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Adult and Child Canadian Passport Application Pack for Applicants Abroad

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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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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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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 alsofill out Appendix D

Please read on for more detailed information.


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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, by le Directeur de l'étatcivil in 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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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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Photo Requirements

Please include two (2) identical passport photos taken within the pasttwelve (12) months with your application. These photos must not exceed asize of 50mm wide x 70 mm (2” x 2.75”) long. The name of thephotographer or studio, date, and address along with the guarantor’sstatement 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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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 whosepassport 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 can’t 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 swornto or declared before, and signed by, a person authorized by law toadminister an oath or a solemn declaration. If completed outside Canada, aqualified official includes a Canadian or British diplomatic or consularrepresentative, or a qualified local official.


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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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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 of Canadian offices abroad visit:

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.asp

http://www.voyage.gc.ca/main/foreign/fordest/foreign_view_client-fr.asp


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Processing Time

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

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

Fee

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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 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.

Our goal is to have the passport ready in 15 working days upon receipt of a complete application. Visit our website atwww.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 individualpassport (use form PPTC 042 "Child Passport Application").

� All THREE (3) pages of the application form completed and signed within the last 12 months

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

� Application form and one of the photos certified byyour 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 françaisFailure to complete all the required sections of this form will result in your application being rejected.

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

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

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

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

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

Montréal, 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.

INSTRUCTIONS

Signature Unacceptable

Signature Inner Limits

Acceptable

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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 of citizenship, 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 instruction no. 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 not appear 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 all THREE (3) pages. Your signature in section 1will appear in the passport. Therefore, your signature MUST NOT exceed the inner limits of the signature box.

A guarantor is a person other than yourself who confirms your identity. Your guarantor must perform free of charge the following THREE (3) 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 (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 Support

Identity").

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" form PPTC 132, available from any Canadian government office providing passport services. This form must be completed at your expense before a person authorized by law to administer an oath or solemn affirmation. This may delay the processing time of the passport.

• Enclose any Canadian passport or travel document issued to you within the last FIVE (5) years. If your current passport expires more than 12 months from the date you submit your application, provide a written explanation for why you are applying at this time. Should Passport Canada not be satisfied that you have a valid reason for applying early, your application for a new passport 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 applicant’s personal attributes such as name, approximate age, place of birth, physical description and some personal history such as occupation and place of residence.

*

1 Personal Information

Proof of Canadian Citizenship4P

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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 QuebecOnly birth certificates issued on or after January 1, 1994, by the Directeur de l'état civil in the province of Quebec are accepted.

CERTIFICATE OF CANADIAN CITIZENSHIPLarge commemorative documents of citizenship issued after February 14, 1977, are not accepted. If you require 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

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 (applicant’s 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 application form. Further documentation may be required.Documents to support your identity must be valid, must be issued by a federal, provincial, territorial or municipal authority in Canada, or local equivalent, and must include the bearer's name and signature. For example:

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– Provincial, territorial or local driver's licence– Provincial health care card– Certificate of Indian Status

– Other federal, provincial, territorial or municipal identification card– Valid Canadian passport or Canadian passport expired for a period of less than one year

– Federal, provincial, territorial or municipal employee 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 guarantor must 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 indicate that the originals have been seen. If you have no documents to support your identity, call the nearest Canadian government office providing passport services.

Your passport application will be rejected if your photos do not meet the 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 or light-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.

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

ADULT PASSPORT APPLICATIONfor Canadians 16 years of age or over

(Abroad)

Aussi disponible en français

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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 Passport Order to determine the applicant’s 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 applicant’s 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 (see instruction No. 1)

INFORMATION PROTECTED ADULT PASSPORT APPLICATION

for Canadians 16 years of age or over (Abroad)

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

Date of birth

Address of permanent residence

Place of birth Year Month Day

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

City Province/Territory (if applicable) Country

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.

Daytime telephone number

Year Month Day

Date Signed at

Evening telephone number Daytime telephone number

Business address

Date Signed at Year 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

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)

Void if signature touches border

Personal InformationMonth Day

Date of travel

Unknown

1


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

DECLARATION – I solemnly declare that I am a Canadian citizen, that the photos enclosed are a true likeness of me and that all of the statements made in this application are true. I declare that I have read and understood the WARNING to all 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 theapplicant’s identity confirming that I have seen the original(s). I declare that I have read and understood the WARNING 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 Page 2 of 3

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Previous Canadian Passport

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• 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 must include with this application form a completed "Statutory Declaration" form PPTC 203, available from any Canadian government office 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

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

Year Month DayDate of expiry (if applicable)


Documents to Support Identity5

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Registration number Date of issue

Country Effective date

Year Month Day

Proof of Canadian Citizenship4

Certificate number Date of issue


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

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

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

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

� Certificate of retention of Canadian citizenship (issued before February 15, 1977)

2) To be completed if you were born outside of Canada between February 15, 1977 and April 16, 1981 inclusively. (You do not need 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 receive Canadian 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 at

www.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 naturalization

� Yes Go to section


� No Continue to question b)

� No Continue to c)

Declaration of Applicant

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

State number of years


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 have known 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 if you have an accident or become ill while travelling outside of Canada.

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References

Relationship to applicant Daytime phone

( )

Evening phone

( )

Cell. number

Relationship

Address


Given name(s)Surname (last name)

Daytime phone



Signature of applicant Signed at Year Month Day

Date

City Country

Page 3 of 3

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1.

2. To Year Month From Year Month

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 Month From Year Month

Additional Personal Information

Mother's maiden name Provide 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.


Signature (see instruction No. 1)

INFORMATION PROTECTED ADULT PASSPORT APPLICATION

for Canadians 16 years of age or over (Abroad)


Date of birth


Place of birth Year Month Day



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)



Year Month Day

Date Signed at

Evening telephone number Daytime telephone number

Business address

Date Signed at Year Month Day

City Country

City Country

Eye colour

Given name(s) Surname (last name)


Sex Female

Male




Cell. number or email address (optional)


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

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2


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DECLARATION – I solemnly declare that I am a Canadian citizen, that the photos enclosed are a true likeness of me and that all of the statements made in this application are true. I declare that I have read and understood the WARNING to all 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 theapplicant’s identity confirming that I have seen the original(s). I declare that I have read and understood the WARNING to all applicants and guarantors above.

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Previous Canadian Passport

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• 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?


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 must include with this application form a completed "Statutory Declaration" form PPTC 203, available from any Canadian government office providing passport services or at www.passportcanada.gc.ca

Year Month Day


Signature of applicant Signed at Date

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

Proof of Canadian Citizenship4



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

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

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

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

� Certificate of retention of Canadian citizenship (issued before February 15, 1977)

2) To be completed if you were born outside of Canada between February 15, 1977 and April 16, 1981 inclusively. (You do not need 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 receive Canadian 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 at

www.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 naturalization



� No Continue to question b)

� No Continue to c)

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 have known 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 if you have an accident or become ill while travelling outside of Canada.

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References

Relationship to applicant Daytime phone

( )

Evening phone

( )

Cell. number

Relationship

Address


Given name(s)Surname (last name)

Daytime phone



Signature of applicant Signed at Year Month Day

Date

City Country

Page 3 of 3

ENSU

RE A

LL THR

EE (3

)PA

GES A

RE C

OM

PLETED

1.

2. To Year Month From Year Month



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 Month From Year Month

Additional Personal Information

Mother's maiden name Provide 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.

Where to Apply

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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 universally accepted 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 days upon receipt of a complete application. Visit our website atwww.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 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 Honorary Consuls).

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 intolocal 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 tothe Canadian Embassy, High Commission or Consulate asthe case may be

Administrative fees and any applicable interest will be applied to 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 first 12 months may be issued a one-time replacement passport, free of charge, valid for the balance of the three-year validityperiod of the original passport. Full application requirementsmust be met. To ensure the photo is a current and true likenessof the child, it must be taken within one month of the date theapplication is submitted.

BOTH pages of the application form completed and signed within the last 12 months

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

Application form and one of the photos certified by your guarantor

Proof of Canadian citizenship (no copies or certified copies)

Any valid Canadian passport or travel document issued to the child

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

The fee

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

Aussi disponible en françaisFailure to complete all the required sections of this form will result in your application being rejected.

Processing Times

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

Periods of Validity for Passports Issued to Children

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 or consult your local telephone directory.

INFORMATION ON TRAVEL CONDITIONS AND REQUIREMENTS

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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)

Montréal, 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

INSTRUCTIONS

Signature Unacceptable

Signature Inner Limits

Acceptable

Information on Applicant2

Proof of Canadian Citizenship

Previous Canadian Passport3

4

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NAME TO APPEAR IN PASSPORT Write 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 documentary evidence 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 not appear in the passport).

PLACE OF BIRTH The 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 a written request. Be sure to contact the consulate or embassy of every country you plan to visit to ensure that the child will be admitted if the passport does not include the place of birth.

SIGNATURE Children 11 years of age or over MUST sign their usual signature. The child’s signature in section 1 will appear in the passport. Therefore, the signature MUST NOT exceed the inner limits of 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 birth certificate showing information on both parents. Where a legal guardian is the applicant, the other legal guardian as the case may be is also requested to 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 documents that 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 of marriage 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 child’s current passport expires more than 12 months from the date of submission of the application, provide a written explanation for why you are applying at this time. Should Passport Canada not be satisfied that you have a valid reason for applying early, your application for a new passport may be refused.

• If the valid passport has been lost, stolen, damaged, destroyed or is inaccessible, complete a "Statutory Declaration" form PPTC 203, available from any Canadian government office providing passport services or at www.passportcanada.gc.ca A Canadian 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 certificate may be obtained from the Vital Statistics authorities of the child's province or territory of birth. To avoid possible delays, we strongly recommend that you provide a long-form birth certificate showing information on both parents.

If the child was born in QuebecOnly birth certificates issued on or after January 1, 1994, by the Directeur de l'état civil in 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

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A guarantor is a person other than the applicant who confirms the applicant’s 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 child’s 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 child’s 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 your expense before a person authorized by law to administer an oath or solemn affirmation. This may delay the processing time of the passport.

To know an applicant personally means that the guarantor is able to confirm aspects of the applicant’s personal attributes such as name, approximate age, place of birth, physical description and some personal history such as occupation and place of residence.

*

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

IMAGE INFORMATION• Only the head and shoulders of young children must appear on

the photo (e.g. no hands holding the child).

• Photos must be taken with uniform lighting and not showshadows 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 or light-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 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 (child’s name)”.

Photo Specifications

(child’s name)

5 Declaration of Guarantor

Complete and sign BOTH pages of the application form.

CHILD PASSPORT APPLICATIONfor Canadians under 16 years of age

(Abroad)


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042 (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 Passport Order to 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 child’s 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 PROTECTED CHILD PASSPORT APPLICATION

for Canadians under 16 years of age (Abroad)



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


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 birth Surname (last name) at birth

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

Sex

Female Male


Given name(s) Given name(s)



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 birth Year Month Day

Date of marriage (if applicable) Year Month Day

Date of marriage (if applicable)Year Month Day

Date of birth

Relationship with parent applying

Year Month Day

Year Month Day

Date Year Month Day

Daytime phone

( )

Evening phone

( )

Cell. number (optional)

( )

Daytime phone

( )

Evening phone

( )


( )

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


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EXT PA

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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 statements made in this application are true. I declare that I have read and understood the WARNING to all applicants and guarantors above.


Child's Personal Information1


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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

Date Year 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


Number

If the passport has been lost, stolen, damaged, destroyed or is inaccessible, you must include with this application form a completed "Statutory Declaration" 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

Surname (last name) Given name(s)


Business address

Name of applicant Signed at Name 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 of 2

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OTH

PAG

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RE C

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PLETED

4 Proof of Canadian Citizenship




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

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

DECLARATION – I solemnly declare that the child named herein is a Canadian citizen, that the photos enclosed are a true likeness of the child and that the statements made in this application are true. I declare that I have read and 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 least TWO (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 WARNING to all applicants and guarantors on page 1.


� 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


Travelling with Children or Children Travelling Alone

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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

INFORMATION PROTECTED CHILD PASSPORT APPLICATION

for Canadians under 16 years of age (Abroad)



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


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 birth Surname (last name) at birth

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

Sex

Female Male


Given name(s) Given name(s)



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 birth Year Month Day

Date of marriage (if applicable) Year Month Day

Date of marriage (if applicable)Year Month Day

Date of birth

Relationship with parent applying

Year Month Day

Year Month Day

Date Year Month Day

Daytime phone

( )

Evening phone

( )


( )

Daytime phone

( )

Evening phone

( )


( )

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


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Child's Personal Information1


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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

Date Year 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


Number

If the passport has been lost, stolen, damaged, destroyed or is inaccessible, you must include with this application form a completed "Statutory Declaration" 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



Business address

Name of applicant Signed at Name 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 of 2

ENSU

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OTH

PAG

ESA

RE C

OM

PLETED

4 Proof of Canadian Citizenship




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

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

DECLARATION – I solemnly declare that the child named herein is a Canadian citizen, that the photos enclosed are a true likeness of the child and that the statements made in this application are true. I declare that I have read and 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 least TWO (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 WARNING to all applicants and guarantors on page 1.


� 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


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, 1981inclusively, 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

INFORMATIONPROTECTED

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.

Applicant’s Personal InformationSurname (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 toPassport 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

Françaisau

versoP

PT

C001

(09-04)

Country

Given name(s)

Date Signed atYear Month Day

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

1. Before you were born, was one of your parents granted Canadian citizenship following immigration � No � Yesto canada?

2. Was one of your Canadian parents born outside Canada before February 15, 1977, AND was his or her birth � No � Yesabroad 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 answered No 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 � No � YesJanuary 1, 1947, and February 14, 1977 (inclusively) AND, although eligible to be registered as a Canadiancitizen 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 � No � YesFebruary 14, 1977, to a Canadian parent?

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

� No � 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 answered Yes to question 1 OR 2,

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

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

Applicant’s Personal Information


)s(emaN neviGemanruS

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, thestatements 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 Iam 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 child’s

Date of Birth Place of BirthYear Month Day

Year Month Day

yrtnuoC)elbacilppa fi( yrotirreT/ecnivorPytiC

yrotirreT/ecnivorPytiC Signature

Français au verso

Document NumberType of Document

Child’s Name Year Month Day

Year Month Day City (Exact location)

Place of issue

Year Month Day

Police Report Filed No Yes (Specify) Date of Report

ta dengiSetaD

Declaration of Official)s(emaN neviGemanruS

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.

PP

TC

203 (09-04)