PPTC 203 E : Declaration concerning a lost, stolen ...

(DISPONIBLE EN FRAN AIS - pptc 203 F)PROTECTED WHEN COMPLETED - BPage 1 of 2 Declaration concerning A LOST, stolen , INACCESSIBLE, DAMAGED OR FOUND CANADIAN TRAVEL DOCUMENTPPTC 203 (06-2019) EWARNING to applicant Any false or misleading statement on this form or relating to any document in support of your Canadian travel document application, including concealment of any material fact, may lead to refusal to issue or revocation of a Canadian travel document and be grounds for criminal OR PRINT IN CAPITAL LETTERS using black or dark blue INFORMATION AS INDICATED ON MOST RECENT CANADIAN TRAVEL DOCUMENTThe Canadian travel document was issued in:My nameChild's nameSurname (last name)Given name(s)Date of birth(YYYY-MM-DD)Place of (if applicable)Document number (if known)Date of issue (if known)(YYYY-MM-DD)Place of issue (if known)CityCountrySignature of applicant(YYYY-MM-DD)DateSigned atCityCountryIs the Canadian travel document being submitted with your Declaration ?NoYes4 Continue to section 24 Continue to section 32 INFORMATION concerning A VALID CANADIAN TRAVEL DOCUMENT NO LONGER IN MY POSSESSIONNote: Incomplete descriptions may result in the delay or refusal of your application.

PPTC 203 (06-2019) E. WARNING to applicant —Any false or misleading statement on this form or relating to any document in support of your Canadian travel document application, including concealment of any material fact, may lead to refusal to issue or revocation of a Canadian travel document and be grounds for criminal prosecution.

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