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Office Tel: 888-908-3841
Surrey: 604-562-8140
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U.S. ENTRY WAIVER SERVICES – Client Information Form – Waiver

NOT EVERY CONVICTION WILL REQUIRE A US ENTRY WAIVER BY LAW. YOU MAY QUALIFY FOR THE LIFETIME CLERANCE.

Please complete this form using ALL CAPS so that we can start your your us entry waiver case. This form will be sent to to us via e-mail or print it out and send it via regular mail (address is at the bottom of the page). NOTE: All information must be completed in detail. If it does not apply to you please enter N/A (Not Applicable). By completing this form you agree to retain US ENTRY WAIVER SERVICES to prepare your us entry waiver application.
You agree to the payment plan created (if any) and to our mutually agreed upon terms and condition.

Full Legal Name (First, Middle, Last) *

Gender *

Other Names Used (Include birth name, legal name change, married name or alias)

Birth Name

Legal Name Change

Married Name

Alias

Date of Birth (mm/dd/yy): *

Citizenship: *

Cell Phone Number: *

Today’s Date: *

Place of Birth

City *

Province or State *

Country *

Favourite USA Border: *

Means of Transportation (car, bus, plane, train): *

What is your postal code for your residence: *

U.S. Alien Registration Number (if known):

List all address, in full, that you have resided at for the last 5 years for your waiver packet.
If you also want a Canadian pardon, then please list 10 years of address history.

Residence Addresses (List present address first)

1) Full Address (Street Address, City, Province, Country) *

From *

To:

Present Time

2) Full Address (Street Address, City, Province, Country)

From

3) Full Address (Street Address, City, Province, Country)

From

4) Full Address (Street Address, City, Province, Country)

From

5) Full Address (Street Address, City, Province, Country)

From

6) Full Address (Street Address, City, Province, Country)

From

7) Full Address (Street Address, City, Province, Country)

From

8) Full Address (Street Address, City, Province, Country)

From

9) Full Address (Street Address, City, Province, Country)

From

10) Full Address (Street Address, City, Province, Country)

From

11) Full Address (Street Address, City, Province, Country)

From

12) Full Address (Street Address, City, Province, Country)

From

13) Full Address (Street Address, City, Province, Country)

From

14) Full Address (Street Address, City, Province, Country)

From

15) Full Address (Street Address, City, Province, Country)

From

List all employment information for the last five years.

List present employer first. (If none, state so)

1) Full Name and Address of Employer

Occupation

From

To:

Present Time

2) Full Name and Address of Employer

Occupation

From

3) Full Name and Address of Employer

Occupation

From

4) Full Name and Address of Employer

Occupation

From

5) Full Name and Address of Employer

Occupation

From

6) Full Name and Address of Employer

Occupation

From

7) Full Name and Address of Employer

Occupation

From

8) Full Name and Address of Employer

Occupation

From

9) Full Name and Address of Employer

Occupation

From

10) Full Name and Address of Employer

Occupation

From

Biographic Information – Parental Background Information.

Father's Details

First Name *

Middle Name *

Legal Last Name for Father: *

Date Of Birth

City and Country of Birth: *

City and Country of Residence: *

Mother's Details

First Name *

Middle Name *

Legal Last Name for Mother: *

Date Of Birth

City and Country of Birth: *

City and Country of Residence: *

Biographic Information – Spousal Information (if none, state so).

Have Spouse *YesNo

Check To Add Details For Each Of Spouse

Current SpouseFormer Spouse #1Former Spouse #2Former Spouse #3Former Spouse #4Former Spouse #5

Current Spouse

First Name

Middle Name

Legal Last Name

Date Of Birth

City Of Birth

Country of Birth

Date Of Marriage

City and Country of Marriage

Former Spouse #1

First Name

Middle Name

Legal Last Name

Date of Birth

Date of Marriage

City Of Marriage

Date of Termination of Marriage

Place of Termination of Marriage

Former Spouse #2

First Name

Middle Name

Legal Last Name

Date of Birth

Date of Marriage

City Of Marriage

Date of Termination of Marriage

Place of Termination of Marriage

Former Spouse #3

First Name

Middle Name

Legal Last Name

Date of Birth

Date of Marriage

City Of Marriage

Date of Termination of Marriage

Place of Termination of Marriage

Former Spouse #4

First Name

Middle Name

Legal Last Name

Date of Birth

Date of Marriage

City Of Marriage

Date of Termination of Marriage

Place of Termination of Marriage

Former Spouse #5

First Name

Middle Name

Legal Last Name

Date of Birth

Date of Marriage

City Of Marriage

Date of Termination of Marriage

Place of Termination of Marriage

Criminal Conviction History – Please provide information about your convictions:

Have you been granted a pardon? *YesNo

Upload file

No file chosen

Have you been convicted in the US? *YesNo

What was the conviction and where did it take place. (ANSWER IN DETAILS BELOW),

Have you been convicted in the Canada? *YesNo

Please list your criminal conviction(s) below.

Have you previously applied for a US Waiver? *YesNo

Where did you apply?

When did you apply?

Have you ever been in the United States for a period of 6 months or more? *YesNo

When, for how long and in what immigration status?

Have you ever filed an application or petition for Immigration Benefits with the US Government or has one ever been filed on your behalf? *YesNo

list the applications, the filing locations and describe the outcome of each application?

Have you ever been denied or refused an immigration benefit by the US Government or had a benefit revoked or terminated (including but not limited to visas)? Describe in details. *

Have you ever been in the Canadian military? *YesNo

Biographical Data

Height *

Weight *

Eye Colour *

Hair Colour *

Race *

We’re based in beautiful Surrey, B.C., Canada. We are also in Burnaby, Vancouver, Winnipeg, Calgary, Edmonton, London U.K., Estonia, and Washington State

Direct#: 604 562-8140

Office and Fax No.: 1 888 908-3841

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Open Time

Opening Day:

Monday – Friday: 9am to 7pm

Saturday: 8am to 6pm

Vacation:

All Sunday Day

All Vacation Holiday

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Disclaimer:- The information contained herein does not, and is not intended to, constitute legal advice. Instead, all information, content, and materials available on this site is general in nature and is not and should not be considered legal advice.

Office Tel

1 888 908-3841

Email Us

[email protected]

Corporate Mailing Centre

182-7184 120TH St Surrey, B.C., V3W 0M6

“Please note that due to the nature of our work and some people that we deal with, all personnel may be subject to security screening prior to arrival at any of our locations. Also note that firearms or other weapons are not allowed at our locations except by law enforcement.”

US Entry Waiver 2024 – US Waiver Application for Canadians.

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