Read Instructions
3
Previous Canadian Travel Document (see Instructions, section K)
Has a Canadian travel document (passport, certificate of identity or refugee travel document) been issued to the child?
Number
Date of issue
No
Yes (specify)
Year
Month
Day
If the Canadian travel document is still valid, you must include it with your application.
Would you like the previous passport returned to you? If not, it will be securely destroyed by the Passport Program to
protect the child's personal information.
Yes, please return it to me.
Note: If a valid Canadian travel document has been lost, stolen, damaged or is inaccessible, complete form PPTC 203, Declaration
concerning lost, stolen, inaccessible, damaged or found Canadian travel document, available online at Canada.ca/passport. A
Canadian travel document, once reported lost or stolen, is no longer valid. There is an administrative fee for the replacement of
a valid lost or stolen Canadian travel document (see section D).
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Proof of Canadian Citizenship (see Instructions, sections J and L)
Provide one (1) of the documents listed below (original only):
Registration number
Date of issue
Birth certificate in Canada
(to be completed if the child was born in Canada)
Date of issue or Effective date of citizenship
Certificate number
Certificate of Canadian citizenship
5
Declaration of Applicant
Surname (last name) of applicant
Given name(s) of applicant
Relationship to the child
Surname (last name) of child
Given name(s) of child
Declaration—I solemnly declare that the child named above is a Canadian citizen, that the photos enclosed are unaltered and a true likeness of the child, 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 on page 1 and the 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, 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 the Instructions.
Signature of applicant
Date
Signed at
Year
Month
Day
City
Country
Declaration of Guarantor
(see Instructions, section M-A Passport holder or section M-B Occupation)
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The guarantor must know the applicant identified in section 5.
Surname (last name)
Given name(s)
Canadian passport number (see section M-A) or Occupation (see section M-B)
Telephone (daytime)
Date of birth in passport (see section M-A) or Name of firm or organization (see section M-B)
Telephone (other)
Year
Month Day
Current home address (see section M-A) or Business address (see section M-B)
Number
Street
City
Country
Postal/ZIP code
Full name of applicant (parent or legal guardian)
Full name of child
I have known
Declaration—I solemnly declare that I have known the applicant identified above personally for at least two (2) years and have knowledge of the child. I have signed the back of one (1)
photo to certify that the image is a true likeness of the child. I declare that I have read and understood the Warning on page 1 and the Privacy Notice Statement (see section O). I consent
the applicant
to the collection, use and disclosure of my personal information by the Passport Program, Immigration, Refugees and Citizenship Canada, other federal government institutions,
(parent or legal
Government of Canada offices abroad and third party entities as outlined in the Privacy Notice Statement in the Instructions.
guardian) for
Signature of guarantor
Date
Signed at
Year
Month Day
Number of years
Country
City
Emergency Contact Information (optional)
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(see Instructions, section N)
Surname (last name)
Given name(s)
Relationship to the child
Telephone (daytime)
Telephone (other)
Email address
Current home address
Number
Country
Street
Apartment City
Postal/ZIP code
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