Adult Abroad General Passport Application - Canada
Adult Abroad General Passport Application
for Canadians 16 years of age or over applying outside of Canada
Protected B when completed
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.
Personal Information (see Instructions, section H)
1
Surname (last name)
Given name(s)
Surname (last name) at birth
Former surname (last name)
If passport requested in spousal
surname (last name), enter
Year of marriage Surname (last name) of spouse
Date of birth
Year Month Day
Place of birth
City Country Prov./Terr./State (if applicable)
Sex
Female
Male
Marital status
Eye colour Current hair colour Height
(cm/in)
Weight
(kg/lbs)
Current home address
Number
Street
Apartment
City
Country
Postal code
Mailing address (if different from above)
Number
Street
Apartment City
Country
Postal code
Telephone (daytime) Telephone (other) Email address
(optional)
Declaration—I solemnly declare that I am a Canadian citizen, that the
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 N). I consent to the collection, use and
disclosure of my personal information by Passport Program, Citizenship
and Immigration Canada, other federal government institutions,
Government of Canada offices abroad and third party entities as
outlined in the Privacy Notice Statement in the Instructions.
Sign within border
Signature (see Instructions, section H)
Date
Year Month Day
Signed at
City
Country
Date of travel
Unknown
Month Day
Declaration of Guarantor (see Instructions, section I-A Passport holder or section I-B Occupation)
Note: You must complete and sign all three (3) pages of this application form before requesting that your guarantor complete and sign this section.
2
Surname (last name) Given name(s)
Canadian passport number (see section I-A) or Occupation (see section I-B) Telephone (daytime)
Current home address (see section I-A) or Business address (see section I-B)
Number Street City
Country
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) photo to certify
that the image is a true likeness of the applicant. If applicable, I have signed and dated
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 N). I consent to the collection, use
and disclosure of my personal information by Passport Program, Citizenship and
Immigration Canada, other federal government institutions, Government of Canada
offices abroad and third party entities as outlined in the Privacy Notice Statement in the
Instructions.
I have known
the applicant
for
Number
of years
Signature of guarantor
Date
Year Month Day
Signed at
City Country
Telephone (other)Date of birth in passport (see section I-A) or Name of firm/organization (see section I-B)
Year Month Day
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