcanada.gc.ca ACanadian passport, once reported lost or stolen, is no longer valid and is not to be used for any travel.

Provide ONE (1) of the documents listed in section 4 of the application form (copies or certified copies are not accepted). It will be

returned to you. Additional information may be requested to confirm the child's citizenship.

CERTIFICATE OF BIRTH IN CANADAA birth cer tificate may be obtained from the Vital Statistics authorities of the child's province or territory of birth. To avoid possibledelays, we strongly recommend that you provide a long-form birth certificate showing information on both parents.

If the child was born in Quebec

Only birth certificates issued on or after January 1, 1994, by the Directeur de l'tat civilin the province of Quebec are accepted.

CERTIFICATE OF CANADIAN CITIZENSHIPLarge commemorative documents of citizenship issued after February 14, 1977, are not accepted. If the child requires a certificate

of Canadian citizenship, contact the nearest Canadian government office. You may also visit the Citizenship and Immigration

Canada website at www.cic.gc.ca

1 Child's Personal Information


23/30

PPTC042A(09-04)M02

Page4of4

A guarantor is a person other than the applicant who confirms the applicants identity and has knowledge of the child. Your

guarantor must perform free of charge the following TWO (2) tasks:

1. Complete and sign the "Declaration of Guarantor" section. (Ensure you have completed and signed the form before submitting it

to your guarantor.)

2. Write "I certify this to be a true likeness of (child's name)" on the back of ONE (1) of the childs photos, and sign.

Your guarantor:

must have known you (the applicant) personally for at least TWO (2) years*;

must have known you and the child well enough to be confident that the statements you have made in the application form are true;

must be included in ONE (1) of the following groups:

dentist, medical doctor notary public

judge, magistrate, police officer practising lawyer, notary

mayor signing officer of a bank

The list above is not a recognition or endorsement by Passport Canada of professional status or superior qualifications.

must live within the jurisdiction of the Canadian government office providing passport services;

must sign the "Declaration of Guarantor" section on your application form;

must sign the statement on the back of ONE (1) of the childs photos; and

must be accessible to Passport Canada for verification.

If you have not known an eligible guarantor for at least TWO (2) years, complete a "Statutory Declaration in Lieu of Guarantor"form PPTC 132, available from any Canadian government office providing passport services. This form must be completed at yourexpense before a person authorized by law to administer an oath or solemn affirmation. This may delay the processing time of thepassport.

To know an applicant personally means that the guarantor is able to confirm aspects of the applicants personal

attributes such as name, approximate age, place of birth, physical description and some personal history such asoccupation and place of residence.

*

Your passport application will be rejected if the photos of the childdo not meet the following specifications:

IMAGE INFORMATION

Only the head and shoulders of young children must appear onthe photo (e.g. no hands holding the child).

Photos must be taken with uniform lighting and not show

shadows or flash reflection on the face and head. Photos withshadows on the face or background are unacceptable.

Photos must show a full front view of the face with both edgesof the face showing clearly. The face and shoulders must becentred in the photo and squared to the camera.

Eyes must be open and clearly visible. Glasses, including tintedones with prescription, may be worn as long as the eyes areclearly visible. Sunglasses are unacceptable.

Facial expression must be neutral (not frowning or smiling)with the mouth closed.

The image must be clear, sharp and in focus.

Photos must be taken against a plain, uniform, white orlight-coloured background.

Photos must reflect/represent natural skin tones.

The length from chin to crown of head (natural top of head)must be between 31 mm and 36 mm.

Hats or head coverings are not permitted except when worn forreligious reasons and only if the full facial features are clearly visible.

Black and white or colour photos are acceptable.

Photos must be originals, not taken from any existing photo, andhave been taken within the last 12 months or if applying fora one-time replacement passport, taken within the last month.

QUANTITY AND FORMAT TWO (2) identical unaltered photos produced from the same film or

from the same electronic file capturing the digital image.

SIZE AND PAPER The photos must measure 50 mm x 70 mm in size.

Heavy weight paper is unacceptable.

Photos must be printed on plain, high quality photographic paper.

PHOTOGRAPHER AND GUARANTOR Photos must be taken by a commercial photographer.

The name of the photographer or studio, the address and the datethe photo was taken (not the date the photo was printed) must beprovided directly on the back of one photo (see illustration).

The guarantor must clearly write on the back of ONE (1) photo:I certify this to be a true likeness of (childs name).

Photo Specifications

(childs name)

5 Declaration of Guarantor


24/30

Complete and sign BOTHpages of the application form.

CHILD PASSPORT APPLICATIONfor Canadians under 16 years of age

(Abroad)


PPTC042(09-04)M02

To obtain the most recent version of this form, visit our website at www.passportcanada.gc.ca

Protection of Information

Personal information provided on this application form is protected and used in accordance with the provisions of the Privacy

Act(Personal Information Bank No. FAI PPU 030). This information is collected under the Canadian PassportOrderto determine the

current and ongoing entitlement of the child to a Canadian passport, to administer passport services and to provide information to the

Consular Affairs Bureau of Foreign Affairs and International Trade Canada in the event that the child requires assistance while travelling

abroad. The information provided, including the childs photo, is subject to routine verifications and security queries. To further strengthen

Canadian passport security, the photo is stored on an alphanumeric template and incorporated into the passport as a digital image.

Passport Canada may use the services of third parties to receive passport applications submitted in person and to process the return of

incomplete passport applications. In the performance of these services, personal information will be protected and used in accordance

with the provisions of the Privacy Act.

Passport Canada may contact the applicant to solicit feedback about passport services.

INFORMATION

PROTECTEDCHILD PASSPORT APPLICATIONforCanadians under16 years of age (Abroad)

Given name(s) (see instruction No.1)


Surname(lastname)atbirth/formersurname(formerlastname) (see instruction No.1)

PRINT ORTYPEINCAPITAL LETTERSusing black ordark blue ink.

Children 11 years of age or over must sign in the signature block.

Is the child the subject of an adoption process?Are there any separation agreements, court orders or legal proceedingspertaining to custody or mobility of, or access to the child?

If yes, include alldocuments(see instruction No.2)

Signed at

City Country

Eye colour

Surname(lastname)

Surname (last name) at birthSurname (last name) at birth

Applicant (parent or legal guardian) Other parent or legal guardian

Sex

Female Male


Given name(s)Given name(s)


Haircolour Height Weight

Number Street Apartment


City Country Postal code

Date of birth Place of birth


No

No

Yes

Yes

Date of birth

Relationship with other parent

Address


Address

Country of birth Country of birthYear Month Day

Date of marriage (if applicable)Year Month Day


Date of birth

Relationship with parent applying

Year Month Day

Year Month Day

DateYear Month Day

Daytime phone

( )

Evening phone

( )

Cell.number (optional)

( )

Daytime phone

( )

Evening phone

( )

Cell.number(optional)

( )

Signatureofapplicant (alsosignsection 4) Dat e Si gne dat Signatureofother parentorlegal guardian Dat e Si gne da t

Signature of child (seeinstructionNo.1)

Date of travel

Month Day

Unknown


PPTC042(09-04)M02

Page1of2

COMPLETENEXTPAGE


WARNINGtoallapplicantsandguarantorsAnyfalseormis leadingstatementonthis formorrelatingtoanydocumentinsupportofthi sappl i cation,includingconcealmentofanymaterial fact,mayleadtorefusalorrevocationofapassportandbegroundsforcriminalprosecution.Failure to complete all the required sections of this form will result in your application being rejected.

DECLARATION I solemnly declare that the child named above is a Canadian citizen,that I am the parent or legalguardian of the child named above and that the statementsmade in this application are true.I declare that I have read and understood theWARNING to all applicants and guarantors above.

DECLARATION I solemnly declare that the child named above is a Canadian citizen,that I am the parent or legalguardian of the child named above and that the statementsmade in this application are true.I declare that I have read and understood theWARNING to all applicants and guarantors above.

Child's Personal Information1


PPTC042(09-04)M02

Surname (last name) of applicant(see General Information and Instructions,page 1 "Who May Apply for a Passport on Behalf of a Child?")

Given name(s) of applicant

Relationship to child Surname (last name) of child Given name(s) of child

Signed at

City Country

DateYear Month Day

Signature of applicant (seeinstructionno. 1)


Does the child's name appear in any valid Canadian passport, Certificate of I dentity or Travel Document?

3 Previous Canadian Passport

If yes, include itwith your application.

Number

If the passport has been lost, stolen, damaged, destroyed or is inaccessible, you must include with this application form a completed "StatutoryDeclaration" form PPTC203, available from any Canadian government office providing passport services or at www.passportcanada.gc.ca.

Date of issue


DateYear Month Day

Surname (last name) Given name(s)

Occupation (see instruction No.5) Name of firm/organization

Business address

Name of applicant Signed atName of child

Number Street City Country

City Country

Postal code


( )


( )

Cell.number

( )

Number of years

Foradditionalinformationon passports,wesuggest youvisit ourwebsiteat

www.passportcanada.gc.ca

Page

2of2

ENSUREBOTHPAGES

ARECOMPLETED

4 Proof of Canadian Citizenship




A To be completed if the child was bornin Canada.Provide ONE (1) of the two documents listed below (no copies):

B To be completed if the child was bornoutside of Canada.Provide the following document(no copies):

DECLARATION I solemnly declare that the child named herein is aCanadian citizen, that the photos enclosed are a true likeness of the child andthat the statements made in this application are true.I declare that I have readand understood the WARNING to all applicants and guarantors on page 1.

DECLARATIONI solemnly declare that I have known

the applicant identified above personally for at leastTWO (2) years.I have certified on the back of ONE (1)photo that the image is a true likeness of the child.I

declare that I have read and understood the WARNINGto all applicants and guarantors on page 1.

I have known

the applicant for

No Yes (specify)

Birth certificate in Canada

Certificate of Canadian citizenship


Declaration of Guarantor(to be completed by the guarantor only if the applicant has completed and signed this application form)5



25/30

Travelling with Children or Children Travelling Alone

PPTC042(09-04)M02

IMPORTANT INFORMATION CONCERNING CHILDREN TRAVELLING ABROAD

Immigration authorities in most countries are becoming increasingly vigilant when children are crossing international

borders. Whether travelling alone or accompanied by an adult, each child travelling abroad must have a valid passport

and may also require supporting documentation. Prior to any travel that includes a child, you should contact the embassy

or consulate of all countries the child will be visiting to inquire about entry requirements.

The following documents may be required to support the entry of a child to another country:

Birth certificate showing the names of both parents

Documents pertaining to custody

If the child is travelling with one parent, a letter signed and dated from the other parent authorizing travel (letter may

have to be notarized)

If the child is travelling with someone other than the parent, a letter signed and dated from both parents authorizing

travel with that person (letter may have to be notarized)

If the child is travelling alone, a letter signed and dated from both parents authorizing travel (letter may have to

be notarized)

If one of the parents is deceased, the death certificate

The following tips may help to avoid delays when a child is returning to Canada:

Always carry proper identification for yourself and the child passport, birth certificate, citizenship card, Record of

Landing (IMM 1000), permanent resident card or Indian Status Card.

If you have custody of the child, carry copies of documents specifying custody rights with you.

If you are not the legal guardian of the child, carry a letter of permission or authorization for you to have custody when

entering Canada. When a parent is travelling alone with a child, a letter from the other parent can also facilitate the

return of both the parent and the child. The letter should also contain telephone numbers where the parent or legal

guardian can be contacted.

If you are travelling as part of a caravan, ensure you are in the same vehicle as the child you are accompanying

when arriving at a border crossing.

Have the child memorize your home and/or office telephone number and teach him or her to call you in an emergency.

1. Custody arrangements in Canada may not be recognized in another country. In extreme cases, the child may not be able to leave

the country visited. It is recommended that, before leaving on a trip, you check with the embassy or consulate of the country or

countries the child will be visiting to determine what documentation may be required relating to the custody of the child.

For further information, contact:

Foreign Affairs and International Trade Canada:

Outside Canada:...................................613-943-1055

2. If a custody dispute could possibly arise while travelling with the child, you should talk to a Canadian lawyer prior to your

departure. We suggest you also read the publication International Child Abductions: A Manual for Parents.

For a free copy, call:

Outside Canada:...................................613-944-4000

You may also order a copy online or access an online version:

Website:................................www.international.gc.ca

Documentation and Tips to Facilitate the Return to Canada

Documentation to Facilitate Travel Abroad

Custody Information


26/30

INFORMATION

PROTECTEDCHILD PASSPORT APPLICATION

for Canadians under 16 years of age (Abroad)

Given name(s) (see instruction No. 1)


Surname (last name) at birth/former surname(former last name)(see instruction No. 1)

PRINT OR TYPE IN CAPITAL LETTERS using black or dark blue ink.

Children 11 years of age or over must sign in the signature block.

Is the child the subject of an adoption process?Are there any separation agreements, court orders or legal proceedings

pertaining to custody or mobility of, or access to the child?

If yes, include all

documents(see instruction No. 2)

Signed at

City Country

Eye colour

Surname (last name)

Surname (last name) at birthSurname (last name) at birth

Applicant (parent or legal guardian) Other parent or legal guardian

Sex

Female Male


Given name(s)Given name(s)


Hair colour Height Weight

Number Street Apartment


City Country Postal code

Date of birth Place of birth


No

No

Yes

Yes

Date of birth

Relationship with other parent

Address


Address

Country of birth Country of birthYear Month Day



Date of birth

Relationship with parent applying

Year Month Day

Year Month Day

DateYear Month Day

Daytime phone

( )

Evening phone

( )

Cell. number (optional)

( )

Daytime phone

( )

Evening phone

( )

Cell. number (optional)

( )

Signature of applicant(also sign section 4) Date Signed at Signature of other parent or legal guardian Date Signed at

Signature of child (see instruction No. 1)

Date of travel

Month Day

Unknown


PPTC042(09-04)M02

Page

1

of2

COMPLETENEXTPAGE


WARNING to all applicants and guarantors Any false or misleading statement on this form or relating to any document in supportof this application, including concealment of any material fact, may lead to refusal or revocation of a passport and be grounds forcriminal prosecution.Failure to complete all the required sections of this form will result in your application being rejected.

DECLARATION I solemnly declare that the child named above is a Canadian citizen,that I am the parent or legal guardian of the child named above and that the statementsmade in this application are true. I declare that I have read and understood theWARNING to all applicants and guarantors above.

DECLARATION I solemnly declare that the child named above is a Canadian citizen,that I am the parent or legal guardian of the child named above and that the statementsmade in this application are true. I declare that I have read and understood theWARNING to all applicants and guarantors above.

Child's Personal Information1



27/30

PPTC042(09-04)M02

Surname (last name) of applicant (see General Information and Instructions,page 1 "Who May Apply for a Passport on Behalf of a Child?")

Given name(s) of applicant

Relationship to child Surname (last name) of child Given name(s) of child

Signed at

City Country

DateYear Month Day

Signature of applicant (see instruction no. 1)


Does the child's name appear in any valid Canadian passport, Certificate of Identity or Travel Document?

3 Previous Canadian Passport

If yes, include itwith your application.

Number

If the passport has been lost, stolen, damaged, destroyed or is inaccessible, you must include with this application form a completed "StatutoryDeclaration" form PPTC 203, available from any Canadian government office providing passport services or at www.passportcanada.gc.ca

Date of issue


Date

Year Month Day


Occupation(see instruction No. 5) Name of firm/organization

Business address

Name of applicant Signed atName of child

Number Street City Country

City Country

Postal code


( )


( )

Cell. number

( )

Number of years

For additional information on passports, we suggest you visit our website at

www.passportcanada.gc.ca

Page

2

of2

ENSUREBOTHPAGES

ARECOMPLETED

4 Proof of Canadian Citizenship




A To be completed if the child was bornin Canada. Provide ONE (1) of the two documents listed below (no copies):

B To be completed if the child was bornoutside of Canada. Provide the following document (no copies):

DECLARATION I solemnly declare that the child named herein is aCanadian citizen, that the photos enclosed are a true likeness of the child andthat the statements made in this application are true. I declare that I have readand understood the WARNING to all applicants and guarantors on page 1.

DECLARATION I solemnly declare that I have knownthe applicant identified above personally for at leastTWO (2) years. I have certified on the back of ONE (1)photo that the image is a true likeness of the child. Ideclare that I have read and understood the WARNINGto all applicants and guarantors on page 1.

I have known

the applicant for

No Yes (specify)

Birth certificate in Canada



Declaration of Guarantor(to be completed by the guarantor only if the applicant has completed and signed this application form)5



28/30

Date appliedYear Month Day

PROOF OF CANADIAN CITIZENSHIP ADDITIONAL INFORMATION

This form must be completed by those born outside of Canada between February 15, 1977 and April 16, 1981

inclusively, to a Canadian parent. It must be fully completed, signed and submitted with your passport application.

You do NOT need to complete this form if:

you are presenting a certificate of Canadian citizenship issued after January 1, 2007; OR one of your parents was born in Canada; OR

you received Canadian citizenship after being adopted by a Canadian parent.

PRINT OR TYPE IN CAPITAL LETTERS using black or dark blue ink

INFORMATION

PROTECTED

WARNING Any false or misleading statement on this form or relating to any document in support of your application, includingconcealment of any material fact, may lead to refusal or revocation of a passport and be grounds for criminal prosecution.

Applicants Personal Information

Surname (last name)

DECLARATION I solemnly declare that the information provided on this form istrue, correct and complete, and I give my consent to Citizenship and ImmigrationCanada to provide confidential citizenship status information concerning me to

Passport Canada. I declare that I have read and understood the WARNING above.

Name as it appears on the certificate of Canadian citizenship, if different

Date of birth Place of birthYear


Month DayCity Province/territory/state (if applicable)

City Province/territory/state Signature

Franaisauverso

PPTC001(09-04)

Country

Given name(s)


Additional Information on Canadian CitizenshipIf you do not know the answers to the following questions, contact Citizenship and Immigration Canada at 1-888-242-2100 (in Canada

only) or visit their website at www.cic.gc.ca.

1. Before you were born, was one of your parents granted Canadian citizenship following immigration H No H Yes

to canada?

2. Was one of your Canadian parents born outside Canada before February 15, 1977, AND was his or her birth H No H Yes

abroad registered with Canadian Citizenship and Immigration authorities before February 15, 1977?

complete and sign the declaration below and attach the present form to your passport application.

proceed to questions 3 and 4.

If you answeredNo to questions 3 AND 4,

If you answered Yes to question 3 OR 4,

3. Is one of your parents a Canadian citizen because he or she was born outside Canada between H No H Yes

January 1, 1947, and February 14, 1977 (inclusively) AND, although eligible to be registered as a Canadian

citizen at birth, was not registered until after February 14, 1977?

4. Is one of your parents a Canadian citizen because he or she was born outside Canada after H No H Yes

February 14, 1977, to a Canadian parent?

5. Have you applied to Citizenship and Immigration Canada to retain your Canadian citizenship?

H No H YesReference number (if known)

1

2

3 Declaration of Applicant (to be completed by all applicants required to provide additional information on their Canadian citizenship)

If you answeredYes to question 1 OR 2,

If you answeredNo to questions 1 AND 2,

complete and sign the declaration below and attach the present form to your passport application.

you may be subject to loss of Canadian citizenship pursuant to section 8 of the Citizenship Act. If so,you will automatically lose your Canadian citizenship on your 28th birthday unless you take steps toretain it. If it is confirmed that you are subject to section 8 of the Citizenship Actand your 28th birthday

has already passed, no passport will be issued to you. If it is confirmed that you are subject tosection 8 of the Citizenship Actand your 28th birthday is within five years, the validity of any passport

issued to you will be limited to the day before your 28th birthday . For more information on retentionof Canadian citizenship, contact Citizenship and Immigration Canada at 1-888-242-2100 or visit theirwebsite at www.cic.gc.ca. Proceed to question 5 and complete and sign the declaration below andattach the present form to your passport application.


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STATUTORY DECLARATIONconcerning a lost, stolen, damaged, destroyed or

inaccessible Canadian passport or travel document

Print in block letters using black or dark blue ink

INFORMATIONPROTECTED

Applicants Personal Information


)s(emaNneviGemanruS

1. I hereby declare that

2. I have made the following efforts to locate this document:

3. This document was last seen or used

This form must be completed before, and signed by, a qualified official who has the authority to administer an oath or solemn declaration (e.g. acommissioner for oaths, notary public, lawyer, etc.). If completed outside Canada, a qualified official includes a Canadian or British diplomatic orconsular representative, or a qualified local official.

DECLARATION - I solemnly declare that, to my knowledge, the

statements made in this declaration are true.

4. Should I ever regain possession of the above original document, I promise to return it immediately to Passport Canada, or, if I

am abroad, to the nearest Canadian government office. I acknowledge that a Canadian passport, once reported lostor stolen, is no longer valid and is not to be used for any travel.

, number

name,

or inaccessible on

, on at

at

under the following circumstances (full and detailed information must be provided below):

becamelost

damaged

stolen

destroyed

, issued in my name or my childs

Date of Birth Place of BirthYear Month Day

Year Month Day

yrtnuoC)elbacilppafi(yrotirreT/ecnivorPytiC

yrotirreT/ecnivorPytiC Signature

Franaisauverso

Document NumberType of Document

Childs Name Year Month Day

Year Month Day City (Exact location)

Place of issue

Year Month Day

Police Repor t Filed No Yes (Specify) Date of Report

tadengiSetaD

Declaration of Official

)s(emaNneviGemanruS

As

Address

Business Telephone Number/Extension

DateDECLARATION made before me on

( ) ( )

Home Telephone Number

Signed at

Fax Number or E-Mail Address (Optional)

Commissioner for Oaths Lawyer Notary Public Other qualified official (Specify)

yrotirreT/ecnivorPytiCteertSrebmuN Appartment Postal Code

Year Month Day

yrotirreT/ecnivorPytiC Signature of Official

No.

PPTC

203(09

-04)


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