This form constitutes an official authorization for a Canadian office abroad to charge your credit card for the payment of services requested. It is the only acceptable form for credit card payment.
This form must be fully completed, signed and attached to any service request sent by mail to a Canadian office abroad for which you wish to pay by credit card. It pertains only to programs and services delivered by a Canadian office abroad on behalf of Global Affairs Canada and Canada's Passport Program.
For more information on programs, procedures and methods of payment accepted at your local Canadian office abroad, please visit its website.
The form must contain the Canadian dollar amount authorized for services payment. You may refer to the pages below for lists of services and fees.
- Canada's Passport Program services and fees abroad
- Consular services and fees
- International Experience Canada services and fees
Please complete all applicable fields in the form below, print, sign and include as formal authorization of any payment by credit card for a service request sent to a Canadian office abroad:
Alternate non-fillable format (print, complete legibly and sign):
If you need more information, call 613-944-6788 or email firstname.lastname@example.org.
If you need emergency consular assistance, please contact email@example.com.
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