E672 – CANPASS Application Form

A link to the Portable Document Format (PDF) of this form is provided below. The content of the form is duplicated in HTML following the PDF link.

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Protected B when completed

Please print - We will not accept incomplete applications.

Section A – Personal Information

Section B – Address history for the last five years

Mailing address if different from residential address

Previous residential addresses if you have been at your current residence for less than five years (attach a separate sheet if necessary).

Section C – Employment history for the last five years

Previous employer's name and addresses if you have been with your current employer for less than five years (attach a separate sheet if necessary).

Section D – This section must be completed by all non-Canadian citizens and all non-Canadian permanent residents

Section E – Additional information

Section F – Customs programs

(complete if applicable)

CANPASS Corporate Aircraft

Company information

CANPASS Private/Corporate Aircraft information while in Canada (attach a separate sheet if necessary)

Please provide information for any aircraft on which you may be travelling

CANPASS Private Boats – Vessel information

(attach a separate sheet if necessary)

Section G – Fee payment (non-refundable)

No fee required for applicants under 18 years of age.

Section H – Non-custodial parent or legal guardian

Non-custodial parents or legal guardians must attach a copy of supporting documents, such as a court order or letter of authorization, if this application is for a child under the age of 18 who will be traveling with a non-custodial adult.

Section I – Certification

Privacy Statement

Canada Border Services Agency (CBSA) and is protected pursuant to both the Customs Act and the Privacy Act. In accordance with Canadian laws and regulations, this information will be shared with other government departments or agencies in Canada for the purpose of the operation of the CANPASS Air, CANPASS Corporate Air, CANPASS Private Air or CANPASS Private Boats programs, and to conduct applicable checks and verifications to determine your eligibility and continued eligibility to any of these programs. If the required information is not provided, your application may not be processed and the authorization may not be granted.

Individuals to whom the information relates have rights of access to, correction of and protection of, their personal information under the Privacy Act. The information collected is described in Personal Information Bank # CBSA PPU 002. Instructions for obtaining information are provided in Info Source, which is available at public libraries, government public reading rooms and on the Internet at: http://infosource.gc.ca.

Consent Statement

I understand that any information gathered for the purposes of this application, including any supporting documentation or background information (and in the context of CANPASS Air, biometric data), as well as information obtained from the relevant files of law enforcement agencies, including intelligence gathered for law enforcement purposes, will be used for the purpose of the operation of the CANPASS Air, CANPASS Corporate Air, CANPASS Private Air or CANPASS Private Boats programs, and to conduct applicable checks and verifications to determine eligibility and continued eligibility in the CANPASS programs as described in the Presentation of Persons (2003) Regulations. My contact information may also be used by the CBSA to send me notifications related to changes to the CANPASS program(s).

In addition, I understand that my personal information gathered for the purposes of this application, including my supporting documentation, background information, (and in the context of CANPASS Air, biometric data), and any other information obtained and collected for the purpose of the operation of the CANPASS programs and to conduct applicable checks and verifications to determine my eligibility and continued eligibility in the program(s), may be accessed and used by the CBSA, as well as by other government departments or agencies in Canada (including the Royal Canadian Mounted Police and the Canadian Security Intelligence Service), in accordance with the Privacy Act.

If you do not consent to the above-noted collection, use and sharing of your personal information, your application cannot be processed and an authorization cannot be granted.

Do you consent to the above-noted collection, use, and sharing of your personal information?

Yes/No

Certification

I certify that all information given on this application, and in support of this application, is provided voluntarily and is true, accurate and complete.

I certify that I have read, understood, and agree to abide by all conditions applicable to the program to which I apply and to the use of the associated authorization, including all instructions and notices accompanying this application.

Signature of applicant or signature of parent or legal guardian if applicant is under the age of 18:

Name (print)
Signature
Date

How to complete the application

Each person who wants to participate in a CANPASS program has to complete and sign an application form. Parents or legal guardians must complete the application on behalf of children less than 18 years of age. NOTE: Their processing fee is waived.

The following provides additional details about certain sections of the application form.

Preferred language - Indicate English or French. We will correspond with you in the language of your choice.

Preferred Interview location - for CANPASS Air only. Indicate the airport in which you want to have your interview. Please visit the following CBSA site for a list of available Enrolment Centers: http://www.cbsa-asfc.gc.ca/prog/canpass/canpassair-eng.html#s2x2.

CANPASS Programs - Indicate the program in which you want to participate. A separate application form is required for each applicant and program.

Section A - Personal information

Other names used - If you have ever changed your name (including by marriage), provide previous name(s).

Citizenship and residency - Indicate whether you are a citizen of Canada, the United States, or another country. Check the box that corresponds with your country of residence.

Proof of citizenship or permanent resident status - Provide a photocopy and check the type of the document(s) confirming your citizenship or permanent resident status. Provide the document number and expiry date, if applicable. For the Canadian permanent resident document number: provide the serial number located on the upper left of the back of the card, e.g., RA0123456789.

Section B - Address history for the last 5 years - Provide details of your address history for the past five years. Use the space provided, starting with your current address. Attach a separate sheet, if necessary.

Section C - Employment history for the last 5 years - Provide details of your employment history for the past five years. Use the space provided, starting with your current employer. Attach a separate sheet, if necessary. Lack of employment will not disqualify you from participation, if you are otherwise admissible to the United States and Canada, and meet all other program requirements.

Section D - Purpose of your travel - If you are a United States citizen or resident alien you must indicate the purpose of your travel to Canada.

Section E - Additional information - Indicate whether you have been convicted of a criminal offence. Also include any immigration and customs violations you may have experienced.

Section F - Customs Programs - excluding CANPASS Air

Section G - Fee payment - Include a money order or a certified cheque in Canadian funds, for applicant 18 years of age or older, made payable to the Receiver General for Canada. If you are paying by credit card, provide your VISA or MasterCard or AMEX number, including expiry date, along with your signature.Corporate Aircraft applicants do not need to include any form of payment (certified cheque, money order, or personal credit card number), as your corporation pays for the fee.

Section H - Non-Custodial Parent or Legal Guardian - To meet Canadian requirements, non-custodial parents or legal guardians applying for a child under the age of 18, for whom they do not have legal custody, must attach a copy of the applicable legal documents showing custody rights, or a notarized copy of the parent or legal guardian's consent, in writing, for the enrolment of that child in the CANPASS program.

Section I - Certification - Read the privacy statements and the certification statement on the application form carefully. Then, sign and date this section. For a child under the age of 18, the legal guardian or parent must sign this certification.

Complete, sign the application form and send it with the non-refundable fee payment, along with your photocopied documents to the Canadian Processing Centre nearest you.

CANPASS Air applications must be sent to either:

Canadian Processing Centre Canadian Processing Centre
28–176th Street
Surrey BC V3S 9R9
Telephone: (604) 538-3689 / 1-866-496-3987

OR

Canadian Processing Centre
400 Place d'Youville
Montréal QC H2Y 2C2
Telephone: (514) 350-6137

CANPASS Corporate Aircraft, CANPASS Private Aircraft and CANPASS Private Boat applications can be sent to any one of the three Canadian Processing Centres:

Canadian Processing Centre
28–176th Street
Surrey BC V3S 9R9
Telephone: (604) 538-3689 / 1-866-496-3987

Canadian Processing Centre
400 Place d'Youville
Montréal QC H2Y 2C2
Telephone: (514) 350-6137

Canadian Processing Centre
6080 Mcleod Road
P.O. Box 126
Niagra Falls, ON L2G 7T4

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