Fillable ADULT SIMPLIFIED RENEWAL PASSPORT APPLICATION (Government of Canada)

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ADULT SIMPLIFIED RENEWAL PASSPORT APPLICATION (Government of Canada)

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Page 1 of 5
ADULT SIMPLIFIED RENEWAL PASSPORT APPLICATION
for eligible Canadians applying in Canada or 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, and/or the imposition of a period of refusal of passport services, and may be grounds for criminal
prosecution as per subsection 57 (2) of the Criminal Code (R.C.S. 1985, C-46).
PROTECTED WHEN COMPLETED - B
Type or print in CAPITAL LETTERS using black or dark blue ink.
Personal Information (see Instructions, section I)
1
Surname (last name) as it appears in the previous passport
Given name(s) as it appears in the previous passport
All former surnames (including surname at birth if different from above. These will not appear in the passport).
Mother's maiden name
Place of birth
City
Country
Prov./Terr./State (if applicable)
Date of birth as it appears in the previous
passport
Year Month Day
Sex as it appears in the previous
passport
F Female
M Male
X Another gender
Natural eye colour
Height
(cm/in)
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
Telephone (daytime)
Telephone (other) Email address
Declaration—I solemnly declare that I am a Canadian citizen, that all of the
information provided and all statements made on this application, as well as
all documents and photos submitted to support this application are unaltered
and true. I declare that I have read and understood the Warning at the top of
this page and the Privacy Notice Statement in Instructions, section K. I
consent to the collection, use and disclosure of my personal information as
outlined in the Privacy Notice Statement.
Sign within border
Signature (see Instructions, section I)
Date
Year Month Day
Signed at
City
Province/Territory/State
Anticipated date of travel
Unknown
Month Day
It is recommended that you do not
finalize travel plans until you receive
the requested passport.
Previous Canadian Passport (see Instructions, section J)
2
Enclose any Canadian passport issued to you that is
not expired or is expired for less than one year from
the date the application is submitted.
Passport number
Date of issue
Year
Month Day
Date of expiry
Year Month Day
If you cannot submit the previous passport, or if the previous passport is damaged, or was ever reported lost or stolen, you cannot use this
form. Any passport that is damaged, or was ever reported lost or stolen will not be returned. Unreturned passports will be securely
destroyed to protect your personal information.
Yes, please return it to me. If this box is not checked, the passport will not be returned and will be securely destroyed.
Would you like the previous passport to be cancelled and returned to you?
Canadian Citizenship
3
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
Canadian citizenship following immigration to Canada?
Yes – Go to page 2 No – Continue to question b)
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?
After January 1, 2007
Before January 1, 2007
Submit the certificate with your application (original only).
Complete and submit form PPTC 001, Proof of Canadian Citizenship—Additional Information, available
online at Canada.ca/passport.
(DISPONIBLE EN FRANÇAIS - PPTC 055)PPTC 054 (06-2019)
Read Instructions
Page 2 of 5
Period of Validity (see Instructions, section C)
4
Choose one (1) of the following periods of validity:
5-year or 10-year
Additional Personal Information
5
Note: If insufficient space, attach a separate signed and dated sheet.
A Addresses in the last two (2) years
Same as current home address
Different from current home address (complete below)
1.
From
Year Month
To
Year Month
2.
From
Year Month
To
Year Month
B
Occupation in the last two (2) years (check all that apply):
I was employed (full- or part-time)
I was in school (full- or part-time)
Other, e.g. homemaker, unemployed or retired
Enter full details below for the last two (2) years:
Employer, school or other Address Telephone (daytime) Field of employment or studies Date (from) Date (to)
References
6
Provide the following information for two (2) persons who are neither your relatives; are 18 years of age or over; and who have
known you for at least two (2) years. They must agree to have their contact information provided as they may be contacted to confirm
your identity. Visit Canada.ca/passport for more information on the Passport Program's definition of a relative.
1. Surname (last name) Given name(s)
Relationship to the applicant
Address
(Number, Street, Apartment, City, Province/Territory/State, Country, Postal/ZIP code)
Telephone (daytime)
Telephone (other)
Email address
Has known me for
Number of years
2. Surname (last name)
Given name(s) Relationship to the applicant
Address
(Number, Street, Apartment, City, Province/Territory/State, Country, Postal/ZIP code)
Telephone (daytime) Telephone (other) Email address
Has known me for
Number of years
Emergency Contact Information (optional)
7
This information is helpful if you require emergency assistance while outside of Canada.
Surname (last name) Given name(s)
Relationship to the applicant
Telephone (daytime)
Telephone (other)
Email address
Current home address
Number Street Apartment City
Province/Territory/State Postal/ZIP code
Signature of applicant Date
Year Month Day
PPTC 054 (06-2019)
Ongoing occupation?
Read Instructions
Page 3 of 5
Adult Simplified Renewal Passport Application
for eligible Canadians applying in Canada or the USA
Instructions
Who May Use This Form?
A
Important notice: We recommend that you not finalize your travel plans until
you receive the requested passport.
Note: If you cannot answer yes to all of the conditions outlined here, or if this is your first
application for a Canadian passport, you must complete form PPTC 153, Adult General Passport
Application.
Additional documents or information may be requested in support of this application.
You may use this form to renew a passport only if all of the following conditions are met:
• you were at least 16 years of age at the time of your previous application
• the information (name, date of birth, sex and place of birth) on this application form is
exactly as it appears on page 2 of the submitted passport
1
• the Canadian passport being renewed:
• is valid or expired for no more than one (1) year
2
• was or is valid for five (5) years or ten (10) years
3
• is not damaged
• was never reported lost or stolen
Requirements Checklist
B
Both pages of the application form completed and signed within the last twelve (12) months
Two (2) identical and unaltered passport photos taken within the last six (6) months. No signature is required on the photos
Enclose any Canadian passport issued to you within the last six (6) years
The fee
Fee and Period of Validity
C
Where the application is made in Canada and the
passport is to be delivered in Canada:
5-year validity – CAN$120*
10-year validity – CAN$160*
Where the application is made from the USA** or the
passport is to be delivered to the USA**:
5-year validity – CAN$190*
10-year validity – CAN$260*
*A CAN$25 consular services fee is included in the above-mentioned fee.
**Includes Bermuda, American Samoa, the Midway Islands, Puerto Rico and the US Virgin Islands.
Methods of payment (Canadian funds only):
• Debit card (Interac), Visa Debit, Virtual Visa Debit or other prepaid cards (Visa, MasterCard, American Express) only for in person applications
submitted by the cardholder. Prepaid debit cards are not accepted;
• Credit card and prepaid card (embossed only). If you are applying by mail, see section D; or
• Certified cheque or money order (postal or bank) in the exact amount, payable to the Receiver General for Canada.
Important
• Every person who requests passport services must pay the applicable fee in the exact amount.
• Applicants who cancel their application or are refused a passport are not eligible for a refund of the passport service fee. Only the consular services
fee of CAN$25, applied only to adult applications, is refundable.
• The Passport Program, Immigration, Refugees and Citizenship Canada does not accept personal cheques or payment in cash for applications
submitted in Canada.
• Administrative fees and applicable interest will be applied to all dishonoured payments.
• Fees are subject to change.
Credit Card Information
D
If you are applying in person, do not complete this section. If you are applying by mail and paying by credit card, complete and submit this
section with your application.
Card type:
Visa MasterCard American Express
Name as it appears on card Card number
Date of expiry
Month Year
Name of applicant
For official use only
Authorization—I authorize the Passport Program
to charge
CAN$
to my credit card.
Signature of cardholder
Date
Year Month Day
PPTC 054 (06-2019)
Complete Form
Page 4 of 5
Applying in Person
E
Canadians can submit an application in Canada at:
• a Passport Program regional office; or
• a participating Service Canada Centre.
For information on service locations, service standards and requirements for expedited services, visit Canada.ca/passport.
For Canadians submitting an application from the USA:
If you require a passport in exceptional circumstances, contact the nearest Government of Canada office. You can find a list of Government of
Canada offices in the USA online at travel.gc.ca or in your local telephone directory.
Applying by Mail
F
Mailed-in applications are processed in Canada.
By mail
Passport Program
Gatineau QC K1A 0G3
Canada
By courier
Passport Program
22 de Varennes Street
Gatineau QC J8T 8R1
Canada
The original documents that you enclose with your application are valuable. We
recommend that you use a courier or mail service that allows you to track your
package
Personal Information
I
Surname and given name(s) to appear in passport
Your name must be written exactly as it appears on page 2 of the submitted passport. Your surname (last name) and given name(s) must be spelled the
same and be placed in the same order. If your name has changed, you cannot use this form. You must complete form PPTC 153, Adult General Passport
Application.
All former surnames
All former surnames that differ from the surname requested to appear in the passport, including your surname at birth must be declared. These former
surnames will not appear in the passport.
Mother's maiden name
Indicate your mother's surname (last name) at birth.
Place of birth
Your place of birth must be provided on the application form. If you do not wish the place of birth to appear in the passport, complete and submit form
PPTC 077, Request for a Canadian passport without place of birth, available online at Canada.ca/passport.
Date of birth
The specific year, month and day of your birth will be entered as shown on the submitted passport.
Sex
The sex will be entered as shown on the submitted passport. If you request a different sex identifier, you cannot use this form. Visit Canada.ca/passport for
more details.
Signature
You must sign your usual signature on both pages.
Contact Information
G
General information is available 24 hours a day, 7 days a week. Agents are available Monday to Friday from 7:30 a.m. to 8:00 p.m. (Eastern Time) in
Canada.
Information on passports, fees and processing times
Canada.ca/passport
Toll-free: 1-800-567-6868
Outside the continental USA: 1-819-997-8338
TTY (for people who are Deaf or hard of hearing)
Toll-free: 1-866-255-7655
Travel reports, warnings and requirements
For travel advice and warnings or foreign entry and exit requirements (how long the passport has to be valid for travel to a foreign country), visit
travel.gc.ca
Anticipated Date of Travel
H
Regardless of the date of travel you indicate on the application form, processing times and requirements for expedited services are still applicable.
Processing times begin once a completed application form and all required supporting documentation are received (see section B). Processing times do
not include mailing time. Visit Canada.ca/passport for more details.
It is recommended that you do not finalize travel plans until you receive the requested passport.
The Government of Canada, or any representative of the Government of Canada will not be liable for any loss incurred as a result of or arising out of the
passport not being delivered in time for you to travel on the date you have specified on the application form.
PPTC 054 (06-2019)
Complete Form
Page 5 of 5
Previous Canadian Passport
J
Enclose any Canadian passport issued to you in your current name or any other name that is not expired or is expired for less than one year from the date
you submit your application. If the passport is valid for more than twelve (12) months from the date the application is submitted, provide a written
explanation as to why you are applying at this time. Should the Passport Program not be satisfied that you have an acceptable reason for applying early,
your application for a new passport may be refused.
Note: If the passport has been lost, stolen, damaged or is inaccessible, you cannot use this form.
Canadian Passport Photo Instructions
L
You must submit two (2) identical and unaltered photo prints with each passport application. Electronic photos are not acceptable.
More information is available at Canada.ca/passport.
The photos must:
be taken in person by a commercial photographer;
be professionally printed on plain, high quality photographic paper
(photos printed at home are not acceptable);
be clear, sharp and in focus; in colour or black and white;
show a neutral facial expression (no smiling, mouth closed) and
looking straight at the camera, with eyes open and clearly visible;
have uniform lighting—no shadows, glare or flash reflections;
show a full front view of the face and top of the shoulders squared to
the camera (face and shoulders centered in the photo, head not tilted
or turned);
reflect natural skin tone and be taken against a plain white or light-
coloured background with enough contrast between the background,
facial features and clothing, so that your features appear clearly
against the background;
be originals that have not been altered in any way and not taken
from an existing photo;
be taken within the last six (6) months from the date the application is
submitted and reflect your current appearance.
Frame Height 70 mm (2
3/4
in.)
Minimum Face Height
31 mm (1
1/4
in.)
Maximum Face Height
36 mm (1
7/16
in.)
Frame Width 50 mm (2 in.)
Photo Co. Ltd.
111 Any Street
Any Town, COUNTRY
Photo taken
Date
Not actual size (refer to measurements above)
No signature is required on the photos.
The following must appear on the back of one photo
The name and complete address of the photo studio (not a P.O. Box) and the date the photo was taken. The photographer may use a
stamp or handwrite this information (stick-on labels are not acceptable).
No signature is required on the photos.
Additional information
Prescription glasses may be worn in photos as long as there is no glare and the eyes are clearly visible.
Hats and head coverings must not be worn, except for religious beliefs or medical reasons. The head covering and hair must not cast
shadows on the face and the full face must be clearly visible.
The red-eye effect, tinted glasses and sunglasses make the photos unacceptable.
PPTC 054 (06-2019)
Privacy Notice Statement
K
Personal information provided on this form is collected by Immigration, Refugees, and Citizenship Canada (IRCC) under the authority of the Canadian
Passport Order. The personal information provided will be used for the purpose of processing applications, determining entitlement to passport services
and administering passport services. The personal information provided may be disclosed to other federal government institutions, provincial/territorial
governments, foreign governments, investigative bodies and/or law enforcement for the purpose of validating identity, determining current and ongoing
entitlement to passport services and administering or enforcing any law or carrying out a lawful investigation.
Personal information may also be used for purposes including research, statistics, quality assurance, program and policy evaluation, internal audit,
compliance, risk management, strategy development and reporting. Failure to complete the form in full may result in a delay or the application not being
processed. The Privacy Act gives individuals the right of access to, protection, and correction of their personal information. If you are not satisfied with the
manner in which IRCC handles your personal information, you may exercise your right to file a complaint to the Office of the Privacy Commissioner of
Canada. The collection, use, disclosure and retention of your personal information is further described in IRCC’s Personal Information Bank – IRCC PPU
081 and IRCC PPU 082.
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ADULT SIMPLIFIED RENEWAL PASSPORT APPLICATION (Government of Canada)

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Completed 4 September 2020

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