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Declaration concerning a lost, stolen, inaccessible, damaged or found canadian travel document

DECLARATION
concerning a lost, stolen, inaccessible, damaged or found Canadian travel document
WARNING to applicant—Any false or misleading statement on this form or relating to any document in support of your travel document application, including concealment of
any material fact, may lead to refusal to issue or revocation of a travel document and be grounds for criminal prosecution.
TYPE OR PRINT IN CAPITAL LETTERS using black or dark blue ink.
Personal Information as Indicated on Most Recent Canadian Travel Document Signature of applicant
Is the travel document being submitted with your declaration? Information Concerning a Valid Canadian Travel Document No Longer in My Possession 2 Note: Incomplete descriptions may result in the delay or refusal of your application. If insufficient space, attach a separate signed and dated sheet.
The travel document listed in section 1 is no longer in my possession because (please provide a detailed explanation as to why you are not submitting the travel document and what has happened to it) I have made the following efforts to recover this travel document (please explain) Please provide the reason for not filing a police report Were any other provincial or federal identification documents lost or stolen? Information Concerning a Damaged or Found Canadian Travel Document Note: If insufficient space, attach a separate signed and dated sheet.
Detailed circumstance of how the travel document was damaged or found Explain why you are applying for a replacement travel document Date travel document was damaged or found Location Reminder: A travel document application form must also be completed if a replacement travel document is required. Please note that
the travel document specified in this form cannot be used for the simplified renewal process.
DECLARATION—I solemnly declare that, to my knowledge, the statements made in this declaration are true. Should I ever regain
possession of the Canadian travel document reported in section 1, I will return it immediately to Passport Canada or if abroad to the
nearest Government of Canada office. I acknowledge that a Canadian travel document once reported lost, stolen, inaccessible,
damaged or found is no longer valid and is NOT to be used for any travel. I understand multiple occurrences of Lost/Stolen or
Damaged travel documents may result in either the refusal to issue a replacement travel document, or if approved, a severely limited
validity of the replacement travel document. I also acknowledge that additional requirements may apply, such as demonstrating the
need to be issued a travel document. I declare that I have read and understood the WARNING to applicant at the top of page 1.
Signature of applicant
Based on the information provided by the applicant on this form, the travel document has been identified as Name of officer who reviewed the above information (stamp recommended) To obtain the most recent version of this form, visit our website at www.passportcanada.gc.ca.

Source: http://www.ppt.gc.ca/form/pdfs/pptc203_eng.pdf