(DISPONIBLE EN FRANÇAIS - PPTC 077 F)

PROTECTED WHEN COMPLETED - B

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REQUEST FOR A CANADIAN PASSPORT WITHOUT PLACE OF BIRTH

PPTC 077 (12-2018) E

A

I, ,

am applying for a new passport and I do not wish my place of birth to be shown in the passport.

I have been advised by the Passport Program, Immigration, Refugees and Citizenship Canada (IRCC) that I may encounter difficulties with the officials of other countries such as additional questioning, the requirement to obtain a visa that would not be required if the passport showed my place of birth, or denial of entry, if the passport does not show my place of birth. I understand that I will have to apply for a new passport at my expense if I wish my place of birth inscribed in my passport.

B

I, ,

am applying for a new passport on behalf of

,

who is under the age of 16, and I do not wish their place of birth to be shown in the passport. I am aware of the warnings provided in section A above.

Signature Date (YYYY-MM-DD)