PPTC 154
PPTC 154
PPTC 154
Toll-free: 1-800-567-6868
Outside continental USA: 819-997-8338
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2 Declaration of Guarantor
A guarantor is a person other than yourself who confirms your identity.
Your guarantor:
must be a Canadian citizen 18 years of age or over;
must hold a five-year Canadian passport that is valid or has been expired for no more than one year on the day you submit your
application;
must have been 16 years of age or older when he or she applied for the passport identified in section 2 of this application form;
must have known you personally for at least TWO (2) years*;
* To know an applicant personally means that the guarantor is able to confirm aspects of the applicant's personal
attributes such as name, approximate age, place of birth, physical description and some personal history such as
occupation and place of residence.
must provide the requested information contained in his or her passport;
must be accessible to Passport Canada for verification;
must reside in Canada, in the USA or in any of the areas where submission of this application form is authorized, e.g. Bermuda.
It is not necessary that the guarantor reside in the same country as the applicant.
A family member or person residing at the same address as you may be your guarantor, provided that he or she meets the
specified requirements.
Your guarantor must perform free of charge the following THREE (3) tasks:
1. Complete and sign the "Declaration of Guarantor" section. (Ensure you have completed and signed the form before submitting
it to your guarantor.)
2. Write "I certify this to be a true likeness of (your name)" on the back of ONE (1) of your photos, and sign.
3. If applicable, sign and date a copy of each document to support your identity (see instruction no. 5 "Documents to Support
Identity").
Passport Canada reserves the right to request an alternate guarantor.
If you have not known an eligible guarantor for at least TWO (2) years, complete a "Statutory Declaration in Lieu of Guarantor"
form PPTC 132, available from any Passport Canada service location in Canada or any Canadian government office in the USA.
This form must be completed at your expense before a person authorized by law to administer an oath or solemn affirmation. This
may delay the processing time of the passport.
Photo Specifications
Your passport application will be rejected if your photos do not SIZE AND PAPER
meet the following specifications: The photos must measure 50 mm X 70 mm in size
IMAGE INFORMATION (2 in. wide x 2 3/4 in. high).
Photos must be taken with uniform lighting and not show Heavy weight paper is unacceptable.
shadows or flash reflection on the face and head. Photos with Photos must be printed on plain, high quality photographic paper.
shadows on the face or background are unacceptable. PHOTOGRAPHER AND GUARANTOR
Photos must show a full front view of the face with both edges Photos must be taken by a commercial photographer.
of the face showing clearly. The face and shoulders must be The name of the photographer or studio, the address and the date
centred in the photo and squared to the camera. the photo was taken (not the date the photo was printed) must be
Eyes must be open and clearly visible. Glasses, including tinted provided directly on the back of one photo (see illustration).
ones with prescription, may be worn as long as the eyes are The guarantor must clearly write on the back of ONE (1) photo:
clearly visible. Sunglasses are unacceptable. "I certify this to be a true likeness of (applicant's name)".
Facial expression must be neutral (not frowning or smiling)
with the mouth closed.
The image must be clear, sharp and in focus.
Photos must be taken against a plain, uniform, white or
light-coloured background.
Photos must reflect/represent natural skin tones.
The length from chin to crown of head (natural top of head)
must be between 31 mm and 36 mm (1 1/4 in. and 1 7/16 in.).
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 (2) identical unaltered photos produced from the same
film or from the same electronic file capturing the digital image.
Protection of Information
Personal information provided on this application form is protected and used in accordance with the provisions of the Privacy
Act (Personal Information Bank No. FAI PPU 030). This information is collected under the Canadian Passport Order to determine the
applicant's current and ongoing entitlement to a Canadian passport, to administer passport services and to provide information to the
Consular Affairs Bureau of Foreign Affairs and International Trade Canada in the event that the applicant require assistance while
travelling abroad. The information provided, including the applicant's photo, is subject to routine verifications and security queries. To
further strengthen Canadian passport security, the photo is stored on an alphanumeric template and incorporated into the passport as a
digital image.
Passport Canada may use the services of third parties to receive passport applications submitted in person and to process the return of
incomplete passport applications. In the performance of these services, personal information will be protected and used in accordance
with the provisions of the Privacy Act.
Passport Canada may contact the applicant to solicit feedback about passport services.
1 Personal Information
Surname (last name)
ELIAS
Given name(s) (see instruction no. 1)
CHERIE CLAUDETTE Date of travel
Month Day
Surname (last name) at birth (see instruction no. 1) Former surname (former last name) (see instruction no. 1) 03
BRISEBOIS Unknown
If passport requested in Year of marriage Surname (last name) of spouse (see instruction no. 1)
spousal surname (last name), enter 1996 ELIAS
Date of birth Place of birth
Year Month Day CANADA
EDMONTON AB
1976 11 23 City Country Prov./Ter./State(if applicable)
Sex ✖ Female Marital status Eye colour Hair colour Height Weight
Male MARRIED BLUE BLONDE 5.9FT 170LBS
City Province/Territory/State
2 Declaration of Guarantor (to be completed by the guarantor only if the applicant has completed and signed this application form)
Surname (last name) Given name(s)
Surname (last name) in passport, if different Daytime telephone number Evening telephone number
( ) ( )
Address of permanent residence
2) After becoming a Canadian citizen, did you reside outside of Canada for TEN (10) consecutive years or more before July 1967?
From To
No Yes (specify) Year Month Day Year Month Day
3) To be completed if you were born outside of Canada between February 15, 1977 and April 16, 1981 inclusively. (You do not
need to complete this section if you are presenting a certificate of Canadian citizenship issued after January 1, 2007.)
a) Are you a naturalized Canadian? (i.e. Did you receive Yes - Go to section 5 No - Continue to question b)
Canadian citizenship following immigration to Canada?)
b) Was one of your parents born in Canada? Yes - Go to section 5 No - Continue to c)
c) Complete and submit form PPTC 001 "Proof of Canadian Citizenship – Additional Information" which you can obtain at
www.passportcanada.gc.ca or at any Passport Canada service location, participating Canada Post office, participating
Service Canada Centre in Canada or any Canadian government office in the USA.
5 Documents to Support Identity
Provide the following information. Include signed copies (both sides) or original documents (see instruction no. 5).
Type of document Document number Date of expiry (if applicable) Name of bearer as it appears on the document
CERTIFICATE OF Year Month Day
CHERIE CLAUDETTE BRISEBOIS
76-08-029948
BIRTH
Type of document Document number Date of expiry (if applicable) Name of bearer as it appears on the document
Year Month Day
Declaration of Applicant
DECLARATION – I solemnly declare that the statements made in this application are true.
Signature of applicant Date Signed at
Year Month Day
City Province/Territory/State
1.
From To
Year Month Year Month
2.
B Occupation in the last TWO (2) years (If insufficient space, attach a separate sheet. If you are, for example, a homemaker or are retired, indicate this in the
"Employer/School or Other" column.)
In the last TWO (2) years, my employers were and/or I was attending educational institutions as follows:
Employer/school or other Address Daytime phone Nature of employment/studies Date (From) Date (To)
C Provide your mother's surname (last name) at the time of her birth.
Mother's maiden name BRISEBOIS
8 References
Provide the following information with respect to TWO (2) persons who are neither your relatives nor your guarantor 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)
SCHILLING KATIE
Relationship Address (Number, Street, Apartment, City, Province/Territory/State, Country)
FRIEND 129 RUE MOREAU,BEAUMONT,AB CANADA
Daytime phone Evening phone Cell. number or email address (optional) Has known me for
780-929-9211 14
State number of years
2. Surname (last name) Given name(s)
VAUGHN STACEY
Relationship Address (Number, Street, Apartment, City, Province/Territory/State, Country)
FRIEND 52152 VOYAGEUR EASTATES, APT184, SHERWOODPARK,AB CANADA
Daytime phone Evening phone Cell. number or email address (optional) Has known me for
780-922-4152 780-922-4152 2
State number of years
Address
BEAUMONT AB
Number Street Apartment City Prov./Ter./State Postal/Zip code
Declaration of Applicant
DECLARATION – I solemnly declare that the statements made in this application are true.
Signature of applicant Date Signed at
Year Month Day
City Province/Territory/State
PPTC 153 (09-01) M02 Page 3 of 3
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