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Request for the return of a cancelled passport

I, the undersigned, as the next of kin of ______________________________________, who has passed away, request that the Canadian Passport issued in his/her name be returned to me for safekeeping after cancellation.

I solemnly declare under my personal responsibility what follows, believing it to be true to the best of my knowledge.

Name of the person deceased   ________________________________________

Date of birth   _______________________

Date of death   _______________________

Passport number   ___________________

My name   ________________________________________________________

Link of kinship   ___________________________

My date of birth   _______________________

My current address   ________________________________________________

My phone numbers   ________________________________________________

 

_______________________
Signature

I have attached:
___ the death certificate (translated, if necessary) and
___ photocopy of my identification document

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Date Modified:
2011-10-26