Form Pptc 156 - Child General Passport Application For Canadians Under 16 Years Of Age Applying In Canada Or From The Usa
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8Read Instructions
PROTECTED WHEN
Child
General Passport Application
COMPLETED - B
for Canadians under 16 years of age applying in Canada or from the USA
Warning: Any false or misleading statement with respect to this application and any supporting document, including the concealment
of any material fact, may result in the refusal to issue a passport, the revocation of a currently valid passport, or the refusal of passport
services, and may be grounds for criminal prosecution. Your application will not be processed if you fail to complete all of the required
sections of this form and/or refuse to consent to the exchange or disclosure of any personal information required for the delivery of
passport services.
Type or print in CAPITAL LETTERS using black or dark blue ink.
1
Child's Personal Information (see Instructions, section I)
Surname (last name)
Given name(s)
Date of travel
Month
Day
Surname (last name) at birth
Former surname (last name)
Unknown
Date of birth
Place of birth
Year
Month
Day
City
Country
Prov./Terr./State(if applicable)
Sex
Female
Height (cm/in)
Weight (kg/lbs)
Eye colour
Current hair colour
Male
Current home address
Number
Street
Apartment
City
Province/Territory/State
Postal/ZIP code
Mailing address (if different from current home address)
Number
Street
Apartment
City
Province/Territory/State
Postal/ZIP code
Children 11 years of age or over must sign in this signature box.
Sign within border
Note: At no time should a person other than the child sign in this
signature box, without exception.
Date
Signed at
Year
Month
Day
Signature of child (see Instructions, section I)
Province/Territory/State
City
2
Information on Applicant (see Instructions, section J)
Is the child currently the subject of an adoption process or partially or fully in
No
Yes
the care of a provincial or territorial family services organization in Canada?
If yes, include all documents
Are there any separation agreements, court orders or legal proceedings
No
Yes
pertaining to custody of, mobility of, or access to the child?
Relationship between the applicant (parent or legal guardian) and the other parent or legal guardian
Date of marriage (if applicable)
Year
Month
Day
Applicant (parent or legal guardian)
Other parent or legal guardian
Surname (last name) at your birth
Surname (last name) at your birth
Given name(s)
Given name(s)
Country of birth
Country of birth
Date of birth
Date of birth
Year
Month
Day
Year
Month
Day
Address
Address
Telephone (daytime)
Telephone (other)
Telephone (daytime)
Telephone (other)
Cell number (optional)
Cell number (optional)
Declaration—I declare that the child named above is a Canadian citizen, that I am the
Declaration—I declare that the child named above is a Canadian citizen, that I am the
parent or legal guardian of this child and that the statements made in this application are
parent or legal guardian of this child and that the statements made in this application are
true. I declare that I have read and understood the Warning at the top of this page and the
true. I declare that I have read and understood the Warning at the top of this page and the
Privacy Notice Statement (see section O). I consent to the collection, use and disclosure of
Privacy Notice Statement (see section O). I consent to the collection, use and disclosure of
my personal information and that of the child by the Passport Program, Immigration,
my personal information and that of the child by the Passport Program, Immigration,
Refugees and Citizenship Canada, other federal government institutions, Government of
Refugees and Citizenship Canada, other federal government institutions, Government of
Canada offices abroad and third party entities as outlined in the Privacy Notice Statement in
Canada offices abroad and third party entities as outlined in the Privacy Notice Statement in
the Instructions.
the Instructions.
Signature of applicant
Date
Signed at
Signature of other parent or legal guardian
Date
Signed at
(also sign section 5)
Aussi accessible en français - PPTC 156
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