Application Formadmin2021-12-03T22:35:28+00:00 Canadian Criminal Record Pardon Record Suspension and US Waiver Application Canada Pardons & US Waivers Secure Online Application Directions: 1) Enter the required information (*). 2) Print the completed application (for your records). 3) Submit the application or press Enter on your keyboard. ________________________________________________________________________________________________ * Full Name * Other Names (your Full Legal Currently Used Name) (maiden name, previous married name(s), legal name changes, documented nick names, names stated to authorities) * Mailing Address Physical Address (needed if mailing address is different or is a PO Box #) * City * Province and Country * Postal Code * How long have you lived at this address? (month & year you moved in) * Home Phone Cell Phone * Work Phone * Present Employer I am Self-Employed. I need to enter the U.S. for business. (Kept Confidential) * Private Email (No Hotmail Please) Get Free Gmail * 1st Preferred Method of Contact: Home phone Mail E-mail Work phone Cell phone Fax * 2nd Preferred Method: Home phone Mail E-mail Work phone Cell phone Fax * Are members of your household aware of this application? Yes No Married/Common Law Single Separated (i.e. March 14, 1970) * Date of Birth * Male Female * City, Province and Country of Birth * Driver's Lic. # and Province (i.e. 55-555-555 Alberta) * Citizenship (you must be a Canadian Citizen to get a U.S. Waiver through our office, and the same goes for Indictable Offense Pardons) *If you are applying for a Pardon or Waiver, please write all the Additional Addresses of where you have lived in the last 5 or 10 years in the boxes below. If you are applying for a Pardon it's 10 years, and there will be an additional $33.33 plus GST = $35.00 Admin Fee plus Police Agency Fee (if applicable) to cover Local Police Record Searches for each additional city/town you have lived in, within the last 5 years. Multiple charges will not apply if the same police agency serves each location. For Waiver applications it's 5 years and there are no additional charges. 1. , From: (MM YY) To: (MM YY) * ( PO Box Numbers are not accepted by the PBC ) 2. , From: (MM YY) To: (MM YY) ( Postal Codes are NOT required ) 3. , From: (MM YY) To: (MM YY) 4. , From: (MM YY) To: (MM YY) 5. , From: (MM YY) To: (MM YY) 6. , From: (MM YY) To: (MM YY) 7. , From: (MM YY) To: (MM YY) * Service(s) Required: Premium Canadian Pardon: $695.00 plus GST ($34.75) = $729.75. Note: When your application is ready to be submitted you will be required to pay the Parole Board Filing Fee, which is $657.77. Does not include a Biometric Fingerprinting Fee. Note: Additional Court Record Search fees will apply for all offenses. Additional fees will also apply if you have served in the Canadian Military, and for each Local Police Records Check from where you have lived for last 5 years. Court Record and Military Record Searches are $84.00 each, and Local Police Record Checks are $35.00, including GST, plus the Police Agency Fee (if applicable). For more information please see our Fees page. Premium US Entry Waiver: $695.00 plus GST ($34.75) = $729.75. Note: When your application is ready to be submitted to US Customs you will be required to pay a $585.00 (USD) United States Department of State filing fee. Does not include a Biometric Fingerprinting Fee. Note: Court Record Searches (not required for all offenses) are normally $84.00 from Alberta. For more information please see our Fees page. Please Note: If you have a Sexual Assault or Drug Trafficking conviction there will be higher fees due to increased paperwork. For more information please see our About/Fees Page. Premium Canadian Pardon and U.S. Entry Waiver: $1295.00 plus GST = $1359.75. (Does not include Court Record Searches or Local Police Records Checks. Does not include a Biometric Fingerprinting Fee, or the $657.77 Parole Board Filing Fee, or the $585.00 USD Department of State Filling Fee.) Priority Service Fee: $120.00 per half hour, plus GST. *NOTE: We prioritize all applications at no extra cost, however, in some cases where staff must work overtime in order to meet a last minute deadline, or all documents are to be sent by courier, this fee will apply. For more information please see FAQ Pardons Page, # 5. Pardoned Record and/or Court Record Search only: $189.00, includes GST. For more information please see our Fees page. Port of Entry Parole (for emergency travel into the U.S.): $252.00, includes GST. Note: This permit is for clients who are applying for a Standard US Entry Waiver, and who need to enter the United States for emergency life-saving medical treatment or to attend a funeral for an immediate family member ONLY. Please call our office or see our Waiver FAQ section (10 & 14) if you are unsure if you are eligible to receive such a permit. Police File Destruction Services: $519.75, includes GST. (For more information please see our Fees page or our Pardon FAQ's) Privacy Act Information Request: $252.00, includes GST. For more information please see our Fees page. US Entry Waiver Renewal (only for past Alberta Pardons clients) $595.00 plus GST = $624.75 -------------------------------------- * Credit Card Information MasterCard or Visa Number Expiry Date / MM/YY CVV Number Name on Card Please bill in 2, 3 or 4 monthly installments. Please Note: Your credit card will be billed in 3 monthly installments for Pardons, 2 for Waivers, and 4 installments for both. An additional $10.50 processing fee will apply. * Have you ever served in the Military? Yes (For Pardons there is a $84.00 charge to cover Military Record Search fees) Note: In the Comments Section below please provide your Military ID Number, Service Dates, Address of Unit, and the Name of your Commander. No * Have you received a Pardon in the past? Yes No * Have you ever applied for a U.S. Waiver in the past? Yes (If YES enter your A-Number, Date & Location Filed or Date and Time Period Granted) No * Have you ever been questioned by U.S. Customs about your criminal record, or denied entry into the U.S. because of your record? Yes (If YES when & where were you questioned & were you denied entry) I was denied entry. No * Do you have a Passport? (Note: Since August of 2008 Passports have been encoded with an FPS (FingerPrint Service) number if you have a criminal record on CPIC at the time your Passport is processed.) Yes (Year obtained or renewed) No * When were you charged or convicted of the offense(s)? Less than 1 year ago 1 - 3 years ago 3 - 5 years ago More than 5 years ago More than 10 years ago More than 15 years ago Multiple offenses in last 5 years Multiple offenses over 5 years ago Multiple offenses over 10 years ago Multiple offenses over 15 years ago Please Select * Do you have any Assault CBH or Assault with a Weapon convictions? Yes (For Pardons an additional $252.00 fee will apply for a Privacy Act Information Search in order to obtain the age of the victim and any injuries) No * Do you have any Sexual Assault convictions? Yes (For Pardons and Waivers an additional $504.00 fee will apply per service due to the much higher work load for these types of offenses) No Comments: (Please include your convictions [if known] and the locations [city or town] of where you were sentenced) For your records please print this form before submitting it. (Click on "File" then "Print") Note: Your credit card will show "ALBERTAPARD-ABFPS" Canada Pardons & US Waivers Office Address: 210, 12781 - 50 St., Edmonton, AB. T5A 4L8 Mailing Address P.O. Box 71111 Edmonton, AB. T5E 6J8 Fax: 780-665-7371 Ph: 780-473-7171 Copyright 2002 - 2021 Canada Pardons & US Waivers. All Rights Reserved.