Fillable Printable Adult Travel Document Application - Canada
Fillable Printable Adult Travel Document Application - Canada
Adult Travel Document Application - Canada
Protection of Infor mation
BY
COURIER
IN
PERSON
Where to Apply
ADULT TRAVEL DOCUMENT APPLICATION
for stateless and protected persons in Canada
(16 years of age or over)
GENERAL INFORMATION AND INSTRUCTIONS
Aussi disponible en français
PPTC 190A (08-01) M02
P age 1 of 4
Travel Document - $87
Certificate of Identity - $127 - Submit $87 with your
application. If it is determined that you are eligible for the
Certificate of Identity, we will ask you for the additional $40.
Note:
• These fees are subject to change.
• These fees are non-refundable processing fees.
Fee
OR
Personal information provided on your application
for m is protected and used in accordance with the
provisions of the Privacy Act (Personal Information
Bank No. FAI PPU 025) to determine your current
and ongoing entitlement to travel documentation and to provide
infor mation to the Consular Affairs Bureau of Foreign Affairs
and International Trade Canada in the event that you require
assistance while travelling abroad. The information provided,
including the photograph, is subj
ect to routine verifications and
security queries. To further strengthen Canadian travel
document security, your photograph is stored on an
alphanumeric template and incorporated into the travel
document as a digital image.
Passport Canada may contact you to solicit feedback about
travel document services.
By mail or courier
• Credit card -
(complete section on application form)
• Certified cheque or money order (postal or bank) payable to
the Receiver General for Canada
In person
• Cash
• Debit (Interac)
• Credit card -
• Certified cheque or money order (postal or bank) payable to
the Receiver General for Canada
Administrative fees and any applicable interest will be applied
to all dishonoured payments.
All FOUR pages of the application f orm completed and signed
within the last 12 months.
TWO identical passport photos taken within the last
12 months.
Application for m and one of the photos certified by my
guarantor.
Original proof of immigration status in Canada (no copies or
notarized copies). The document will be returned to you.
Documents to support identity.
Any travel document or passport in which my 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 may be requested in support of your
application.
Failure to provide all information will delay issuance of the
travel document.
• 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 years who are stateless or who
are unable to obtain a national passport for a valid reason.
Eligibility for either document can only be deter mined after all
required infor mation 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").
Note: 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, Ontario K1A 1L1
BY MAIL
Certificate of Identity Section
Passport Canada
Foreign Affairs and
International Trade Canada
Gatineau Canada K1A 1L2
Certificate of Identity Section
Passport Canada
Place du Centre, Commercial Level 2
200 Promenade du Portage
Gatineau QC J8X 4B7
Several months may be required to process the application.
DO NOT mail or bring your application form to any other
Passport Canada office.
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Entitlement to a Travel Document
Requirements Checklist
Refer to your Immigration loan account number.
Specific infor mation on travel documents is available during regular office hours. Application for ms are available in Braille, on
diskette or in large print for persons with a visual impairment.
Travel document applications and related forms are available from any office of Passport Canada. You may also obtain the application
form on-line. For the location of the office of Passport Canada nearest you, we suggest you visit our Web site or consult your local
telephone directory.
INFORMATION ON TRAVEL DOCUMENTS
AND FEES
OFFICE HOURS:
Monday to Friday 08:30 - 16:30
Web site:
www.passpor tcanada.gc.ca
Toll-free: 1 800 567-6868
Fax: 819-953-9546
TTY
(For persons who are deaf or hard of hearing)
Toll-free: 1 866 255-7655
Web site: www.voyage.gc.ca
PPTC 190A (08-01) M02
P age 2 of 4
INFORMATION ON IMMIGRATION STATUS
AND RETURNING TO CANADA
(Citizenship and
Immigration Canada)
Web site: www.cic.gc.ca
Toll-free: 1 888 242-2100
TTY (For persons who are deaf or hard of hearing)
Toll-free: 1 888 576-8502 (from 07:00 - 17:00)
Permanent Resident Card: 1 800 255-4541
Photo Specifications (same as passport photo)
Note: The photo specifications for the travel document are
different from those for the permanent resident card.
Additional Infor mation
Front
(Not Actual Size)
From 31 mm
To 36 mm
Photo Co. Ltd.
110 Any Street
Any Town, COUNTRY
Photo taken
Back - Photographer's
Information and Sample
of Guarantor's Declaration
Date
I certify this to be a
true likeness of
(applicant's name)
Guarantor's Signature
IMAGE INFORMATION
• 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.
• 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.
• Photos must reflect/represent natural skin tones.
• The length from chin to crown of head (natural top of head)
must be 31 mm to 36 mm.
• The image must be clear, sharp and in focus.
• 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 be taken against a plain, uniform, white or
light-coloured background.
• 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.
QUANTITY AND FORMAT
• Two identical unaltered photos produced from the same film or
from the same electronic file capturing the digital image.
SIZE AND PAPER
• The maximum photo size must be 50 mm wide x 70 mm long.
• Heavy weight paper is unacceptable.
• Photos must be printed on high quality photographic paper.
PHOTOGRAPHER AND GUARANTOR
• Photos must be taken by a commercial photographer.
• The 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).
• One photo must be signed by a guarantor as a true likeness of
the applicant.
Toll-free (refer to your
Immigration loan account
number):
1 800 667-7301
INFORMATION ON IMMIGRANT LOAN
ACCOUNT
(Citizenship and Immigration Canada)
INFORMATION ON TRAVEL CONDITIONS
AND REQUIREMENTS
INSTRUCTIONS
NAME TO APPEAR IN TRAVEL DOCUMENT
Write the name to appear in the travel document. This name will normally be the same as the surname 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).
SURNAME AT BIRTH/FORMER SURNAME
Complete only if different from the sur 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 pages. Your signature MUST NO T
e xceed the inner limits of the signature box.
A guarantor is a person who confirms your identity. Your guarantor must perform free of charge the following THREE tasks:
1. Certify the information on your application form by completing and signing the "Declaration of Guarantor" section;
2. Write on the back of ONE of your photos, "I certify this to be a true likeness of (your name)" and sign;
3. If applicable, sign and date a copy of your supplementary documentation (see instruction No. 7 "Documents to Support Identity").
Your guarantor must:
• be a Canadian citizen or a permanent resident living in Canada and must be accessible to Passport Canada for verification;
• have known you personally for at least SIX months and well enough to be confident that the statements you have made in your
application for m are true;
• sign the "Declaration of Guarantor" section on your application for m;
• sign the statement on the back of ONE of your photos; and
• be included in ONE of the following groups:
- dentist, medical doctor or chiropractor
- judge, magistrate, police officer (municipal, provincial or RCMP)
- lawyer (member of a provincial bar association), notary in Quebec
- mayor
- minister of religion authorized under provincial law to
perform marriages
- notar y public
- optometrist
- pharmacist
The list above is not a recognition or endorsement by Passport Canada of professional status or superior qualifications.
If you have not known an eligible guarantor for at least SIX months, complete a "Statutory Declaration in Lieu of Guarantor for a
Travel Document" form PPTC 326, available from any office of Passport Canada. This form must be completed at your expense
before a person authorized by law to administer an oath or solemn affir mation. This may delay the processing time of the travel
document.
Signature
Unacceptable
Signature
Inner Limits
Acceptable
PPTC 190A (08-01) M02
P age 3 of 4
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").
- postmaster
- principal of pr imary or secondar y school
- professional accountant (member of APA, CA, CGA,
CMA, PA or RPA)
- professional engineer (P. Eng., Eng. in Quebec)
- senior administrator in a community college (includes
CEGEPs)
- senior administrator or teacher in a university
- veterinarian.
1
Personal Information
2
Declaration of Guarantor
Citizenship and Travel Documentation
• Enclose any 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 descr iption of the document, date and place of issue and
explain its present whereabouts.
• If you have visited another country since your entry to Canada, wr ite 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 for m.)
• 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 for m the results of your application including the date you were refused. (If insufficient space, use page 3
(Notes) of the application for m.)
• 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 passpor t 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.)
5
• Enclose any Canadian travel document issued to you in the last FIVE years.
• A person's name may appear in only ONE valid Canadian travel document.
• If the valid travel document has been lost, stolen, damaged, destroyed or is inaccessible, complete a "Statutory Declaration"
for m PPTC 203, available from any office of Passport Canada. A Canadian travel document, once reported lost or stolen, is no
longer valid and is not to be used for any travel.
• 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.
Provide ONE of the immigration status documents listed in section
3 of the application form (copies or notarized copies are not
accepted). 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 - Additional Information).
Note: If you are an applicant with protected person status whose refugee claim was filed in and processed within Canada, you
should include a copy of the certificate issued to you by the Immigration and Refugee Board that certifies the recognition of your
claim to refugee protection.
Documents to Support Identity
Provide at least ONE document to support your identity and the name to appear in the travel document. Further documentation
may be required.
Supplementar y documentation must be valid, must be issued by a federal, provincial or municipal authority, and must include the
bearer's name and signature. For example:
If you are mailing your application, enclose a copy of your documents (both sides). Your guarantor must sign and date the copy to
indicate the originals have been seen.
If you 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 copy of your identification to indicate the originals have been seen. If you have no
documents to support your identity, call Passport Canada.
- Provincial driver's licence
- Provincial health care card
- Other provincial identification card
- Certificat de sélection (Québec)
7
PPTC 190A (08-01) M02
P age 4 of 4
- Old Age Security card
- Other federal identification card
- Federal, provincial or municipal employee identification card.
Proof of Immigration Status in Canada
3
Previous Canadian Travel Document
4
6
Application for Canadian Citizenship
Signature of Guarantor
Signature
(See instruction No. 1)
INFORMATION
PROTECTED
ADULT TRAVEL DOCUMENT APPLICATION
for stateless and protected persons in Canada
(16 years of age or over)
Given Name(s) (See instruction No. 1)
Date of Birth
Address of Permanent Residence
Place of Birth
Year Month Day
Occupation (See instruction No. 2)
Name of Firm/Organization
City Province/Terr itory (If applicable) Country
Surname at Birth (See instruction No. 1)
F ormer Surname (See instruction No. 1)
Surname of Spouse (See instruction No. 1)
Print in block letters using black or dark blue ink.
Home Telephone Number
Year Month Day
Date
Signed at
Home Telephone Number
Business Telephone Number/Extension
Business Address
Date
Signed at
Year Month Day
City Province/Terr itory
City Province/Terr itory
Eye Colour
Aussi disponible en français
WARNING to all applicants and guarantors - Any false statement, misrepresentation or concealment of any material
fact on this form or any document presented in support of this application may lead to refusal or revocation of a tr av el
document and be grounds for criminal prosecution.
DECLARATION - I solemnly declare that I am a permanent
resident of Canada or a Canadian citizen and, to the best
of my knowledge and belief, all of the statements made in
this application are true. I have known the applicant
personally for at least SIX months and have certified, on
the back of one photo, that the image is a true likeness of
the applicant. If applicable, I have also certified on the
copy of the supplementary documentation that, to the best
of my knowledge, the copy is a true likeness of the original.
DECLARATION - I solemnly declare that the statements made in this application
are true and that the photos enclosed are a true likeness of me. 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.
Given Name
Surname
Business Telephone Number/Extension
Sex
Female
Male
Mailing Address (If different from above)
Number Street Apartment City Province/Terr itory Postal Code
Hair Colour
Height
Weight
Cell. Number or E-Mail Address
(Optional)
Knowledge
of applicant
Number of months
Number Street City Province/Terr itory Postal Code
Number Street Apartment City Province/Terr itory Postal Code
Marital Status
()
() () ()
() ()
Cell. Number (Optional)
If travel document requested in spousal
surname, enter
Year of Marriage
PPTC 190 (08-01) M02
Surname
Void if signature touches border
P age 1 of 4
COMPLETE NEXT PAGE
An agency of Foreign Affairs
and International Trade Canada
Un organisme d'Affaires étrangères
et Commerce international Canada
1
Personal Information
2
Declaration of Guarantor
In order to establish your immigration status in Canada, provide ONE of the following documents (No copies):
PPTC 190 (08-01) M02
Permanent Resident Card
Record of Landing (IMM 1000)
Protected Person Status Document
Temporary Resident Permit
Minister's Permit
DECLARATION - I solemnly declare that the statements made in this application are true.
Signature of Applicant
Signed at
Date
City Province/Terr itory
Year Month Day
Has a Canadian travel document ever been issued to you?
If the travel document has been lost, stolen, damaged, destroyed or is inaccessible, enclose with this application form a completed
"Statutor y Declaration" form PPTC 203, available from any office of Passport Canada.
Enclose the document
(See instruction No. 4).
No Yes
No Yes
4
Previous Canadian Travel Document
What is your original citizenship?
Indicate countr y.Did you acquire any other citizenship?
Have you visited another country since your entry to Canada?
Have you, since your date of entry to Canada, applied for a passpor t or travel document (or renewal of such a document) from your
countr y of origin or citizenship?
No Yes
Enclose the document (No copies). If no longer in your possession, explain
(See instruction No. 5).
Do you have any valid or expired travel document or passport from any countr y?
No Provide a detailed explanation of your reasons for not applying (See instruction No. 5).
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).
No
Yes
(
Specify)
Date Left
Year Month Day
Countr y
Reason
Date Returned
Year Month Day
Date Left
Year Month Day
Countr y
Reason
Date Returned
Year Month Day
Date of Expir y (If applicable)
Year Month Day
Serial/Document Number Date of Issue
Year Month Day
P age 2 of 4
COMPLETE NEXT PAGE
3
Proof of Immigration Status in Canada
Citizenship and Travel Documentation
5
Declaration of Applicant
Documents to Support Identity
Provide the following information. Include signed copies (both sides) or or iginal documents (See instruction No. 7).
COMPLETE ONLY if you are not appearing in person and you wish to pay by credit card.
DECLARATION - I solemnly declare that the statements made in this application are true.
AUTHORIZATION - I authorize
Passport Canada to charge
to my credit card.
Name Appearing on Card
Card Number
Date of Expiry
Month Year
Signature of Cardholder
Type of Document Document Number
Type of Document Document Number Name of bearer as it appears on the document
Name of bearer as it appears on the document
Date
Year Month Day
7
Year Month Day
Date of Expiry
Year Month Day
Date of Expiry
Signature of Applicant
Signed at
Date
City Province/Terr itory
Year Month Day
FOR OFFICIAL
USE ONLY
Authorization Number
$
No
6
Application for Canadian Citizenship
Have you applied 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.
PPTC 190 (08-01) M02
P age 3 of 4
COMPLETE NEXT PAGE
Notes
Declaration of Applicant
Credit Card Information
Given Name
1. Surname
2. Surname
Given Name
Relationship Address
Number Street Apartment City Province/Terr itory Country
Address
Number Street Apartment City Province/Terr itory
State number of months
State number of months
Country
Home Telephone No. Business Telephone No./Extension
Business Telephone
No./Extension
Cell. No. or E-Mail Address
(Optional) Has known me for
Cell. No. or E-Mail Address
(Optional) Has known me for
()
()
() ()
()
Addresses in the last TWO years in or outside Canada (not including current address.
If insufficient space, attach a separate white sheet.) (Use a black or dark blue ink pen.)
Provide the following information with respect to TWO persons who are not relatives and have known you for at least SIX months .
They will be contacted to confirm your identity.
W e recommend that you provide the name of someone who would not normally trav el with you. This information is helpful if
you hav e an accident or become ill while travelling outside of Canada.
1.
PPTC 190 (08-01) M02
To
Year Month
From
Year Month
2.
To
Year Month
From
Year Month
Number Street Apartment City Province/Terr itory Country
Occupation (If insufficient space, attach a separate white sheet.) (Use a black or dark blue ink pen.)
In the last two years,
my employers were and/or
I was attending educational institutions as follows:
Relationship to Applicant Home Telephone Number
()
Cell. Number
()
Business Telephone No./Extension
Relationship
Address
Number Street Apartment City Province/Terr itory Postal Code
Employer/School Address Business Telephone No. From To
Nature of
Employment/Studies
Dates
Given Name
Surname
Home Telephone No.
DECLARATION - I solemnly declare that the statements made in this application are true.
Signature of Applicant
Signed at
Year Month Day
Date
City Province/Terr itory
P age 4 of 4
ENSURE ALL FOUR
PAGES ARE COMPLETE
Mother's Maiden Name
(Provide your mother's surname at the time of her birth.)
Additional Personal Information
References
Emergency Contact
Declaration of Applicant
PPTC 220 (08-01)
Travel Destination Label
List the individual countries to be visited. Travel
documents are not endorsed for the countr y of or igin or
citizenship unless there is evidence that the bearer is
not a citizen of that country.
Name all countries to be visited.
Énumérez tous les pays qui seront visités.
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?
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.
Address Label
Print (in block letters) your full address.
Étiquette d'adresse
Inscrivez (en lettres moulées) votre adresse au complet.
BOTH labels MUST be completed.
Les DEUX étiquettes DOIVENT
ÊTRE remplies.
Name / Nom
Number / Numéro Street / Rue Apt. / App.
City / Ville Prov. / Terr. Postal Code / Code postal
