Adult Abroad General Passport Application For Canadians 16 Years Of Age Or Over Applying Outside Of Canada And From The Usa

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Read Instructions
PROTECTED WHEN
Adult
Abroad General Passport Application
COMPLETED - B
for Canadians 16 years of age or over applying outside of Canada and 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
Personal Information (see Instructions, section H)
Date of travel
Month
Day
Surname (last name)
Unknown
Given name(s)
Surname (last name) at birth
Former surname (last 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 (daytime)
Telephone (other)
Email address
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 section M). I consent to the collection, use and
disclosure of my personal information by the Passport Program,
Signature (see Instructions, section H)
Immigration, Refugees and Citizenship Canada, other federal
government institutions, Government of Canada offices abroad and
Date
Signed at
third party entities as outlined in the Privacy Notice Statement in the
Year
Month
Day
Instructions.
Country
City
Declaration of Guarantor (see Instructions, section J-A Passport holder or section J-B Occupation)
2
Note: You must complete and sign all three (3) pages of this application form before requesting that your guarantor complete and sign this section.
Surname (last name)
Given name(s)
Canadian passport number (see section J-A) or Occupation (see section J-B)
Telephone (daytime)
Telephone (other)
Date of birth in passport (see section J-A) or Name of firm or organization (see section J-B)
Year
Month Day
Current home address (see section J-A) or Business address (see section J-B)
Number
Street
City
Country
Postal/ZIP code
Declaration—I solemnly declare that I have known the applicant identified above
I have known
Signature of guarantor
personally for at least two (2) years. I have signed the back of one (1) photo to certify
the applicant
that the image is a true likeness of the applicant. If applicable, I have signed and dated
for
a copy of each document to support the applicant's identity to confirm that I have seen
the original(s). I declare that I have read and understood the Warning at the top of this
page and the Privacy Notice Statement (see section M). I consent to the collection, use
and disclosure of my personal information by the Passport Program, Immigration,
Date
Signed at
Refugees and Citizenship Canada, other federal government institutions, Government
Number
Year
Month Day
of Canada offices abroad and third party entities as outlined in the Privacy Notice
of years
City
Country
Statement in the Instructions.
Aussi accessible en français - PPTC 041
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