Directions:
1) Enter the required information (*).
2) Print the completed application (for your records).
3) Submit the application or press Enter on your keyboard.
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* 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 * 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
* 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 * 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
* 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)
* City
* Province
* 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)
* 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
Yes
No
Married/Common Law
Single
(i.e. MAR 14, 1970) * Date of Birth * Male Female
* Place of Birth
* Driver's Lic. # and Province (i.e. 55-555-555 Alberta)
* 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 $63.00 charge to cover Local Police Record Searches for each additional city/town you have lived in, within the last 5 years. Additional charges will not apply if the same police force 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)
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:
Standard Canadian Pardon (removes your criminal record from CPIC): $395.00 plus disbursements = $521.00. (Includes 1 Court Record Search and 1 Local Police Records Check. Note: When your application is ready to be submitted you will be required to pay the Parole Board Filing Fee, which is currently $150.00 (as of December 29, 2010) but may increase in the future. For more information please see our Detailed Fees page. Does not include $70.00 fingerprinting fee) Note: Additional fees will be incurred if you have multiple offences where fines were imposed, or if you have served in the Canadian Military, or if you have lived in more than 1 city within the last 5 years. Additional Court Record, Local Police Record and Military Record Searches are $63.00. US Entry Waiver: $519.75. (Includes 1 Court Record Search. Does not include $70.00 fingerprinting fee) Note: When your application is ready to be submitted you will be required to pay a $585.00 (USD) United States Department of State filing fee (as of November 23, 2010). For more information please see our Detailed Fees page. Note: If you have a Sexual Assault conviction we may also need to do 1 or 2 Privacy Act Information Requests for $252.00 each. For more information please see our Detailed Fees page. Standard Canadian Pardon and U.S. Entry Waiver: Standard Total = $1040.75 (Includes 2 Court Record Searches and 1 Local Police Records Check. Does not include $140.00 fingerprinting fee or the $150.00 Parole Board Filing Fee.) * PBC Priority Pardon Service: $126.00 *NOTE: We prioritize all applications at no extra cost, however, the NPB will prioritize Pardon applications in some cases. For more information please see our FAQ Pardons Page, # 5. Additional Court, Police or Military Record Searches: $63.00 For each record. 1 2 3 4 5 I Don't Know Number of Records Required For more information please see our Detailed Fees page. Pardoned Record and/or Court Record Search only: $126.00 For more information please see our Detailed Fees page. Port of Entry Parole (for emergency travel into the U.S.): $252.00 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: $252.00 (For more information please see our Detailed Fees page or our Pardon FAQ's) Privacy Act Information Request: $252.00. For more information please see our Detailed Fees page. US Entry Waiver Renewal (only for past Alberta Pardons clients) $467.25. -------------------------------------- * Credit Card Information MasterCard or Visa Number Expiry Date / MM/YY Name on Card Please bill in 2 or 4 monthly installments. Please Note: Your credit card will be billed in 2 monthly installments for Pardons or Waivers, and 4 installments for both.
Standard Canadian Pardon (removes your criminal record from CPIC): $395.00 plus disbursements = $521.00. (Includes 1 Court Record Search and 1 Local Police Records Check. Note: When your application is ready to be submitted you will be required to pay the Parole Board Filing Fee, which is currently $150.00 (as of December 29, 2010) but may increase in the future. For more information please see our Detailed Fees page. Does not include $70.00 fingerprinting fee) Note: Additional fees will be incurred if you have multiple offences where fines were imposed, or if you have served in the Canadian Military, or if you have lived in more than 1 city within the last 5 years. Additional Court Record, Local Police Record and Military Record Searches are $63.00.
US Entry Waiver: $519.75. (Includes 1 Court Record Search. Does not include $70.00 fingerprinting fee) Note: When your application is ready to be submitted you will be required to pay a $585.00 (USD) United States Department of State filing fee (as of November 23, 2010). For more information please see our Detailed Fees page. Note: If you have a Sexual Assault conviction we may also need to do 1 or 2 Privacy Act Information Requests for $252.00 each. For more information please see our Detailed Fees page.
Standard Canadian Pardon and U.S. Entry Waiver: Standard Total = $1040.75 (Includes 2 Court Record Searches and 1 Local Police Records Check. Does not include $140.00 fingerprinting fee or the $150.00 Parole Board Filing Fee.)
* PBC Priority Pardon Service: $126.00 *NOTE: We prioritize all applications at no extra cost, however, the NPB will prioritize Pardon applications in some cases. For more information please see our FAQ Pardons Page, # 5.
Additional Court, Police or Military Record Searches: $63.00 For each record. 1 2 3 4 5 I Don't Know Number of Records Required For more information please see our Detailed Fees page.
Pardoned Record and/or Court Record Search only: $126.00 For more information please see our Detailed Fees page.
Port of Entry Parole (for emergency travel into the U.S.): $252.00 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: $252.00 (For more information please see our Detailed Fees page or our Pardon FAQ's)
Privacy Act Information Request: $252.00. For more information please see our Detailed Fees page.
US Entry Waiver Renewal (only for past Alberta Pardons clients) $467.25.
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* Credit Card Information
MasterCard or Visa Number
Expiry Date / MM/YY
Name on Card
Please bill in 2 or 4 monthly installments. Please Note: Your credit card will be billed in 2 monthly installments for Pardons or Waivers, and 4 installments for both.
* Have you ever served in the Military?
Yes (For Pardons there is a $63.00 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.
* Have you received a Pardon in the past?
* Have you ever applied for a U.S. Entry Waiver in the past?
Yes (If YES enter your A-Number, Date & Location Filed or Date and Time Period Granted)
* 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 at that time) I was denied entry.
* 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)
* When were you charged or convicted of the offence(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
How did you hear about Alberta Pardons? Please Select Lawyer Radio Ad Referral TV Ad Newspaper Ad Travel Agent Web Search Yellow Pages Other
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"
Alberta Pardons 205, 12907 - 97 Street, Edmonton, AB. Mailing Address P.O. Box 71111, Edmonton, AB. T5E 6J8 Ph: 780-473-7171, Fax: 780-665-7371
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