PPTC040
PPTC040
PPTC040
Date of travel
Month
Day
Month
Place of birth
Day
City
Sex
Female
Male
Marital status
Country
Eye colour
Height (cm/in)
Weight (kg/lbs)
Street
Apartment City
Country
Postal code
Country
Postal code
Street
Telephone (daytime)
Apartment City
Telephone (other)
Signed at
Year
Month
Day
City
Country
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.
Given name(s)
Canadian passport number (see section I-A) or Occupation (see section I-B)
Telephone (daytime)
Date of birth in passport (see section I-A) or Name of firm/organization (see section I-B)
Telephone (other)
Year
Month Day
Current home address (see section I-A) or Business address (see section I-B)
Number
Street
City
Country
DeclarationI solemnly declare that I have known the applicant identified above
I have known Signature of guarantor
personally for at least two (2) years. I have signed the back of one (1) photo to certify the applicant
that the image is a true likeness of the applicant. If applicable, I have signed and dated
for
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
Date
Signed at
Immigration Canada, other federal government institutions, Government of Canada
Number
Year
Month Day
offices abroad and third party entities as outlined in the Privacy Notice Statement in the
of years
City
Instructions.
PPTC 040 (2015-05) R1 - Page 1 of 7
Country
Read Instructions
Has a Canadian travel document (passport, certificate of identity or refugee travel document) been issued to you?
Date of issue
Month
Year
Number
No
Yes (specify)
Day
A To be completed by all applicants. Did you acquire citizenship of another country before January 1, 1947?
Effective date
Country
By birth
Year
No
Yes (specify)
By naturalization
Month
Day
B To be completed if you were born in Canada. Provide one (1) of the documents listed below (original only):
Birth certificate in Canada
Certificate of Canadian citizenship
Registration number
Date of issue
Certificate number
Certificate of naturalization
2) To be completed if you were born outside of Canada between February 15, 1977 and April 16, 1981 inclusive.
(you do not need to complete this section if you are presenting a certificate of Canadian citizenship issued after January 1, 2007).
a) Are you a naturalized Canadian, i.e. did you receive Canadian citizenship following immigration to Canada?
Yes Go to section 5
No Continue to question b)
No
Provide the following information. Include signed and dated copies (both sides), or original documents.
Note: The document provided in this section must not be the proof of Canadian citizenship provided in section 4.
Type of document
Document number
Type of document
Document number
Month
Month
Day
Day
Signature of applicant
Date
Year
Month
Day
Read Instructions
10-year
From
Year
Month
Year
Month
To
Year
Month
Year
Month
1.
From
2.
B Occupation in the last two (2) years (check all that apply):
To
Enter full details below for the last two (2) years:
Employer/school or other
Address
Telephone (daytime)
Field of employment/studies
Date (from)
Date (to)
yyyy-mm yyyy-mm
Provide your mother's surname (last name) at the time of her birth.
References
Provide the following information with respect to two (2) persons who are neither your relatives nor your guarantor and who have
known you for at least two (2) years. They may be contacted to confirm your identity.
1. Surname (last name)
Relationship
Given name(s)
Telephone (other)
Given name(s)
Relationship
Telephone (other)
We recommend that you provide the name of someone who would not normally travel with you. This information is helpful if
you have an accident or become ill while travelling.
Surname (last name)
Given name(s)
Telephone (daytime)
Telephone (other)
Cell number
Street
Apartment City
Signature of applicant
Country
Date
Year
PPTC 040 (2015-05) R1 - Page 3 of 7
Month
Day
Complete Form
Instructions
Important noticeWe recommend that you not finalize your travel plans until you receive the requested passport.
A Canadian passport is the only reliable and universally accepted travel and identification document for Canadians who travel abroad.
Issued to Canadian citizens only, a Canadian passport reflects the identity of the applicant as determined by documentary evidence of
citizenship and documents to support identity.
For Canadians under 16 years of age, use form PPTC 042, Child Abroad General Passport Application.
Applicants who were previously issued a Canadian passport may be able to renew their passport using form PPTC 482, Adult Abroad
Simplified Renewal Passport Application. To find out if you are eligible, visit passportcanada.gc.ca.
Translation
All documents submitted throughout the passport application process that are in a language other than English or French must be
translated by a certified translator.
Requirements Checklist
All three (3) pages of the application form completed and signed within the last twelve (12) months
Two (2) identical unaltered passport photos taken within the last six (6) months
Application form and one of the photos certified by your guarantor
Proof of Canadian citizenship (original onlythe document will be returned to you)
Document(s) to support identity
Any valid Canadian travel document (passport, certificate of identity or refugee travel document) issued in your name
The fee
Additional documents or information may be requested in support of this application.
Where the application is made outside Canada or the passport is to be delivered outside Canada:
5-year validity Can$190*
10-year validity Can$260*
*A Can$25 consular services fee is included in the above-mentioned fee.
The fee is in Canadian funds and should be converted to local funds. Please confirm fee and accepted methods of payment with the
nearest Government of Canada office abroad.
There is a separate, non-refundable Can$45 administrative fee for the replacement of a valid lost or stolen Canadian travel
document.
Methods of payment
Cash (where accepted).
Debit card (Interac), Visa Debit, Virtual Visa Debit or other prepaid cards (Visa, MasterCard) only for in-person applications submitted
by the cardholder. Prepaid debit cards are not accepted.
Credit card (where accepted).
Certified cheque or international money order (postal or bank) in the exact amount, payable to the Canadian Embassy, High
Commission or Consulate, as the case may be (where accepted).
Important
Every person who requests passport services must pay the applicable fee in the exact amount.
Applicants who cancel their application or are refused a passport are not eligible for a refund of the passport service fee. Only the
consular services fee of Can$25, applied only to adult applications, is refundable.
Administrative fees and applicable interest will be applied to all dishonoured payments.
Fees are subject to change.
All Canadian passports contain 36 pages.
Payment by credit card for passport services at a Government of Canada office abroad requires the completion of a separate credit card
authorization form. By completing and signing the authorization form, you are providing formal authorization to charge your credit card for
payment of the services requested. The form must be included with your passport application.
Important notice: There is a fee to use the credit card payment service, a payment solution developed by Foreign Affairs, Trade and
Development Canada. This fee is separate and independent from the amount payable to the Government of Canada for any passport
service.
For more information and to access the credit card authorization form online, visit the Government of Canada website at travel.gc.ca.
PPTC 040 (2015-05) R1 - Page 4 of 7
Complete Form
Where to Apply
Submit your application at the nearest Government of Canada office that provides passport services in the country where you reside or
are visiting. A list of Government of Canada offices abroad is available online at travel.gc.ca or consult your local telephone directory.
Offices authorized to process passport applications include:
Canadian embassies
Canadian high commissions
Canadian consulates (except those headed by honorary consuls)
Contact Information
General information is available 24 hours a day, 7 days a week. Specific information is available at the nearest Government of Canada
office that provides passport services (consult your local telephone directory).
passportcanada.gc.ca
Passport Program
819-997-8338
514-283-5197
Website
Application forms are available in large print.
A passport application instruction booklet is available in Braille.
Personal Information
Date of birth
If your proof of citizenship does not show a complete date of birth, the specific year, month and day of your birth will be entered as
shown on your supporting identification. Provide original or copies signed and dated by your guarantor of any supporting identification
showing that date of birth.
Place of birth
Your place of birth must be provided on the application form. If you do not wish the place of birth to appear in the passport, complete and
submit form PPTC 077, Request for a Canadian passport without place of birth, available online at passportcanada.gc.ca.
Signature
You must sign your usual signature on all
three (3) pages.
Complete Form
Declaration of Guarantor
A guarantor is a person other than yourself who confirms your identity. A family member or a person who resides at the same address as
the applicant may be the guarantor provided that the individual meets the specified requirements.
The guarantor must:
have known you personally for at least two (2) years. To know an applicant personally means that the guarantor is able to confirm
aspects of the applicant's personal attributes;
perform the following three (3) tasks free of charge:
1. Complete and sign the Declaration of Guarantor (section 2) (ensure you have completed and signed all three (3) pages of the
application before submitting it to your guarantor).
2. Write "I certify this to be a true likeness of (your name)" on the back of one (1) of your photos, and sign it.
3. If applicable, sign and date a copy of each document to support your identity (see section L).
know you well enough to be confident that the statements you have made on the application form are true.
be accessible to the Passport Program for verification; Passport Program reserves the right to request a new guarantor.
The applicant must not assist the guarantor in performing his or her duties. If your guarantor requires assistance, contact Passport
Program.
The guarantor can be either a Canadian passport holder (see section I-A below) or a member of an eligible occupation
(see section I-B below).
Section I-A: Canadian passport holder
The guarantor must:
be a Canadian citizen, 18 years of age or over;
hold a 5-year or a 10-year Canadian passport that is valid or has expired within the last year from the date we receive this application;
have been 16 years of age or over when the application was submitted for the passport identified in section 2 on this application form;
and
provide the requested information contained in the passport issued in his or her name by completing, by hand, the declaration of
guarantor section of the application form.
A Canadian passport holder guarantor does not need to reside in the same country as the applicant.
OR
Section I-B Occupation
The guarantor must:
currently work and/or reside within the area of accreditation served by the Government of Canada office abroad where the application
is submitted; and
be currently registered/licensed with the appropriate local authority to practice one (1) of the following professions:
Dentist
Notary public
Medical doctor
Pharmacist
Dean or head of university or college
Veterinarian
Judge
Police officer
Lawyer or notary
Signing officer of a bank or trust company, or of a financial institution that offers a
full range of banking services (cash withdrawals, deposits, savings)
The above list is not a recognition or endorsement by Passport Program of professional status or superior qualifications.
A guarantor from the eligible list of occupations does not need to be a Canadian citizen.
If you have not known an eligible guarantor from either section I-A, Canadian passport holder, or section I-B, Occupation, for at
least two (2) years, complete form PPTC 132, Statutory Declaration in Lieu of Guarantor, available at any Government of Canada office
that provides passport services. The form must be completed at your expense before a person who is authorized by law to administer an
oath or solemn affirmation. This may delay the processing time of the passport.
Enclose any valid Canadian travel document (passport, certificate of identity or refugee travel document) issued in your name. If the
passport is valid for more than twelve (12) months from the date the application is submitted, provide a written explanation as to why
you are applying at this time. Should Passport Program, Citizenship and Immigration Canada not be satisfied that you have a valid
reason for applying early, your application for a new passport may be refused.
A person's name may appear in only one (1) valid Canadian travel document.
Note: If a valid Canadian travel document has been lost, stolen, damaged or is inaccessible, complete form PPTC 203, Declaration,
available online at passportcanada.gc.ca. A Canadian travel document, once reported lost or stolen, is no longer valid. If found, it
must not be used for travel and must be returned immediately to Passport Program or if abroad to the nearest Government of Canada
office. There is an administrative fee for the replacement of a valid lost or stolen Canadian travel document (see section D).
Provide one (1) of the documents indicated in section 4 on the application form (original only). It will be returned to you. Additional
information may be requested to confirm your citizenship.
If you are a woman who, before 1947, married a man who was not a British subject, contact Passport Program.
Complete Form
Provide at least one (1) document to support your identity with the name, sex, date of birth, signature and photo to appear in the
passport. More than one document may be used to fulfill the requirements.
All documents submitted to support your identity must be valid and, must be issued by a federal or, provincial/territorial authority (or
local equivalent abroad),
The document (or documents when combined), must include your name, sex, date of birth, signature and photo.
Copies are acceptable provided your guarantor has signed and dated a copy of each document (both sides) confirming that the original
document has been seen. If you are submitting original documents, they will be returned to you.
If you are submitting copies and are using form PPTC 132, Statutory Declaration in Lieu of Guarantor, the same official who signs the
Declaration must also sign and date the copies of the original document (both sides) to indicate that the original document has been
seen.
You must submit two (2) identical unaltered photos with each passport application. Digital (electronic format) photos are unacceptable.
Photo taken
Date
I certify this to be a
true likeness of
(applicant's name)
Guarantor's Signature
Additional information
Prescription glasses may be worn in photos as long as there is no glare and the eyes are clearly visible. The red-eye effect, tinted
glasses and sunglasses make the photos unacceptable.
Hats and head coverings must not be worn, except for religious beliefs or medical reasons. However, the head covering must not cast
shadows on the face and the full face must be clearly visible.
More information is available at passportcanada.gc.ca.
All personal information provided on this application form is collected by Passport Program, Citizenship and Immigration Canada (CIC)
for the purpose of determining entitlement of the applicant to a Canadian passport and to provide information to the Consular Operations
Bureau of Foreign Affairs, Trade and Development Canada in the event that the passport holder requires assistance while travelling
abroad. In the performance of those services, personal information is collected, used and disclosed under the authority of the Canadian
Passport Order and in accordance with the Privacy Act and any other federal laws, regulations and policies applicable to the protection of
personal information, as described in Personal Information Bank PPTC PPD 102 (Regular and Official Travel Passports). In the context
of the delivery of passport services, CIC and other federal government institutions or Government of Canada offices abroad assisting in
the delivery of passport services may exchange personal information. In addition, in determining current and ongoing entitlement and to
maintain the integrity of the Passport Program, all personal information collected is subject to verification and security queries to
authenticate identity and citizenship, as well as to identify the existence of grounds for refusal to issue a passport, the revocation of a
currently valid passport or the refusal of passport services. In the same context, the guarantor's personal information is also subject to
verification and security queries to determine whether the individual meets the guarantor requirements. Personal information may be
disclosed to third party entities, such as law enforcement authorities and identity document issuing institutions, for verification and
security queries required in the delivery of passport services. Personal information may also be disclosed by third party entities to CIC or
other federal government institutions or Government of Canada offices abroad for those same purposes. To strengthen the security of the
Canadian passport, CIC uses facial recognition technology. Also, an electronic chip is inserted into the booklet. The chip contains, in
electronic format, the photo of the bearer and the personal information found on page 2 of the booklet.
CIC may contact the applicant/passport holder to solicit feedback about passport services.
PPTC 040 (2015-05) R1 - Page 7 of 7