Adult Abroad Simplified Renewal Passport Application - Canadians Applying Outside Of Canada And From The Usa
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1
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5Read Instructions
Abroad Simplified Renewal
Adult
Passport Application
PROTECTED
WHEN
for Canadians applying outside of Canada and from the USA
COMPLETED - B
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
Personal Information (see Instructions, section G)
Date of travel
Month
Day
Surname (last name)
Unknown
Given name(s)
Surname (last name) at birth
Former surname (last name)
Mother's maiden name
Place of birth
City
Country
Prov./Terr./State (if applicable)
Date of birth
Sex
Height (cm/in)
Natural eye colour
Year
Month
Day
Female
Male
Current home address
Country
Number
Street
Apartment City
Postal/ZIP code
Mailing address (if different from current home address)
Number
Street
Apartment City
Country
Postal/ZIP code
Telephone (other)
Email address
Telephone (daytime)
Declaration—I solemnly declare that I am a Canadian citizen, that the
Sign within border
photos enclosed are unaltered and a true likeness of me, that all of the
statements made and the information provided in this application, as
well as any supporting documents, are true. I declare that I have read
and understood the Warning at the top of this page and the Privacy
Notice Statement (see Instructions, section I). I consent to the
collection, use and disclosure of my personal information by the
Signature (see Instructions, section G)
Passport Program, Immigration, Refugees and Citizenship Canada,
other federal government institutions, Government of Canada offices
Date
Signed at
abroad and third party entities as outlined in the Privacy Notice
Year
Month
Day
Statement in the Instructions.
City
Country
2
Previous Canadian Passport (see Instructions, section H)
Enclose any Canadian passport issued to you
Date of issue
Date of expiry
Passport number
Year
Month
Day
Year
Month
Day
within the last six (6) years.
If you cannot submit the previous passport, or if the previous passport is damaged, you cannot use this form.
Would you like the previous passport returned to you? If not, it will be securely destroyed by the Passport Program to protect your
personal information.
Yes, please return it to me.
3
Canadian Citizenship
To be completed if you were born outside of Canada between February 15, 1977 and April 16, 1981 inclusive.
a) Are you a naturalized Canadian, i.e. did you receive
Yes – Go to page 2
No – Continue to question b)
Canadian citizenship following immigration to Canada?
b) Was one of your parents born in Canada?
Yes – Go to page 2
No – Continue to question c)
c) When was your current certificate of Canadian citizenship issued?
Submit the certificate with your application (original only).
After January 1, 2007
Complete and submit form PPTC 001, Proof of Canadian Citizenship—Additional Information,
Before January 1, 2007
available online at Canada.ca/passport.
Aussi accessible en français - PPTC 483
- Page 1 of 5
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