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Government Gouvernement

l♦I of Canada du Canada

PASSPORT CL AI M SLIP

Name of applicant

File num ber

Pas sport ready on

Ensure that the passport is pic ked


up wit hin 30 day s.

Present this passport claim slip


and per son al ide nti fica tio n.

D Per son al app ear anc e of app lica nt


is req uire d.

OR
App lica nt ma y app ear in per son or
del ega te this res pon sib ility to


ano the r per son ove r 16 years of age
by com ple ting the foll owi ng
aut hor izat ion :

I authorize
PRINT IN CAPITAL LET TER S the nam
e of lhc person au\hollZed
to pick up the passport (mu st sho
w Identification).

Signature of applicant
Date

PPTC 171 (09-2014) (FRAN<;AIS AU VERSO )


Cana d a

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