Free Adult Passport Application in the USA - Canada

ADULT PASSPORT APPLICATION
for Canadians 16 years of age or over (in the USA)

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 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. · Children under 16 years of age must have an individual passport (use form PPTC 142 "Child Passport Application").
·

Applying in Person
If you require a passport in exceptional circumstances, contact the nearest Canadian government office. Canadian government offices in the USA are listed on page 2 of this application and on our website at www.passportcanada.gc.ca

Requirements Checklist
All THREE (3) 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 Canadian citizenship (no copies or certified copies) Documents to support identity Any Canadian passport or travel document issued to you within the last FIVE (5) years The fee Additional documents or information may be requested in support of this application.

Processing Times
For information on the current processing times, visit our website at www.passportcanada.gc.ca or contact us by phone (see "Contact Us", page 2).

Applying by Mail
Mailed-in applications are processed in Canada.

BY MAIL Passport Canada Foreign Affairs and International Trade Canada Gatineau QC K1A 0G3 CANADA
·

BY COURIER Passport Canada 22 de Varennes Building 22 de Varennes Street Gatineau QC J8T 8R1 CANADA

Fee
C$97
(includes the passport fee (C$72) and consular service fee (C$25))

Note ­ These fees are subject to change. ­ Only Canadian funds are accepted. Important ­ Every person who requests a passport service must pay the applicable fee. This fee is non-refundable. Preferred method of payment · Credit card (Complete section on application form.) Other acceptable methods of payment · Certified cheque or international 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.
PPTC 140A (09-04) M02 Page 1 of 4

Applications for Canadians living in the USA are processed in Canada and passports are delivered by overnight courier. · DO NOT mail or bring this application to a Canadian government office in the USA. However, passport applications and related forms are available from these offices. · 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. · If you are travelling soon, you should send your documents to Canada by overnight courier. This will also ensure the safety of your documents in transit.

Contact Us
General information is available 24 hours a day, 365 days a year. Specific information is available during regular office hours. INFORMATION ON PASSPORTS AND FEES INFORMATION ON TRAVEL CONDITIONS AND REQUIREMENTS Website:...................................................www.passportcanada.gc.ca Website:.....................................................www.voyage.gc.ca Toll-free:.....................................................................1-800-567-6868 Outside continental USA:..............................................819-997-8338 TTY (For persons who are deaf or hard of hearing) Toll-free:..........................1-866-255-7655 (7:30 a.m. to 8:00 p.m. ET)
· ·

To obtain the most recent version of this form, visit our website. Application forms are also available in Braille, on diskette or in large print for persons with a visual impairment.

Canadian Government Offices in the USA (NOT MAILING ADDRESSES)
DO NOT mail or bring your application form to a Canadian government office in the USA listed below. However, passport applications and related forms are available from these offices or may be obtained online at www.passportcanada.gc.ca

ATLANTA The Consulate General of Canada 100 Colony Square Suite 1700 1175 Peachtree Street NE Atlanta GA BOSTON The Consulate General of Canada Three Copley Place Suite 400 Boston MA

DENVER The Consulate General of Canada Suite 2600 1625 Broadway Denver CO DETROIT The Consulate General of Canada 600 Renaissance Center Suite 1100 Detroit MI LOS ANGELES The Consulate General of Canada 9th Floor 550 South Hope Street Los Angeles CA MIAMI The Consulate General of Canada Wachovia Financial Center Suite 1600 200 South Biscayne Boulevard Miami FL MINNEAPOLIS The Consulate General of Canada 9th Floor 701 Fourth Avenue South Minneapolis MN

NEW YORK The Consulate General of Canada 1251 Avenue of the Americas New York NY SAN FRANCISCO The Consulate General of Canada 14th Floor 580 California Street San Francisco CA SAN JUAN The Honorary Consulate of Canada Hato Rey Center Suite 802 268 Ponce de Leon Avenue San Juan PR SEATTLE The Consulate General of Canada Suite 600 1501 Fourth Avenue Seattle WA WASHINGTON D.C. The Embassy of Canada 501 Pennsylvania Avenue NW Washington DC

BUFFALO The Consulate General of Canada HSBC Center Suite 3000 Buffalo NY CHICAGO The Consulate General of Canada Two Prudential Plaza Suite 2400 180 North Stetson Avenue Chicago IL DALLAS The Consulate General of Canada Suite 1700 750 North St. Paul Street Dallas TX

PPTC 140A (09-04) M02 Page 2 of 4

INSTRUCTIONS 1
NAME TO APPEAR IN PASSPORT
Write the name you want to appear in the passport. If this name is different from the name on your documentary evidence of citizenship, the original of the documentation listed below may be required: ­ Marriage certificate ­ Legal change of name (original document from issuing authority). Additional documentation will be required to verify your identity as well as the name to appear in the passport (see instruction no. 5 "Documents to Support Identity").

Personal Information

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

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, submit a written request. Be sure to contact the consulate or embassy of every country you plan to visit to ensure that you will be admitted if the passport does not include your place of birth.

SIGNATURE
You MUST sign your usual signature on all THREE (3) pages. Your signature in section 1 will appear in the passport. 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. Sign and date a copy of each document to support your identity (see instruction no. 5 "Documents to Support Identity"). Your guarantor: · must be a citizen of Canada or the USA; · 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 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: ­ dentist, medical doctor or chiropractor ­ police officer, judge, magistrate ­ lawyer ­ signing officer of a bank or trust company, or of a financial ­ notary public (notarial seal must appear institution that offers the full range of banking services on the application form) (cash withdrawals, deposits and savings) ­ pharmacist ­ veterinarian 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.
·

If you have not known an eligible guarantor for at least TWO (2) years, complete a "Statutory Declaration in Lieu of Guarantor" form PPTC 132, available from any Canadian government office in the USA. 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 passport.

PPTC 140A (09-04) M02 Page 3 of 4

3
·

Previous Canadian Passport

Enclose any Canadian passport or travel document issued to you within the last FIVE (5) years. If your current passport 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 passport may be refused. · A person's name may appear in only ONE (1) valid Canadian passport, Certificate of Identity or Travel Document. · If the valid passport has been lost, stolen, damaged, destroyed or is inaccessible, complete a "Statutory Declaration" form PPTC 203, available from any Canadian government office in the USA or at www.passportcanada.gc.ca A Canadian passport, once reported lost or stolen, is no longer valid and is not to be used for any travel.

4

Proof of Canadian Citizenship

Provide ONE (1) of the documents listed in section 4 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 citizenship. If you are a woman who, before 1947, married a man who was not a British subject, contact Passport Canada.

CERTIFICATE OF BIRTH IN CANADA
You may obtain a birth certificate from the Vital Statistics authorities of your province or territory of birth. If you were born in Quebec Only birth certificates issued on or after January 1, 1994, by the Directeur de l'état civil in the province of Quebec are accepted.

CERTIFICATE OF CANADIAN CITIZENSHIP
Large commemorative documents of citizenship issued after February 14, 1977, are not accepted. If you require a certificate of Canadian citizenship, contact the nearest Canadian government office. You may also visit the Citizenship and Immigration Canada website at www.cic.gc.ca

5

Documents to Support Identity

At least ONE (1) document to support your identity and the name to appear in the passport must be submitted with your application form. Further documentation may be required. Documents to support your identity must be valid, must be issued by a federal, provincial/territorial/state or municipal authority, and must include the bearer's name and signature. For example: ­ Valid Canadian passport or Canadian passport ­ Provincial health care card ­ Old Age Security card expired for a period of less than one year ­ Other federal, provincial/territorial/ ­ Certificate of Indian Status ­ Non-Drivers License state or municipal identification card ­ Alien Registration Card ­ Provincial/territorial/state driver's licence ­ Military identification ­ Federal, provincial/territorial/state or municipal employee identification card Your guarantor must sign and date the copies of the documents (both sides) you are submitting to indicate that the originals have been seen. If you 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 documents to support your identity to indicate that the originals have been seen. If you have no documents to support your identity, call Passport Canada.

Photo Specifications
Your passport 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 1 in. and 1 in. · 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 2 in. X 2 ¾ in. 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 140A (09-04) M02 Page 4 of 4

(applicant's name)

QUANTITY AND FORMAT
· TWO

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

ADULT PASSPORT APPLICATION
for Canadians 16 years of age or over (in the USA)
To obtain the most recent version of this form, visit our website at www.passportcanada.gc.ca

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 030). This information is collected under the Canadian Passport Order to determine the applicant's current and ongoing entitlement to a Canadian passport, to administer passport 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 passport security, the photo is stored on an alphanumeric template and incorporated into the passport as a digital image. Passport Canada may use the services of third parties to receive passport applications submitted in person and to process the return of incomplete passport 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 passport services.

Helpful Tips for Completing Your Passport Application











Complete and sign all THREE (3) pages FAILURE TO COMPLETE ALL THE REQUIRED SECTIONS OF THIS FORM WILL RESULT IN YOUR APPLICATION BEING REJECTED. You must sign your usual signature in the THREE (3) signature blocks provided (one signature per page). Sign within the white box (section 1) Your signature must not touch the shaded border in the signature box on page 1. This signature will appear in the passport. If the signature touches the border, it may be rejected and a new signature will be required which will cause delays. Photos ("General Information and Instructions", page 4) The finished photos must have a white or light-coloured background and be free of shadows and glare on the face and background. You must have a neutral expression. Your photographer may consult www.passportcanada.gc.ca to access the specifications. Proof of Canadian citizenship (original document) Your original birth certificate or citizenship certificate/card (not a copy) must be submitted. Commemorative certificates are not acceptable. If you were born in the province of Quebec, only birth certificates issued on or after January 1, 1994, by the Directeur de l'état civil are accepted. Complete citizenship information (section 4) All applicants must complete the question: "Did you acquire citizenship of another country before JANUARY 1, 1947?". See the application form, section 4A. Fees (section 6) Submit the correct fee in Canadian funds only. Fill out your credit card information or use a certified cheque or international money order. The preferred method of payment is by credit card. Guarantor requirements (section 2) Your guarantor must be from an approved occupational group as listed in "General Information and Instructions". Retired guarantors are not eligible unless still registered in their professional association listing of active members. You must complete your passport application before submitting it to your guarantor. Ensure your guarantor completes and signs section 2 on the application form. Your guarantor must also sign the back of ONE (1) photo and a copy (both sides) of each document to support your identity.







Provide documents to support your identity (ID) (section 5) Provide a copy (both sides) of at least one valid government-issued ID with your name and signature. Both sides must be submitted and signed and dated by your guarantor. References (section 8) Provide TWO (2) references who are not your guarantor or a relative. Friends, co-workers and neighbours may be used as references provided they have known you for at least TWO (2) years. Submit any valid passport or travel document If your passport is still valid when you apply, you must submit it. Any travel document issued in the last FIVE (5) years must be submitted. If your passport has expired, you do not need to submit it. To use your spousal name (section 1) If you want the passport issued in your spousal surname (last name), you must complete the requested information about your marriage, including year of marriage. See the application form, section 1, line 4. Additional Personal Information (section 7) Addresses Indicate "Same as current address" if your address has not changed in the last TWO (2) years. Occupation State your occupation over the last TWO (2) years. If you have been a homemaker or retired for the last TWO (2) years, indicate this on the form. Mother's Maiden Name Indicate your mother's surname (last name) when she was born. Children's application If applying for a child under 16 years of age, you must use the "Child Passport Application" form PPTC 142 and, if applicable, ensure that all documents regarding custody or mobility of, or access to the child are submitted. To avoid delays in issuing the passport, use the Requirements Checklist on page 1 of the "General Information and Instructions" and ensure your application is complete.

Aussi disponible en français PPTC 140 (09-04) M02

ADULT PASSPORT APPLICATION
for Canadians 16 years of age or over (in the USA)
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 passport 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.

INFORMATION PROTECTED

1
Surname (last name)

Personal Information

Date of travel
Month Day

Unknown

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 passport 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/State (if applicable) Country

Sex

Female Male

Marital status

Eye colour

Hair colour

Height

Weight

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

Mailing address (if different from above)
COMPLETE NEXT PAGE
Number Street Apartment City State 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 and guarantors above.

Void if signature touches border

Date
Year Month Day

Signed at
City State

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 3

Surname (last name)

Occupation (see instruction No. 2)

Name of firm/organization

Daytime telephone number ( )

Evening telephone number ( )

Cell. number (optional) ( )

Business address
Aussi disponible en français PPTC 140 (09-04) M02
Number Street City State Zip code

DECLARATION ­ I solemnly declare that I have known the applicant identified above personally for at least TWO (2) years. 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 support the applicant's identity confirming that I have seen the original(s). I declare that I have read and understood the WARNING to all applicants and guarantors above.

I have known the applicant for

Number of years

Signature of guarantor

Date
Year Month Day

Signed at
City State

3
· · ·

Previous Canadian Passport

Enclose any Canadian passport or travel document issued to you within the last FIVE (5) years. Would you like the passport to be returned to you? No Yes If the passport issued to you in the last FIVE (5) years 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 Canadian government office in the USA or at www.passportcanada.gc.ca

4
No Yes (specify) By birth

Proof of Canadian Citizenship
Country Effective date
Year Month Day

A To be completed by ALL applicants. Did you acquire citizenship of another country before JANUARY 1, 1947?
By naturalization

B To be completed if you were born in Canada. Provide ONE (1) of the two documents listed below (no copies):
Birth certificate in Canada (see instruction No. 4) Certificate of Canadian citizenship (see instruction No. 4)
Registration number Certificate number Date of issue Date of issue

C To be completed if you were born outside of Canada.
1) Provide ONE (1) of the four documents listed below (no copies): Certificate of Canadian citizenship (see instruction no. 4) Certificate of registration of birth abroad (issued by the Registrar of
Canadian Citizenship)

Certificate of naturalization
Certificate number

Certificate of retention of Canadian citizenship (issued before
February 15, 1977)
Date of issue

2) To be completed if you were born outside of Canada between February 15, 1977 and April 16, 1981 inclusively. (You do not
need to complete this section if you are presenting a certificate of Canadian citizenship issued after January 1, 2007.)
COMPLETE NEXT PAGE

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)

Yes Go to section 5 No Continue to c) b) Was one of your parents born in Canada? c) Complete and submit form PPTC 001 "Proof of Canadian Citizenship ­ Additional Information" which you can obtain at www.passportcanada.gc.ca or at any Canadian government office in the USA.

5
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) (see instruction No. 5). 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

Page 2 of 3

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

Signed at

PPTC 140 (09-04) M02

6
Name appearing on card

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

COMPLETE ONLY if you are paying by credit card (for applications sent to Canada only).

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

Date
Year Month Day

7
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.
Number Street Apartment Apartment City City Province/Territory/State Province/Territory/State Country Country

2.
Number Street

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.)

In the last TWO (2) years,
Employer/school or other

my employers were and/or
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

8

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) Given name(s)

Relationship

Address
Number Street Apartment City Province/Territory/State Country

ENSURE ALL THREE (3) PAGES ARE COMPLETED

Daytime phone
( )

Evening phone
( )

Cell. number. or email address (optional)

Has known me for
State number of years

2. Surname (last name)

Given name(s)

Relationship

Address
Number Street Apartment City Province/Territory/State Country

Daytime phone
( )

Evening phone
( )

Cell. number. or email address (optional)

Has known me for
State number of years

Page 3 of 3

9

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
( )
PPTC 140 (09-04) M02

Address
Number Street Apartment City Province/Territory/State Postal/Zip 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 State

Signed at