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Get Canada PPTC 203 2007

If completed outside Canada a qualified official includes a Canadian or British diplomatic or consular representative or a qualified local official. As Lawyer Notary Public Other qualified official Specify Address Street Appartment Home Telephone Number Business Telephone Number/Extension Fax Number or E-Mail Address Optional Date Year Signature of Official Fran ais au verso PPTC 203 05-07 DECLARATION made before me on Postal Code. Passport Canada Passeport Canada An agency of Foreign Affairs Canada Un organisme d Affaires trang res Canada STATUTORY DECLARATION concerning a lost stolen damaged destroyed or INFORMATION PROTECTED inaccessible Canadian passport or travel document Print in block letters using black or dark blue ink Applicant s Personal Information Surname Given Name s Date of Birth Place of Birth Year Month Day City Province/Territory if applicable Country Declaration of Applicant 1. I hereby declare that number issued Type of Document name on Child s Name or my child s lost became Place of issue stolen damaged at in my name or Document Number destroyed City Exact location under the following circumstances full and detailed information must be provided below 2. I have made the following efforts to locate this document Police Report Filed No Yes Specify No* Date of Report 3. This document was last seen or used 4. Should I ever regain possession of the above original document I promise to return it immediately to Passport Canada or if I am abroad to the nearest Canadian government office. I acknowledge that a Canadian passport once reported lost or stolen is no longer valid and is not to be used for any travel* DECLARATION - I solemnly declare that to my knowledge the statements made in this declaration are true. Date Signed at Signature This form must be completed before and signed by a qualified official who has the authority to administer an oath or solemn declaration e*g* a commissioner for oaths notary public lawyer etc*. Passport Canada Passeport Canada An agency of Foreign Affairs Canada Un organisme d Affaires trang res Canada STATUTORY DECLARATION concerning a lost stolen damaged destroyed or INFORMATION PROTECTED inaccessible Canadian passport or travel document Print in block letters using black or dark blue ink Applicant s Personal Information Surname Given Name s Date of Birth Place of Birth Year Month Day City Province/Territory if applicable Country Declaration of Applicant 1. I hereby declare that number issued Type of Document name on Child s Name or my child s lost became Place of issue stolen damaged at in my name or Document Number destroyed City Exact location under the following circumstances full and detailed information must be provided below 2. I hereby declare that number issued Type of Document name on Child s Name or my child s lost became Place of issue stolen damaged at in my name or Document Number destroyed City Exact location under the following circumstances full and detailed information must be provided below 2. I have made the following efforts to locate this document Police Report Filed No Yes Specify No* Date of Report 3. .

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