Adult General Passport Application
Adult General Passport Application
for Canadians 16 years of age or over applying in Canada or from the USA
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
Province/Territory/State Postal/ZIP code
Mailing address (if different from above)
Number Street Apartment City
Province/Territory/State Postal/ZIP code
Telephone (daytime) Telephone (other) Cell number or 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
Province/Territory/State
Date of travel
Unknown
Month Day
Declaration of Guarantor (see Instructions, section I)
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) in passport Given name(s)
Date of birth
Year Month Day
Canadian passport number Date of issue
Year Month Day
Date of expiry
Year Month Day
Relationship to applicant Telephone (daytime) Telephone (other)
Current home address
Number Street Apartment City Province/Territory/State 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) 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 Province/Territory/State
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