Immigration Waiver Application Data Sheet
Full Name
Date of Birth
Country of Birth
Country of Citizenship
Passport Number
Passport Expiry Date
Current Address
Phone Number
Email
Marital Status
Single
Married
Divorced
Widowed
Other
Spouse's Full Name
Spouse's Immigration Status
Children (names and DOBs)
Type of Waiver Requested
Date of Last Entry to Country
Status at Last Entry
Summary of Immigration History
Criminal History (if any)
Brief Explanation for Waiver Request