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Waiver Background Data

US Entry Waiver Services Client Information Form - Waiver

NOT EVERY CONVICTION WILL REQUIRE A US ENTRY WAIVER. YOU MAY QUALIFY FOR THE PERMANENT EXEMPTION

Please complete this form and click on the submit button when finished. NOTE: All information must be completed in detail. If it does not apply to you please enter N/A (Not Applicable). You agree to the payment plan created (if any) and to our mutually agreed upon terms and condition.

Personal Information.

Address Information

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.




List all employment information for the last five years.


Biographic Information – Parental Background Information.


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


Complete the following for: Spouse

Complete the following for: Former Spouse #1

Complete the following for: Former Spouse #2

Complete the following for: Former Spouse #3

Complete the following for: Former Spouse #4

Complete the following for: Former Spouse #5

Criminal Conviction History – Please provide information about your convictions:


Biographical Data: