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

1 (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 ?

2 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. If insufficient space, attach a separate signed and dated Canadian travel document listed in section 1 is no longer in my possession because (please provide a detailed explanation as to why you are not submitting the Canadian travel document and what has happened to it)I have made the following efforts to recover this Canadian travel document (please explain)Date this Canadian travel document was lost, stolen or became inaccessible (YYYY-MM-DD)This Canadian travel document was last used on(YYYY-MM-DD)LocationCityCountryWas a police report filed?YesNoDate of report (YYYY-MM-DD)Report numberName of police servicePlease provide the reason for not filing a police reportWere any other provincial or federal identification documents lost or stolen ?

3 YesNoPage 2 of 2 PPTC 203 (06-2019) E3 INFORMATION concerning A DAMAGED OR FOUND CANADIAN TRAVEL DOCUMENT Note: If insufficient space, attach a separate signed and dated circumstance of how the Canadian travel document was damaged or foundExplain why you are applying for a replacement Canadian travel documentDate Canadian travel document was damaged or found(YYYY-MM-DD)LocationCityCountryRemi nder: A Canadian travel document application form must also be completed if a replacement Canadian travel document is required. Please note that the Canadian travel document specified in this form cannot be used for the simplified renewal OF APPLICANTS urname (last name)Given name(s)Daytime telephone numberDate of birth (YYYY-MM-DD) Declaration I solemnly declare that, to my knowledge, the statements made in this Declaration are true. Should I ever regain possession of the Canadian travel document reported in section 1, I will return it immediately to the Passport Program or if abroad to the nearest Government of Canada office.

4 I acknowledge that a Canadian travel document once reported lost, stolen , inaccessible, damaged or found is no longer valid and is NOT to be used for any travel. I understand multiple occurrences of Lost/ stolen or Damaged Canadian travel documents may result in either the refusal to issue a replacement Canadian travel document, or if approved, a severely limited validity of the replacement Canadian travel document. I also acknowledge that additional requirements may apply, such as demonstrating the need to be issued a Canadian travel document. I declare that I have read and understood the WARNING to applicant at the top of page of applicant(YYYY-MM-DD)DateSigned atCityCountryFOR OFFICE USE ONLYB ased on the information provided by the applicant on this form, the Canadian travel document has been identified asLostStolenDamagedMutilatedInaccessible FoundName of officer who reviewed the above information (stamp recommended)Date (YYYY-MM-DD)Document numberDate of issue(YYYY-MM-DD)Place of issueCityCountryTo obtain the most recent version of this form, visit our website at NOTICE STATEMENT Personal information provided on this form is collected by Immigration, Refugees, and Citizenship Canada (IRCC) under the authority of the Canadian Passport Order.

5 The personal information provided will be used for the purpose of processing applications, determining entitlement to passport services and administering passport services The personal information provided may be disclosed to other federal government institutions, provincial/territorial governments, foreign governments, investigative bodies and/or law enforcement for the purpose of validating identity, determining current and ongoing entitlement to passport services and administering or enforcing any law or carrying out a lawful investigation. Personal information may also be used for purposes including research, statistics, quality assurance, program and policy evaluation , internal audit, compliance, risk management, strategy development and reporting. Failure to complete the form in full may result in a delay or the application not being processed. The Privacy Act gives individuals the right of access to, protection, and correction of their personal information.

6 If you are not satisfied with the manner in which IRCC handles your personal information, you may exercise your right to file a complaint to the Office of the Privacy Commissioner of Canada. The collection, use, disclosure and retention of your personal information is further described in IRCC s Personal Information Bank IRCC PPU 081 and IRCC PPU 082.