Fillable Form 1: ADULT ABROAD GENERAL PASSPORT APPLICATION (Government of Canada)

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Form 1: ADULT ABROAD GENERAL PASSPORT APPLICATION (Government of Canada)

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Page 1 of 7
ADULT ABROAD GENERAL PASSPORT APPLICATION
for Canadians 16 years of age or over applying outside of Canada and 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).
(DISPONIBLE EN FRANÇAIS - PPTC 041)PPTC 040 (10-2020)
Type or print in CAPITAL LETTERS using black or dark blue ink.
1
PERSONAL INFORMATION (SEE INSTRUCTIONS, SECTION H)
Surname (last name) requested to appear in the passport
Given name(s) requested to appear in the passport
Anticipated date of travel
Unknown
Month
Day
It is recommended that you do not
finalize travel plans until you receive
the requested passport.
All former surnames (including surname at birth if different from above. These will not appear in the passport.)
Mother's surname at birth
Place of birth
City Country
Prov./Terr./State (if applicable)
Date of birth
(YYYY-MM-DD)
Sex
F Female
M Male X Another gender
Natural eye colour Height (cm or in)
Current home address
Number Street Apt. City
Country Postal/ZIP code
Mailing address (if different from current home address)
Number Street Apt.
City
Country
Postal/ZIP code
Email address Telephone (daytime) Telephone (other)
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 M. 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 H)
Date (YYYY-MM-DD) Signed at
City Country
2
DECLARATION OF GUARANTOR (SEE INSTRUCTIONS, SECTION J-A PASSPORT HOLDER OR SECTION J-B OCCUPATION)
Note: You must complete and sign all three (3) pages of this application form before requesting that your guarantor validate and sign this section.
Surname (last name) in passport Given name(s)
Canadian passport number (see section J-A) or Occupation (see section J-B) Telephone (daytime)
Date of birth in passport (YYYY-MM-DD) (see section J-A) or Name of firm or organization (see section J-B) Telephone (Other)
Current home address (see section J-A) or Business address (see section J-B)
Number Street Apt. City
Country
Postal/ZIP code
Declaration—I solemnly declare that I have known the applicant identified above
personally for at least two (2) years. I have signed the back of one (1) of the photos
to certify that the image is a true likeness of the applicant. Where applicable, I have
signed and dated a copy of each document to support the applicant's identity (see
section 5) to confirm that I have seen the original(s). I declare that I have read and
understood the Warning at the top of page 1 of this application and the Privacy
Notice Statement in Section M of the instructions. I consent to the collection, use
and disclosure of my personal information as outlined in the Privacy Notice
Statement.
Signature of guarantor
I have known the
applicant for
Number of years
Date (YYYY-MM-DD) Signed at
City Country
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Page 2 of 7
PPTC 040 (10-2020)
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 you in your current name or any other name?
No Yes (specify)
Number Date of issue (YYYY-MM-DD)
If the Canadian travel document is still valid, you must include it with your application.
Any passport that is damaged or was ever reported as lost or stolen will not be returned and will be securely destroyed to protect your personal information.
• Would you like the previous passport to be cancelled and returned to you?
Yes, please return it to me. If this box is not checked, the passport will not be returned and will be securely destroyed.
Note: If a Canadian travel document has been reported lost, stolen, damaged or is inaccessible, and has not yet expired, 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 is no longer valid if damaged or reported as lost, stolen, or inaccessible. There is an administrative fee for the replacement of a lost or stolen
Canadian travel document that has not yet expired.
4
PROOF OF CANADIAN CITIZENSHIP (SEE INSTRUCTIONS, SECTION I)
A
To be completed if you were born in Canada. Provide one (1) of the documents listed below (original only):
Canadian provincial or territorial birth certificate
Certificate of Canadian citizenship
Registration number Date of issue
Certificate number Date of issue or Effective date of citizenship
B
To be completed if you were born outside of Canada.
1) Provide one (1) of the documents listed below (original only):
Certificate of Canadian citizenship Certificate of naturalization
Certificate of registration of birth abroad
(issued by the Registrar of Canadian Citizenship)
Certificate of retention of Canadian citizenship
(issued before February 15, 1977)
Certificate number Date of issue or Effective date of citizenship
2) To be completed if you were born outside of Canada between February 15, 1977 and April 16, 1981 inclusive (you do not need to complete this section
if you are presenting a certificate of Canadian citizenship issued after January 1, 2007).
a) Are you a naturalized Canadian, i.e. did you receive Canadian citizenship following immigration to Canada?
Yes, go to section 5 No, continue to question b)
b) Was one of your parents born in Canada?
Yes, go to section 5
Complete and submit form PPTC 001, Proof of Canadian Citizenship—Additional Information, available online at
Canada.ca/passport.
5
DOCUMENTS TO SUPPORT IDENTITY (SEE INSTRUCTIONS, SECTION L)
You need to provide at least one (1) document to support your identity. The identification document (ID) must be valid and be issued by a federal, provincial/
territorial government authority (or local equivalent abroad). The ID must include your name, date of birth, signature and photo. One or more document(s),
when combined, may be used to fulfill these criteria.
• If you are applying in person, your original documents will be validated and returned to you.
• If applying by mail, provide copies of both sides of your ID and have them signed and dated by your guarantor.
Note: The documents provided in this section must not be the proof of Canadian citizenship provided in section 4.
Type of document
Document number
Date of expiry (If applicable YYYY-MM-DD)
Your name as it appears on the document
Type of document Document number
Date of expiry (If applicable YYYY-MM-DD)
Your name as it appears on the document
Signature of applicant Date (YYYY-MM-DD)
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Page 3 of 7
PPTC 040 (10-2020)
6
PERIOD OF VALIDITY (SEE INSTRUCTIONS, SECTION D)
Choose one (1) of the following periods of validity:
5-year or 10-year
7
ADDITIONAL PERSONAL INFORMATION
Note: If insufficient space, include form PPTC 056, Additional Information – Address and Occupation, available on Canada.ca/passport.
A
Addresses in the last two (2) years
Same as current home address
Different from current home address (complete below)
1.
Number Street Apt.
City
Country Postal/ZIP code
From (YYYY-MM) To (YYYY-MM)
Number
2.
Street Apt. City Country Postal/ZIP code
From (YYYY-MM) To (YYYY-MM)
B
Occupation in the last two (2) years (check all that apply):
I was employed (full- or part-time)
Other, e.g. homemaker, unemployed or retiredI was in school (full- or part-time)
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)
8
REFERENCES
Provide the following information for two (2) persons who are neither your relatives nor your guarantor; 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 Apt. Street City
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 Apt. Street City
Country
Postal/ZIP code
Telephone (daytime) Telephone (other) Email address
Has known
me for
Number of years
9
EMERGENCY CONTACT INFORMATION (OPTIONAL)
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
Apt.
City Country
Postal/ZIP code
Signature of applicant
Date (YYYY-MM-DD)
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Ongoing occupation?
Page 4 of 7
PPTC 040 (10-2020)
ADULT ABROAD GENERAL PASSPORT APPLICATION
for Canadians 16 years of age or over applying outside of Canada and the USA
INSTRUCTIONS
A
ENTITLEMENT TO A CANADIAN PASSPORT
Important notice: We recommend that you not finalize your travel plans until you receive the requested passport.
• A Canadian passport is the only reliable and universally accepted travel and identification document for Canadians who travel abroad.
• Canadian passports are issued to Canadian citizens only and reflect their identity, as determined by proof of citizenship and supporting documents.
• For Canadians under 16 years of age, use form PPTC 042, Child General Passport Application.
• Applicants who were previously issued a Canadian passport may be able to renew their passport using form PPTC 482, Adult Abroad Simplified Renewal
Passport Application. To find out if you are eligible, visit Canada.ca/passport.
B
TRANSLATION
All documents submitted throughout the passport application process that are in a language other than English or French must be translated by a certified
translator.
C
REQUIREMENTS CHECKLIST
All three (3) pages of the application form completed and signed within the last twelve (12) months and certified by the guarantor
Two (2) identical and unaltered passport photos taken within the last six (6) months, one (1) certified by the guarantor
Proof of Canadian citizenship (original only); the document will be returned to you
Document(s) to support identity (original or copies); copies must be signed and dated by your guarantor
Any valid Canadian travel document (passport, certificate of identity or refugee travel document) issued to you
The fee
Additional documents or information may be requested in support of this application.
D
FEE AND PERIOD OF VALIDITY
Where the application is made outside of Canada or the passport is to be delivered outside of Canada:
5-year validity – CAN$190* 10-year validity – CAN$260*
*A CAN$25 consular services fee is included in the above-mentioned fee.
The fee is in Canadian dollars and may be converted to the local currency.
There is a separate, non-refundable CAN$45 administrative fee for the replacement of a lost or stolen Canadian travel document that has not yet expired.
Methods of payment
Online payment is available for:
• Adult passport (5-year and 10-year validity)
• The administrative fee for lost and stolen passports
If additional passport services are required and cannot be paid online, contact the closest Government of Canada Office abroad to confirm available
methods of payment.
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.
• Administrative fees and applicable interest will be applied to all dishonoured payments.
• Fees are subject to change.
E
WHERE TO APPLY
Submit your application at the nearest Government of Canada office that provides passport services in the country where you reside or are visiting. You can
find a list of Government of Canada offices abroad online at travel.gc.ca or in your local telephone directory.
Offices authorized to process passport applications include:
• Canadian embassies;
• Canadian high commissions; or
• Canadian consulates (except those headed by honorary consuls).
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PPTC 040 (10-2020)
F
CONTACT INFORMATION
General information is available 24 hours a day, 7 days a week. Specific information is available at the nearest Government of Canada office that provides
passport services (consult your local telephone directory).
Information on passports, fees and processing times
Canada.ca/passport Passport Program 1-819-997-8338
TTY (for people who are Deaf or hard of hearing)
Montréal, Canada: 1-514-283-5197
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
G
ANTICIPATED DATE OF TRAVEL
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 C). 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.
H
PERSONAL INFORMATION
Surname and given name(s) requested to appear in passport
Write your name that you request to appear in the passport. If you are requesting a passport in a name that is different from the name that appears on the
proof of citizenship, please note the following:
• For a change of surname resulting from a relationship, you must provide a marriage or common-law relationship certificate, or a document demonstrating
termination of the relationship (indicating both previous and current surname).
• For a legal change of name, you must provide a Canadian birth certificate or citizenship certificate issued in the new name (a change of name certificate
alone will not be accepted) . If you have your name legally changed, you must apply for a new travel document that accurately reflects your new name.
Additional documentation will be required to verify your identity as well as the name to appear in the passport (see section L).
All former surnames
All former surname(s) that differ from the surname requested to appear in the passport, including the child's surname at birth must be declared. Please
separate your former surnames by a comma. 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
If your proof of citizenship does not show a complete date of birth, the specific year, month and day of your birth will be entered as shown on your supporting
identification (see section 5).
Sex
If the sex or gender identifier requested to appear in the passport does not match the submitted proof of Canadian citizenship or your latest travel document,
complete and submit form PPTC 643, Request – sex or gender identifier on the travel document for an adult 16 years of age or older form (PPTC 643),
available online at Canada.ca/passport.
Signature
You must sign your usual signature on all three (3) pages.
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Page 6 of 7
PPTC 040 (10-2020)
I
PROOF OF CANADIAN CITIZENSHIP
Important: A Canadian provincial or territorial birth certificate does not constitute an acceptable proof of Canadian Citizenship if, at the time of your birth in
Canada, one or both of your parents was or were employed in Canada by a foreign government or international agency and neither parent was a Canadian
citizen or permanent resident. See subsection 3(2) of the Citizenship Act for more information. You may request a formal assessment by submitting an
application for a citizenship certificate to Immigration, Refugee and Citizenship Canada (IRCC). For more details, visit the IRCC website at
Canada.ca/citizenship.
The original proof of Canadian citizenship you submit with your application will be returned to you. Additional information may be requested to confirm your
citizenship.
Canadian provincial or territorial certificate of birth
Only official birth documents issued by the vital statistics office in your province or territory of birth in Canada are accepted. Certain exceptions may apply.
Certain Canadian provinces and territories have other documents that may also be accepted as proof of Canadian citizenship. Visit Canada.ca/passport for
more information.
Note: For Canadians born in the province of Quebec, only a birth certificate or a copy of an act of birth issued after January 1, 1994, by the Directeur de
l'état civil of Québec or a certificate of Canadian citizenship are accepted as proof of Canadian citizenship.
Certificate of Canadian citizenship
Commemorative certificates of citizenship are not accepted as proof of citizenship. If you require a certificate of Canadian citizenship visit the IRCC website at
Canada.ca/citizenship.
J
DECLARATION OF GUARANTOR
A guarantor is a person other than the applicant who can confirm their identity and may be called upon to confirm personal information. A guarantor can be a
relative or someone living at the applicant’s address, as long as they meet all the requirements listed below.
The guarantor must:
• be able to communicate in English or French;
• have known you (the applicant) personally for at least two (2) years. To know you personally to confirm aspects of your personal attributes.
• know you well enough to be confident that the statements you have made on the application form are true.
• be accessible to the Passport Program for verification; the Passport Program reserves the right to request a new guarantor.
The guarantor must perform the following three (3) tasks free of charge:
1. Validate the information and sign the section Declaration of Guarantor (section 2). Ensure you have completed and signed all three (3) pages
of the application before submitting it to your guarantor.
2. Write "I certify this to be a true likeness of (your name)" on the back of one (1) of your photos and sign it.
3. If applicable, sign and date a copy of each document to support your identity (see section L).
The applicant must not assist the guarantor in performing their duties. If your guarantor requires assistance, contact the Passport Program.
The guarantor can be either a Canadian passport holder (see section J-A below) or a member of an eligible occupation (see section J-B below).
Section J-A: Canadian passport holder, the guarantor must:
• be a Canadian citizen, 18 years of age or over;
• hold a 5-year or a 10-year Canadian passport that is valid or has expired within twelve (12) months of the date the Passport Program receives this
application;
• have been 16 years of age or over when the application was submitted for the passport identified in section 2 on this application form; and
• Provide the requested information contained in the passport issued in his or her name and validate and sign the declaration of guarantor section
of the application form.
A Canadian passport holder guarantor does not need to reside in the same country as the applicant OR
Section J-B: Occupation, the guarantor must:
• currently work and/or reside within the area of accreditation served by the Government of Canada office abroad where the application is submitted;
and
• be currently registered/licensed with the appropriate local authority to practice one (1) of the following professions:
• Dentist • Lawyer or notary • Police officer
• Medical doctor • Notary public • Judge
• Dean or head of university or college • Pharmacist • Veterinarian
• Signing officer of a bank or trust company, or of a financial institution that offers a full range of banking services (cash withdrawals, deposits, savings)
The above list is not a recognition or endorsement by the Passport Program of professional status or superior qualifications.
A guarantor from the eligible list of occupations does not need to be a Canadian citizen.
Important: The applicant cannot help the guarantor in performing their duties. If the guarantor needs help they can contact the Passport Program (see
section F).
If you have not known an eligible guarantor for at least two (2) years, complete form PPTC 132, Statutory Declaration in Lieu of Guarantor, available at any
Government of Canada office that provides passport services. The form must be completed at your expense before a person who is authorized by law to
administer an oath or solemn affirmation. This may delay the processing time of the passport requested.
K
PREVIOUS CANADIAN PREVIOUS CANADIAN TRAVEL DOCUMENT
Enclose any Canadian travel document (passport, certificate of identity or refugee travel document) that is not expired and that is issued to you in your current
name or any other name. If the travel document’s expiry date is 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.
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Page 7 of 7
PPTC 040 (10-2020)
L
DOCUMENTS TO SUPPORT IDENTITY
• You need to provide at least one (1) document to support your identity. The identification document (ID) must be valid and be issued by a federal, provincial/
territorial government authority (or local equivalent abroad). The ID must include your name, date of birth, signature and photo. One or more document(s),
when combined, may be used to fulfill these criteria.
• A Canadian passport that is expired for less than one (1) year may be used to support your identity. However, you must submit an additional piece of valid
federal, provincial or territorial identification, with your passport, if:
• the passport was issued to you before you turned 16 years of age; or
• the passport was issued to you with a period of validity of less than five (5) years.
• If you are submitting copies of your ID, each side must be copied and then signed and dated by your guarantor. All original documents that you submit will be
returned to you.
• If you submit copies of your documents and are using form PPTC 132, Statutory Declaration in Lieu of Guarantor, the same official who signs the declaration
must also sign and date the copies of both sides of the identity document(s) to indicate that the official has seen the original(s).
M
PRIVACY STATEMENT
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. In the same context, the guarantor’s personal information is subject to verification and security queries to determine whether
the individual meets the guarantor requirements. 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.
N
CANADIAN PASSPORT PHOTO INSTRUCTIONS
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
I certify this to be a
true likeness of
(applicant's name)
Guarantor's Signature
Not actual size (refer to measurements above)
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).
• The statement "I certify this to be a true likeness of (name of applicant, written by guarantor)".
• The guarantor's signature. Note: If you are using the PPTC 132, Statutory Declaration in Lieu of Guarantor (see section J), the signing official must also sign
the back of the photo.
Additional information
• Prescription glasses may be worn in photos as long as there is no glare and the eyes are clearly visible.
• The red-eye effect, tinted glasses and sunglasses make the photos unacceptable.
• 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.
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Form 1: ADULT ABROAD GENERAL PASSPORT APPLICATION (Government of Canada)

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Completed 7 March 2021

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