Fillable Printable Adult Simplified Renewal Passport Application
Fillable Printable Adult Simplified Renewal Passport Application
Adult Simplified Renewal Passport Application
Adult Simplified Renewal Passport Application
for eligible Canadians applying in Canada or from the USA
Protected B when completed
Warning—Any false or misleading statement with respect to this application 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.
Personal Information (see Instructions, section H)
1
Surname (last name)
Given name(s)
Surname (last name) at birth
Former surname (last name) Mother's maiden name
Date of birth
Year Month Day
Place of birth
City Country Prov./Terr./State (if applicable)
Sex
Female
Male
Marital status Eye colour Current hair colour Height
(cm/in)
Weight
(kg/lbs)
Current home address
Number Street Apartment City
Province/Territory/State Postal/ZIP code
Mailing address (if different from above)
Number Street Apartment City
Province/Territory/State Postal/ZIP code
Telephone (daytime)
Telephone (other) Cell number or email address
(optional)
Declaration—I solemnly declare that I am a Canadian citizen, that the
photos enclosed are unaltered and a true likeness of me, that all of the
statements made and the information provided in this application, 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 (see instructions section K). I consent to the collection, use
and disclosure of my personal information by Passport Program,
Citizenship and Immigration Canada, other federal government
institutions, Government of Canada offices abroad and third party entities
as outlined in the Privacy Notice Statement in the Instructions.
Sign within border
Signature (see Instructions, section H)
Date
Year Month Day
Signed at
City
Province/Territory/State
Date of travel
Unknown
Month Day
Previous Canadian Passport (see Instructions, section I)
2
Enclose any Canadian passport issued to you
within the last six (6) years.
Number
Date of issue
Year
Month Day
Date of expiry
Year Month Day
If you cannot submit the previous passport, or if the previous passport is damaged, you cannot use this form.
Would you like the previous passport returned to you? If not, it will be securely destroyed by Passport Program to protect your
personal information.
Yes, please return the previous passport to me.
Canadian Citizenship
3
To be completed if you were born outside of Canada between February 15, 1977 and April 16, 1981 inclusive.
a) Are you a naturalized Canadian, i.e. did you receive
Canadian citizenship following immigration to Canada?
Yes – Go to page 2 No – Continue to question b)
b) Was one of your parents born in Canada?
Yes – Go to page 2 No – Continue to question c)
c) When was your current certificate of Canadian citizenship issued?
After January 1, 2007
Before January 1, 2007
Submit the certificate with your application (original only).
Complete and submit form PPTC 001, Proof of Canadian Citizenship—Additional Information,
available online at passportcanada.gc.ca.
Aussi accessible en français
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Period of Validity (see Instructions, section C)
4
Choose one (1) of the following periods of validity:
5-year or 10-year
Additional Personal Information
5
Note: If insufficient space, attach a separate signed and dated sheet.
A Addresses in the last two (2) years
Same as current home address
Different from current home address (complete below)
1.
From
Year Month
To
Year Month
2.
From
Year Month
To
Year Month
B
Occupation in the last two (2) years (check all that apply):
I was employed (full- or part-time)
I was in school (full- or part-time)
other, e.g. homemaker, unemployed or retired
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)
References
6
Provide the following information with respect to two (2) persons who are not your relatives 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)
Telephone (daytime)
Telephone (other)
Cell number or email address
(optional)
Has known me for
Number of years
2. Surname (last name)
Given name(s) Relationship
Address
(Number, Street, Apartment, City, Province/Territory/State, Country)
Telephone (daytime) Telephone (other) Cell number or email address
(optional)
Has known me for
Number of years
Emergency Contact Information (optional)
7
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)
Relationship to the applicant
Telephone (daytime)
Telephone (other)
Cell number
Current home address
Number Street Apartment City
Province/Territory/State Postal/ZIP code
Signature of applicant Date
Year Month Day
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Adult Simplified Renewal Passport Application
for eligible Canadians applying in Canada or from the USA
Instructions
Who May Use This Form?
A
Important notice—We recommend that you not finalize your travel plans until you receive the requested passport.
Note: If you cannot answer yes to all of the conditions outlined here, or if this is your first
application for a Canadian passport, you must complete form PPTC 153, Adult General
Passport Application. Additional documents or information may be requested in support
of this application.
You may use this form to renew a passport only if all of the following conditions are met:
you were at least 16 years of age at the time of your previous application;
the information (name, date of birth, sex and place of birth) on this application form is
exactly as it appears on page 2 of the submitted passport ;
1
you submit a previous Canadian passport that:
is valid or expired for no more than one (1) year ;
2
was/is valid for five (5) years or ten (10) years ;
3
is not damaged; and
was never reported lost or stolen.
Requirements Checklist
B
Both 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. No signature is required on the photos
Enclose any Canadian passport issued to you within the last six (6) years
The fee
If you were born outside of Canada between February 15, 1977, and April 16, 1981 inclusive, you may be requested to submit further
documentation (see section 3).
Fee and Period of Validity
C
Where the application is made in Canada and the passport is to
be delivered in Canada:
5-year validity – Can$120*
10-year validity – Can$160*
Where the application is made from the USA** or the passport is
to be delivered to the USA**:
5-year validity – Can$190*
10-year validity – Can$260*
*A Can$25 consular services fee is included in the above-mentioned fee.
**Includes Bermuda, American Samoa, the Midway Islands, Puerto Rico and the US Virgin Islands.
Methods of payment (Canadian funds only)
Debit card (Interac), Visa Debit, Virtual Visa Debit or other prepaid cards (Visa, MasterCard, American Express) only for in-person
applications submitted by the cardholder. Prepaid debit cards are not accepted.
Credit card and prepaid card (embossed only). If you are applying by mail, see section D.
Certified cheque or money order (postal or bank) in the exact amount, payable to the Receiver General for Canada.
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$25, applied only to adult applications, is refundable.
Passport Program, Citizenship and Immigration Canada does not accept personal cheques or payment in cash for applications
submitted in Canada.
Administrative fees and applicable interest will be applied to all dishonoured payments.
Fees are subject to change.
All Canadian passports contain 36 pages.
Credit Card Information
D
If you are applying in person, do not complete this section. If you are applying by mail and paying by credit card, complete and submit with your application.
Card type:
Visa MasterCard American Express
Name as it appears on card Card number
Date of expiry
Month Year
Name of applicant
FOR OFFICIAL USE ONLY
AUTHORIZATION—I authorize the Passport Program
to charge
Can$
to my credit card.
Signature of cardholder
Date
Year Month Day
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Applying in Person
E
Canadians can submit an application in Canada at:
a Passport Program regional office
a participating Canada Post office
a participating Service Canada Centre.
See our service locations, service standards and requirements for expedited services at passportcanada.gc.ca.
For Canadians submitting an application from the USA:
If you require a passport in exceptional circumstances, contact the nearest Government of Canada office. A list of Government of
Canada offices in the USA is available online at travel.gc.ca or consult your local telephone directory.
Applying by Mail
F
Mailed-in applications are processed in Canada.
By mail
Passport Program
Gatineau QC K1A 0G3
Canada
By courier
Passport Program
22 de Varennes Street
Gatineau QC J8T 8R1
Canada
The original documents that you enclose with your application are
valuable. We recommend that you use a courier or mail service that
allows you to trace your mail.
Contact Information
G
General information is available 24 hours a day, 7 days a week. Specific information is available Monday to Friday, from 7:30 a.m.
to 8:00 p.m. (Eastern Time) in Canada.
Information on passports, fees and processing times
Website
passportcanada.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
Travel reports, warnings and requirements
Website travel.gc.ca
Application forms are available in large print.
A passport application instruction booklet is available in Braille.
Personal Information
H
Surname and given name(s) to appear in passport
Your name must be written exactly as it appears on page 2 of the submitted passport. Your surname (last name) and given name(s)
must be spelled the same and be placed in the same order. If your name has changed, you cannot use this form. You must complete
form PPTC 153, Adult General Passport Application.
Note: If you are anticipating a change of name in the near future, a new complete general passport application with fees will need to be
submitted.
Surname (last name) at birth and former surname (last name)
Complete if different from the surname (last name) to appear in the passport (for Passport Program, Citizenship and Immigration Canada
information only—it will not appear in the passport).
Mother's maiden name
Indicate your mother's surname (last name) when she was born.
Date of birth
The specific year, month and day of your birth will be entered as shown on your previous 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, 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 both
pages.
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Previous Canadian Passport
I
Enclose any Canadian passport issued to you within the last six (6) years. If you cannot submit the previous passport, or if the
previous passport is damaged, you cannot use this form. You must complete form PPTC 153, Adult General Passport Application,
available online at
passportcanada.gc.ca.
A person's name may appear in only one (1) valid Canadian travel document (passport, certificate of identity or refugee travel
document).
Note: If your current 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.
Canadian Passport Photo Instructions
J
You must submit two (2) identical unaltered photos with each passport application. Digital (electronic format) photos are unacceptable.
The photos must:
be taken by a commercial photographer;
be clear, sharp and in focus. Photos may be in colour or in black and
white;
have a neutral facial expression (eyes open and clearly visible,
mouth closed, no smiling);
have uniform lighting—no shadows, glare or flash reflections;
be taken straight on with the face and shoulders centred and
squared to the camera;
be taken in front of a plain white or light-coloured background to
clearly distinguish the person from the background. Photos must
reflect or represent natural skin tones;
be originals that have not been altered in any way or taken from an
existing photo;
reflect your current appearance (taken within the last six (6) months);
and
be professionally printed on plain, high-quality photographic paper
(photos printed at home and photos printed on heavy-weight paper
are not acceptable).
Frame Height 70 mm (2
3/4
in.)
Minimum Face Height
31 mm (1
1/4
in.)
Maximum Face Height
36 mm (1
7/16
in.)
Frame Width 50 mm (2 in.)
Photo Co. Ltd.
111 Any Street
Any Town, COUNTRY
Photo taken
Date
Not actual size. Refer to measurements above.
No signature is required on the photos.
The following must appear on the back of one photo
The name and complete address of the photo studio (not a P.O. Box) and the date the photo was taken. The photographer may use a
stamp or handwrite the information (stick-on labels are not acceptable).
No signature is required on the photos.
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 photo 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.
Privacy Notice Statement
K
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
PCPCIC 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.
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