Application Form

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)

*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 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.