Adult Renewal Passport Application for Eligible Canadians

ADULT SIMPLIFIED RENEWAL PASSPORT APPLICATION
for eligible Canadians applying in Canada or from the USA
INFORMATION
PROTECTED
WARNING to all applicants—Any false or misleading statement on this form or relating to any document in support of this
application, including concealment of any material fact, may lead to refusal to issue or revocation of a passport and be
grounds for criminal prosecution.
Failure to complete all the required sections of this form will result in your application being refused.
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 (former last name) Mother's maiden name
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
Daytime telephone number
Evening telephone number Cell number or email address
(optional)
DECLARATION—I solemnly declare that I am a Canadian citizen, that the
photos enclosed are a true likeness of me and that all of the statements made
in this application are true. I declare that I have read and understood the
WARNING to all applicants at the top of this page.
Date
Year Month Day
Signed at
City
Province/Territory/State
Void if signature touches border
Signature (see Instructions, section H)
Date of travel
Unknown
Month Day
Previous Canadian Passport (see Instructions, section I)
2
Enclose any Canadian passport issued to you within the last six (6) years from the date we receive this application.
If you cannot submit the previous passport, you cannot use this form.
Would you like the previous passport returned to you? If not, it will be securely destroyed by Passport Canada to protect your
personal information.
Yes, please return the passport to me
Canadian Citizenship
3
To be completed if you were born outside of Canada between February 15, 1977 and April 16, 1981 inclusively.
a) Are you a naturalized Canadian?
(i.e. did you receive
Canadian citizenship following immigration to Canada?)
Yes – Go to section 4 No – Continue to question b)
b) Was one of your parents born in Canada?
Yes – Go to section 4 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 CitizenshipAdditional Information,
available online at passportcanada.gc.ca.
Aussi disponible en français
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