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PROTECTED WHEN COMPLETED -BPage 1 of 7ADULT ABROAD GENERAL PASSPORT APPLICATIONfor Canadians 16 years of age or over applying outside of Canada and the USAWarning: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 revocationof 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 (03-2022)Type or print in CAPITAL LETTERS using black or dark blue ink.1PERSONAL INFORMATION (SEE INSTRUCTIONS, SECTION H)Surname (last name) requested to appear in the passportGiven name(s) requested to appear in the passportAnticipated date of travelUnknownMonthDayIt is recommended that you do notfinalize travel plans until you receivethe requested passport.All former surnames (including surname at birth if different from above. These will not appear in the passport.)Mother's surname at birthPlace of birthCityCountryProv./Terr./State (if applicable)Date of birth(YYYY-MM-DD)SexFFemaleMMaleXAnother genderNatural eye colourHeight (cm or in)Current home addressNumberStreetApt.CityCountryPostal/ZIP codeMailing address (if different from current home address)NumberStreetApt.CityCountryPostal/ZIP codeEmail addressTelephone (daytime)Telephone (other)Declaration—I solemnly declare that I am a Canadian citizen, that all of theinformation provided and all statements made on this application, as well as alldocuments and photos submitted to support this application are unaltered andtrue. I declare that I have read and understood theWarningat the top of thispage and thePrivacy Notice Statementin Instructions, section M. I consent tothe collection, use and disclosure of my personal information as outlined in thePrivacy Notice Statement.Sign within borderSignature (see Instructions, section H)Date(YYYY-MM-DD)Signed atCityCountry2DECLARATION OF GUARANTOR (SEE INSTRUCTIONS, SECTION J-A PASSPORT HOLDER OR SECTION J-B OCCUPATION)Note:You or your guarantor can complete this section, with the exception of thefour fields in boldwhichmustbe completed by your guarantor.Surname (last name)in passportGiven name(s)Canadian passport number (see section J-A)orOccupation (see section J-B)Telephone (daytime)Date of birth in passport(YYYY-MM-DD)(see section J-A)orName of firm or organization (see section J-B)Telephone (Other)Current home address(see section J-A)orBusiness address (see section J-B)NumberStreetApt.CityCountryPostal/ZIP codeDeclaration—I solemnly declare that I have known the applicant identified abovepersonally for at leasttwo (2)years. I have signed the back ofone (1)of the photos tocertify that the image is a true likeness of the applicant. Where applicable, I have signedand dated a copy of each document to support the applicant's identity (see section 5) toconfirm that I have seen the original(s).

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Term
Fall
Professor
Furt
Tags
Canadian Passport, Immigration to Canada, Passport Canada, Canadian nationality law, Passport Program

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