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Free PPTC 190 - Adult Travel Document Application - Canada



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Excerpt: for stateless and protected persons in Canada (16 years of age or over) ADULT TRAVEL DOCUMENT APPLICATION GENERAL INFORMATION AND INSTRUCTIONS Aussi disponible en français Failure to complete all the required sections of this form will result in your application being rejected. Entitlement to a Canadian Travel Document Important Notice ­ You are advised not to make any travel arrangements until you receive a Canadian travel document. A Canadian travel document reflects the identity of the applicant as determined by proof of immigration status in Canada issued by Citizenship and Immigration Canada and documents to support identity. · Travel Document* (United Nations Convention Relating to the Status of Refugees, 1951 and its Protocol of 1967): issued to persons in Canada with protected person status, including Convention refugees and persons
for stateless and protected persons in Canada (16 years of age or over)

ADULT TRAVEL DOCUMENT APPLICATION
GENERAL INFORMATION AND INSTRUCTIONS

Aussi disponible en français Failure to complete all the required sections of this form will result in your application being rejected.

Entitlement to a Canadian Travel Document
Important Notice ­ You are advised not to make any travel arrangements until you receive a Canadian travel document. A Canadian travel document reflects the identity of the applicant as determined by proof of immigration status in Canada issued by Citizenship and Immigration Canada and documents to support identity. · Travel Document* (United Nations Convention Relating to the Status of Refugees, 1951 and its Protocol of 1967): issued to persons in Canada with protected person status, including Convention refugees and persons in need of protection. · Certificate of Identity*: issued to persons legally landed in Canada for less than THREE (3) years who are stateless or who are unable to obtain a national passport for a valid reason. Warning ­ Some countries may not accept the Certificate of Identity as a valid travel document. You should check with the consulate or embassy of the country you plan to visit before applying for a Certificate of Identity. *Eligibility for either document can only be determined after all required information has been submitted and reviewed. These documents are issued only in Gatineau, Quebec. · Children under 16 years of age must have an individual travel document (use form PPTC 192 "Child Travel Document Application"). Immigrant loan account: If you have an immigrant loan account with Citizenship and Immigration Canada and have not been making regular payments (account in delinquent status), a travel document may not be issued until you have made repayments sufficient to bring your account into good standing with the officials of Citizenship and Immigration Canada. Enquiries regarding payment of such a loan may be made to:
Citizenship and Immigration Canada Collection Services Jean Edmonds Tower North 300 Slater Street, 3rd Floor Ottawa ON K1A 1L1 Refer to your Immigration loan account number.

Where to Apply
BY MAIL Certificate of Identity Section Passport Canada Foreign Affairs and International Trade Canada Gatineau QC K1A 1L2 BY IN COURIER OR PERSON Certificate of Identity Section Passport Canada Place du Centre, Commercial Level 2 200 Promenade du Portage Gatineau QC J8X 4B7

DO NOT mail or bring your application form to any other Passport Canada service location. The original documents that you enclose with your application are valuable. To ensure that these documents are not lost or misplaced, it is preferable to use a courier or mail service that allows you to trace your mail.

Processing Times
Several months may be required to process the application.

Fees
Travel Document ­ C$87 Certificate of Identity ­ C$127 All applicants must submit C$87. If Passport Canada determines that you are not eligible for a Travel Document but may be eligible for a Certificate of Identity, we will ask you to provide the balance payable of C$40 before processing your application. Note ­ These fees are subject to change. ­ Only Canadian funds are accepted. Important ­ Every person who requests a travel document service must pay the applicable fee. This fee is non-refundable. Preferred method of payment · Debit (Interac) (In person only), or · Credit card (Complete section on application form.)
·
PPTC 190A (08-07) M02 Page 1 of 4

Requirements Checklist
All FOUR (4) pages of the application form completed and signed within the last 12 months. TWO (2) identical passport photos taken within the last 12 months. Application form and one of the photos certified by your guarantor. Proof of immigration status in Canada (no copies or certified copies). The document will be returned to you. Documents to support identity (original or copies). Copies must be signed by your guarantor. Any previous Canadian travel document issued to you in the last FIVE (5) years. Any valid or expired foreign travel document or national passport in which your name appears. A copy of the receipt for fees paid (IMM 5401) if I have applied to become a Canadian citizen. The fee. BOTH labels (PPTC 220) completed. Additional documents or information may be requested in support of this application.

Other acceptable methods of payment Certified cheque or money order (postal or bank) payable in Canadian funds to the Receiver General for Canada Administrative fees and any applicable interest will be applied to all dishonoured payments.

Contact Us
Specific information on travel documents is available during regular office hours.

INFORMATION ON TRAVEL DOCUMENTS AND FEES
Website: Toll-free: Fax: www.passportcanada.gc.ca 1-800-567-6868 819-953-9546

INFORMATION ON IMMIGRATION STATUS AND RETURNING TO CANADA (Citizenship and
Immigration Canada)
Website: Toll-free: www.cic.gc.ca 1-888-242-2100

TTY (For persons who are deaf or hard of hearing) Toll-free: 1-866-255-7655

TTY (For persons who are deaf or hard of hearing) Toll-free: 1-888-576-8502 (from 7 a.m. to 5 p.m.) Permanent Resident Card: 1-800-255-4541

OFFICE HOURS: Monday to Friday

8:30 a.m.­4:30 p.m.

INFORMATION ON TRAVEL CONDITIONS AND REQUIREMENTS
Website: www.voyage.gc.ca

INFORMATION ON IMMIGRANT LOAN ACCOUNT (Citizenship and Immigration Canada)
Toll-free (refer to your
Immigration loan account number):

1-800-667-7301

· To

obtain the most recent version of this form, visit our website. document applications and related forms are also available from any Passport Canada service location. For the location of the Passport Canada service location nearest you, we suggest you visit our website or consult your local telephone directory. · Application forms are available in Braille, on diskette or in large print for persons with a visual impairment.
· Travel

Photo Specifications (same as passport photo)
Note: The photo specifications for the travel document are different from those for the permanent resident card. Your travel document application will be rejected if your photos do not meet the following specifications:

SIZE AND PAPER
· The

IMAGE INFORMATION
Photos must be taken with uniform lighting and not show shadows or flash reflection on the face and head. Photos with shadows on the face or background are unacceptable. · Photos must show a full front view of the face with both edges of the face showing clearly. The face and shoulders must be centred in the photo and squared to the camera. · Eyes must be open and clearly visible. Glasses, including tinted ones with prescription, may be worn as long as the eyes are clearly visible. Sunglasses are unacceptable. · Facial expression must be neutral (not frowning or smiling) with the mouth closed. · The image must be clear, sharp and in focus. · Photos must be taken against a plain, uniform, white or light-coloured background. · Photos must reflect/represent natural skin tones. · The length from chin to crown of head (natural top of head) must be between 31 mm and 36 mm. · Hats or head coverings are not permitted except when worn for religious reasons and only if the full facial features are clearly visible. · Black and white or colour photos are acceptable. · Photos must be originals, not taken from any existing photo, and must have been taken within the last 12 months.
·

photos must measure 50 mm x 70 mm in size. weight paper is unacceptable. · Photos must be printed on plain, high quality photographic paper.
· Heavy

PHOTOGRAPHER AND GUARANTOR
· Photos · The

must be taken by a commercial photographer. name of the photographer or studio, the address and the date the photo was taken (not the date the photo was printed) must be provided directly on the back of one photo (see illustration). · The guarantor must clearly write on the back of ONE (1) photo: "I certify this to be a true likeness of (applicant's name)".

PPTC 190A (08-07) M02 Page 2 of 4

QUANTITY AND FORMAT
· TWO

(2) identical unaltered photos produced from the same film or from the same electronic file capturing the digital image.

INSTRUCTIONS 1
Personal Information NAME TO APPEAR IN TRAVEL DOCUMENT
Write the name you want to appear in the travel document. This name will normally be the same as the surname (last name) and given name(s) shown on your proof of immigration status. If this name is different from the name on your proof of immigration status, the original of the documentation listed below may be required: · marriage certificate; · legal change of name document (original document from issuing authority); or · proof that the records of entry at Citizenship and Immigration Canada have been amended (i.e. approved "Request to Amend Immigration Record of Landing" form IMM 1436). Additional documentation will be required to verify your identity as well as the name to appear in the travel document (see instruction No. 7 "Documents to Support Identity").

SURNAME (LAST NAME) AT BIRTH/FORMER SURNAME (FORMER LAST NAME)
Complete only if different from the surname (last name) to appear in the travel document (for Passport Canada information only; will not appear in the travel document).

DATE OF BIRTH
The date of birth will be inscribed in the travel document exactly as it appears on the proof of immigration status unless Citizenship and Immigration Canada records have been amended subsequent to your admission to Canada. In this case, the original approved "Request to Amend Immigration Record of Landing" form IMM 1436 is required. If your proof of immigration status does not show a complete date of birth, indicate a specific day, month and year of your birth. Provide copies of any documents you may have showing this date of birth (i.e. driver's licence, provincial health care card, etc.).

SIGNATURE
You MUST sign your usual signature on all FOUR (4) pages. Your signature in section 1 will appear in the travel document. Therefore, your signature MUST NOT exceed the inner limits of the signature box. Inner Limits

Signature
Acceptable

Signature
Unacceptable

2

Declaration of Guarantor

A guarantor is a person other than yourself who confirms your identity. Your guarantor must perform free of charge the following THREE (3) tasks: 1. Complete and sign the "Declaration of Guarantor" section. (Ensure you have completed and signed the form 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. 3. If applicable, sign and date a copy of each document to support your identity (see instruction no. 7 "Documents to Support Identity"). Your guarantor: · must be a Canadian citizen or a permanent resident living in Canada; · must have known you personally for at least SIX (6) months*; * To know an applicant personally means that the guarantor is able to confirm aspects of the applicant's personal attributes such as name, approximate age, place of birth, physical description and some personal history such as occupation and place of residence. · must be included in ONE (1) of the following groups: ­ postmaster ­ dentist, medical doctor or chiropractor ­ principal of primary or secondary school ­ judge, magistrate, police officer (municipal, provincial or RCMP) ­ lawyer (member of a provincial bar association), notary in Quebec ­ professional accountant (member of APA, CA, CGA, CMA, PA or RPA) ­ mayor ­ professional engineer (P. Eng., Eng. in Quebec) ­ minister of religion authorized under provincial law to ­ senior administrator in a community college (includes perform marriages CEGEPs) ­ notary public ­ senior administrator or teacher in a university ­ optometrist ­ veterinarian. ­ pharmacist The list above is not a recognition or endorsement by Passport Canada of professional status or superior qualifications. must sign the "Declaration of Guarantor" section on your application form; · must sign the statement on the back of ONE (1) of your photos; and · must be accessible to Passport Canada for verification.
·

PPTC 190A (08-07) M02 Page 3 of 4

If you have not known an eligible guarantor for at least SIX (6) months, complete a "Statutory Declaration in Lieu of Guarantor for a Travel Document" form PPTC 326, available from any Passport Canada service location. This form must be completed at your expense before a person authorized by law to administer an oath or solemn affirmation. This may delay the processing time of the travel document.

3

Proof of Immigration Status in Canada

Provide ONE (1) of the immigration status documents listed in section 3 of the application form (copies or certified copies are not accepted). It will be returned to you. Additional information may be requested to confirm your immigration status in Canada. If you require an immigration status document, contact Citizenship and Immigration Canada (see page 2 ­ Contact Us).

4
·

Previous Canadian Travel Document

Enclose any Canadian travel document issued to you in the last FIVE (5) years. If your current travel document expires more than 12 months from the date you submit your application, provide a written explanation for why you are applying at this time. Should Passport Canada not be satisfied that you have a valid reason for applying early, your application for a new travel document may be refused. A person's name may appear in only ONE (1) valid Canadian travel document. If the valid travel document has been lost, stolen, damaged, destroyed or is inaccessible, complete a "Statutory Declaration" form PPTC 203, available from any Passport Canada service location or at www.passportcanada.gc.ca. A Canadian travel document, once reported lost or stolen, is no longer valid and is not to be used for any travel.

· ·

5
·

Citizenship and Travel Documentation

Enclose any valid or expired foreign travel document or national passport issued to you or in which your name appears. If you are no longer in possession of this travel document or passport, write on the application form a description of the document, date and place of issue and explain its present whereabouts. If the document has been seized by Citizenship and Immigration Canada, provide the "Notice of Seizure" (IMM 5265). If you have visited another country since your entry to Canada, write the dates you left Canada, the dates you returned and explain the reason for the visit. (If insufficient space, use page 3 (Notes) of the application form.) If you have been refused a national passport, enclose the letter of refusal. If this letter is not in either English or French, we require a translation of the letter signed before a notary public or other official authorized by law to administer an oath or solemn affirmation as being a true translation. If you have been refused a national passport and have not received a letter of refusal from the authorities to whom you applied, enclose copies of any relevant letters you may have retained regarding your request for a passport or renewal of such a document. Write on the application form the results of your application including the date you were refused. (If insufficient space, use page 3 (Notes) of the application form.) If you have applied for a national passport and have not received a written response, write in detail on the application form all the steps you have taken (in order of their dates) to obtain the passport and the results achieved. Enclose copies of any relevant letters you may have retained. (If insufficient space, use page 3 (Notes) of the application form.)

·

·

·

·

6
· ·

Application for Canadian Citizenship

If you have lost your Canadian citizenship receipt, write the date your application was made. If you were unsuccessful in your application for Canadian citizenship, enclose the letter of refusal. If you have lost the letter of refusal, write the date you applied and the reason for the refusal.

7

Documents to Support Identity

At least ONE (1) document to support your identity and the name to appear in the travel document must be submitted with your application form (see Note below). Further documentation may be required. Documents to support your identity must be valid, must be issued by a federal, provincial/territorial or municipal authority, and must include the bearer's name and signature. For example: ­ Provincial/territorial driver's licence ­ Provincial health care card ­ Other federal, provincial/territorial or municipal identification card ­ Old Age Security card ­ Federal, provincial/territorial or municipal employee identification card

PPTC 190A (08-07) M02 Page 4 of 4

Note: You may submit original documents. They will be returned to you. If you are submitting copies (both sides), your guarantor must sign and date the copies to indicate that the originals have been seen. If you are submitting copies but are using form PPTC 326, "Statutory Declaration in Lieu of Guarantor for a Travel Document", the same official who signs the "Declaration" must also sign and date the copies of the documents you are providing to support your identity to indicate that the originals have been seen. If you have no documents to support your identity, call Passport Canada.

for stateless and protected persons in Canada (16 years of age or over)
WARNING to all applicants and guarantors ­ 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 or revocation of a travel document and be grounds for criminal prosecution. Failure to complete all the required sections of this form will result in your application being rejected. PRINT OR TYPE IN CAPITAL LETTERS using black or dark blue ink.

ADULT TRAVEL DOCUMENT APPLICATION

INFORMATION PROTECTED

1
Surname (last name)

Personal Information

Given name(s) (see instruction no. 1)

Surname (last name) at birth (see instruction no. 1)

Former surname (former last name) (see instruction no. 1)

If travel document requested in spousal surname (last name), enter
Date of birth
Year Month Day City

Year of marriage Surname (last name) of spouse (see instruction no. 1)

Place of birth
Province/Territory (if applicable) Country

Sex

Female Male

Marital status

Eye colour

Hair colour

Height

Weight

Address of permanent residence
Number Street Apartment City Province/Territory Postal code

Mailing address (if different from above)
COMPLETE NEXT PAGE
Number Street Apartment City Province/Territory Postal code

Daytime telephone number ( )

Evening telephone number ( )

Cell. number or email address (optional) ( )

DECLARATION ­ I solemnly declare that the photos enclosed are a true likeness of me and that all of the statements made in this application are true. I understand that if I am issued a Canadian travel document and later obtain a national passport, I am obliged to return the Canadian travel document to Passport Canada. I declare that I have read and understood the WARNING to all applicants and guarantors above.

Void if signature touches border

Date
Year Month Day

Signed at
City Province/Territory

Signature (see instruction no. 1)

2

Declaration of Guarantor (to be completed by the guarantor only if the applicant has completed and signed this application form)
Given name(s)

Page 1 of 4

Surname (last name)

Occupation (see instruction no. 2)

Name of firm/organization

Daytime telephone number ( )

Evening telephone number ( )

Cell. number ( )

Business address
Aussi disponible en français PPTC 190 (08-07) M02
Number Street City Province/Territory Postal code

DECLARATION ­ I solemnly declare that I am a permanent I have known the applicant for resident of Canada or a Canadian citizen and that I have known the applicant identified above personally for at least SIX (6) months. I have certified on the back of ONE (1) photo that the image is a true likeness of the applicant. If applicable, I have signed a copy of each document to Number of months support the applicant's identity confirming that I have seen Date the original(s). I declare that I have read and understood Year the WARNING to all applicants and guarantors above.

Signature of guarantor

Signed at
Month Day City Province/Territory

3

Proof of Immigration Status in Canada
Record of Landing (IMM 1000) Permanent resident card Serial/Document number Protected person status document Temporary resident permit Date of issue
Year Month Day

In order to establish your immigration status in Canada, provide ONE (1) of the following documents (no copies):

Date of expiry (if applicable)
Year Month Day

4

Previous Canadian Travel Document
No Yes Enclose the document (see instruction no. 4).

Has a Canadian travel document ever been issued to you?

If the travel document has been lost, stolen, damaged, destroyed or is inaccessible, you must include with this application form a completed "Statutory Declaration" form PPTC 203, available from any Passport Canada service location or at www.passportcanada.gc.ca.

5
What is your original citizenship? Did you acquire any other citizenship?

Citizenship and Travel Documentation
No Yes Indicate country.

Do you have any valid or expired travel document or passport from any country? No Yes Enclose the document (no copies). If no longer in your possession, explain (see instruction no. 5).

COMPLETE NEXT PAGE

Have you visited another country since your entry to Canada? No Yes (specify) Date left
Year Month Day

Date returned
Year Month Day

Country

Reason

Date left
Year Month Day

Date returned
Year Month Day

Country

Reason

Have you, since your date of entry to Canada, applied for a passport or travel document (or renewal of such a document) from your country of origin or citizenship? No Provide a detailed explanation of your reasons for not applying (see instruction no. 5).
Page 2 of 4

Yes

If request was refused, enclose the letter of refusal. If unable to provide this letter, explain. If no reply received, write all the steps you have taken (see instruction no. 5).
PPTC 190 (08-07) M02

Declaration of Applicant
DECLARATION ­ I solemnly declare that the statements made in this application are true. Signature of applicant Date
Year Month Day City Province/Territory

Signed at

6
Have you applied for Canadian citizenship? No

Application for Canadian Citizenship
Explain why you have not applied.

Yes

Enclose the receipt confirming payment of fees (IMM 5401) or, if applicable, a copy of the letter of refusal.

7
Type of document Document number

Documents to Support Identity
Date of expiry (if applicable)
Year Month Day

Provide the following information. Include signed copies (both sides) or original documents (see instruction no. 7). Name of bearer as it appears on the document

Type of document

Document number

Date of expiry (if applicable)
Year Month Day

Name of bearer as it appears on the document

Notes

COMPLETE NEXT PAGE

8

Emergency Contact (optional)
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 outside of Canada.

Surname (last name)

Given name(s)

Relationship to applicant

Daytime phone
( )

Evening phone
( )

Cell. number
( )
Page 3 of 4

Address
Number Street Apartment City Province/Territory Postal code

Declaration of Applicant
DECLARATION ­ I solemnly declare that the statements made in this application are true. Signature of applicant Date
Year Month Day City Province/Territory

Signed at

9
Name appearing on card

Credit Card Information
FOR OFFICIAL USE ONLY Authorization number Card number Date of expiry
Month Year

PPTC 190 (08-07) M02

COMPLETE ONLY if you are not appearing in person and you wish to pay by credit card.

AUTHORIZATION ­ I authorize Signature of cardholder Passport Canada to charge to my credit card. C$

Date
Year Month Day

10
A Addresses in the last TWO (2) years
Same as current address.

Additional Personal Information

Addresses in the last TWO (2) years if different from current address. (If insufficient space, attach a separate sheet.)
From
Year Month

To To

Year

Month

1. 2.

Number Street Number Street

Apartment Apartment

City City

Province/Territory/State Province/Territory/State

Country Country

From

Year

Month

Year

Month

B Occupation in the last TWO (2) years (If insufficient space, attach a separate sheet. If you are, for example, a homemaker or are retired, indicate
this in the "Employer/school or other" column.) my employers were and/or In the last TWO (2) years,
Employer/school or other Address

I was attending educational institutions as follows:
Daytime phone Nature of employment/studies Date (From) Date (To)

C

Provide your mother's surname (last name) at the time of her birth.

Mother's maiden name

11

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 SIX (6) months. They may be contacted to confirm your identity. 1. Surname (last name) Given name(s)

Relationship

Address
Number Street Apartment City Province/Territory Country

ENSURE ALL FOUR (4) PAGES ARE COMPLETED

Daytime phone
( )

Evening phone
( )

Cell. number or email address (optional)

Has known me for
State number of months

2. Surname (last name)

Given name(s)

Relationship

Address
Number Street Apartment City Province/Territory Country

Daytime phone
( )

Evening phone
( )

Cell. number or email address (optional)

Has known me for
State number of months

Page 4 of 4

Declaration of Applicant
DECLARATION ­ I solemnly declare that the statements made in this application are true. Signature of applicant Date
Year Month Day City Province/Territory

Signed at

Protection of Information
Personal information provided on this application form is protected and used in accordance with the provisions of the Privacy Act (Personal Information Bank No. FAI PPU 025) to determine the applicant's current and ongoing entitlement to travel documentation, to administer travel document services and to provide information to the Consular Affairs Bureau of Foreign Affairs and International Trade Canada in the event that the applicant require assistance while travelling abroad. The information provided, including the applicant's photo, is subject to routine verifications and security queries. To further strengthen Canadian travel document security, the photo is stored on an alphanumeric template and incorporated into the travel document as a digital image. Passport Canada may use the services of third parties to receive travel document applications submitted in person and to process the return of incomplete travel document applications. In the performance of these services, personal information will be protected and used in accordance with the provisions of the Privacy Act. Passport Canada may contact the applicant to solicit feedback about travel document services.
To obtain the most recent version of this form, visit our website at www.passportcanada.gc.ca.
PPTC 190 (08-07) M02

Name all countries to be visited. Énumérez tous les pays qui seront visités. Travel Destination Label List the individual countries to be visited. Travel documents are not endorsed for the country of origin or citizenship unless there is evidence that the bearer is not a citizen of that country. Étiquette de destination Énumérez les pays individuels qui seront visités. Le pays d'origine ou de citoyenneté du titulaire ne figure pas dans le document de voyage, sauf s'il existe une preuve que le titulaire n'est pas citoyen de ce pays.

What is the reason for the trip? Quel est le motif du voyage?

What is the duration of the trip? Quelle sera la durée du voyage?

BOTH labels MUST be completed. Les DEUX (2) étiquettes DOIVENT ÊTRE remplies.
Address Label Print (IN CAPITAL LETTERS using black or dark blue ink) your complete address. Étiquette d'adresse Imprimez (EN LETTRES MAJUSCULES à l'encre noire ou bleu foncé) votre adresse au complet.

Name / Nom

PPTC 220 (08-07)

Number / Numéro

Street / Rue

Apt. / App.

City / Ville

Prov. / Terr.

Postal code / Code postal

File Size: 266.8 kB
Pages: 9
Date: October 14, 2008
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State: Canada
Category: Passport
Author: Passport Canada
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