Declaration concerning a lost, stolen, inaccessible,damaged or found Canadian Travel Document
DECLARATION
concerning a lost, stolen, inaccessible, damaged or found Canadian travel document
PROTECTED WHEN COMPLETED –
B
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WARNING to applicant—Any false or misleading statement on this form or relating to any document in support of your travel document application,
including concealment of any material fact, may lead to refusal to issue or revocation of a travel document and be grounds for criminal prosecution.
TYPE OR PRINT IN CAPITAL LETTERS using black or dark blue ink.
PERSONAL INFORMATION AS INDICATED ON MOST RECENT CANADIAN TRAVEL DOCUMENT
1
The travel document was issued in: My name Child's name
Surname (last name)
Given name(s)
Date of birth
Year Month Day
Place of birth
City Country Prov./Ter./State (if applicable)
Document number (if known)
Date of issue (if known)
Year Month Day
Place of issue (if known)
City
Country
Signature of applicant
Date
Year Month Day
Signed at
City Country
Is the travel document being submitted with your declaration?
No – Continue to section 2 Yes – Go to section 3
Year Month Day
This document was last used on
Year Month Day
Location
City Country
Was a police report filed?
Yes
No
Date of report
Year Month Day
Report number Name of police service
Please provide the reason for not filing a police report
Were any other provincial or federal identification documents lost or stolen?
Yes No
(AUSSI DISPONIBLE EN FRANÇAIS — PPTC 203F)
INFORMATION CONCERNING A VALID CANADIAN TRAVEL DOCUMENT NO LONGER IN MY POSSESSION
Note: Incomplete descriptions may result in the delay or refusal of your application. If insufficient space, attach a separate signed and dated sheet.
2
The travel document listed in section 1 is no longer in my possession because (please provide a detailed explanation as to why you are not
submitting the travel document and what has happened to it)
I have made the following efforts to recover this travel document (please explain)
Date this document was lost, stolen or became inaccessible
PPTC 203E (2014-11) R2
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