Child Under 16 Travel Document Application - Canada

Proof of Immigration Status in Canada (see Instructions, section J)
3
To establish the child's immigration status in Canada, provide one (1) of the following valid documents (original only):
Permanent resident card
Notice of decision
Protected person status document
Temporary resident permit
Verification of status
Document number
Date of issue
Year
Month Day
Date of expiry (if applicable)
Year
Month Day
Declaration of Applicant
4
Surname (last name) of applicant
Given name(s) of applicant
Relationship to the child Surname (last name) of child Given name(s) of child
Declaration—I understand that if the child is issued a Canadian travel document and later obtains a passport issued by the child's country of citizenship, I am obliged to return the Canadian
travel document to Passport Program, Citizenship and Immigration Canada. I solemnly declare that the photos enclosed are unaltered and a true likeness of the child and 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 on page 1 and the
Privacy Notice Statement (see section P). I consent to the collection, use and disclosure of my personal information and that of the child 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.
Signature of applicant
Date
Year
Month Day
Signed at
City Province/Territory
Declaration of Guarantor (see Instructions, section K)
The guarantor must know the applicant identified in section 4.
5
Surname (last name)
Given name(s)
Occupation Name of firm/organization
Telephone (daytime) Telephone (other) Cell number or email address (optional)
Business address
Number Street City Province/Territory/State Postal/ZIP code
Full name of applicant (parent or legal guardian) Full name of child
I have known
the applicant
(parent or legal
guardian) for
Number of months
Declaration—I solemnly declare that I have known the applicant identified above personally for at least six (6) months and have knowledge of the child. I have signed the
back of one (1) photo to certify that the image is a true likeness of the child. I declare that I have read and understood the Warning on page 1 and the Privacy Notice
Statement (see section P). 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.
Signature of guarantor Date
Year
Month Day
Signed at
City
Province/Territory/State
- Page 2 of 10
PPTC 192 (2015-05) R1
Page 2/10
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Child Under 16 Travel Document Application - Canada PDF

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