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Main - Form pptc057 Additional Information Documents To Support Identity and References Canada

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42 views

Main - Form pptc057 Additional Information Documents To Support Identity and References Canada

Uploaded by

zabzebla01
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Sav PROTECTED WHEN COMPLETED - B

e
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File number:
ADDITIONAL INFORMATION
DOCUMENTS TO SUPPORT IDENTITY AND REFERENCES
WARNING—Any false or misleading statement with respect to this form and any supporting document, including the concealment of any
material fact, may result in the refusal to issue a passport, the revocation of a currently valid passport, or the refusal of passport services,
and may be grounds for criminal prosecution. Your application will not be processed if you fail to complete all of the required sections of this
form and/or refuse to consent to the exchange or disclosure of any personal information required for the delivery of passport services.

TYPE OR PRINT IN CAPITAL LETTERS using black or dark blue ink.


APPLICANT'S PERSONAL INFORMATION
Surname (last name) Given name(s) Date of birth (YYYY-MM-DD)

DOCUMENTS TO SUPPORT IDENTITY


Provide at least one (1) document to support your identity with the name to appear in the passport. 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.
Date of expiry, if
Type of document Document number Your name as it appears on the document
1 applicable (YYYY-MM-
DD)

Date of expiry, if
Type of document Document number Your name as it appears on the document
2 applicable (YYYY-MM-
DD)

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.
Surname (last name) Given name(s)

Relationship Address (Number, Street, Apartment, City, Province/Territory/State, Country, Postal/ZIP Code)
1
Daytime telephone number Evening telephone number Cell number or email address Has known me
(optional) for

Number or years
Surname (last name) Given name(s)

Relationship Address (Number, Street, Apartment, City, Province/Territory/State, Country, Postal/ZIP Code)
2
Daytime telephone number Evening telephone number Cell number or email address Has known me
(optional) for

Number or years

DECLARATION OF APPLICANT
DECLARATION—I solemnly declare that I am a Canadian citizen and that all of the statements made and the information provided in this
form, as well as any supporting documents, are true. I declare that I have read and understood the Warning at the top of this page and the
Privacy Notice Statement listed in the Instructions for the passport application form to which this form relates (see section N). I consent to the
collection, use and disclosure of my personal information by the Passport Program, Immigration, Refugees and Citizenship Canada, other
federal government institutions, Government of Canada offices abroad and third party entities as outlined in the Privacy Notice Statement.

Signed at

Signature of applicant Date (YYYY-MM-DD) City Country


PPTC 057 (01-2019) E (DISPONIBLE EN FRANÇAIS - PPTC 057 F)

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