Pardon - Waiver Request - Morley Process Services

U.S. Entry Waiver Online Application Form

Please complete all information

* Indicates required field

What is your full legal name *

First

Last

Name under which you were charged or arrested (surname, first name, middle names) *

All other names used (include names by previous marriages) *

What is your full legal middle name/s *

What is Your Birthdate *

What is your telephone contact number *

What is your present address (including Postal Code) *

What is your email address *

Place of Birth (City-Town, State/Province, Country) *

What is your Birthdate *

Present Citizenship/Nationality *

Please list all addresses you have resided at during the past 5 years *

Please list all places of employment during the past 5 years *

What is the full legal name of your Father (Family Name, First Name, Middle Name) *

When and where was your Father born (birth-date, city and country of birth if known) *

In which city and country does your Father reside *

What is the full legal name of your Mother (Family Name, First Name, Middle Name) *

When and where was your Mother born (birth-date, city and country of birth if known) *

In which city and country does your Mother reside *

What is the legal name of your current Husband or Wife (if none, so state) *

When and where was your current Husband or Wife born (birth-date, city and country) *

What is the legal name of your former Husband or Wife (if none, so state) *

When and where was your former Husband or Wife born (birth-date, city and country) *

Date and place where marriage was terminated *

Desired Port of Entry into the United States *

Your purpose for entering the United States *

Means of Transportation *

Proposed Date of Entry *

Approximate Length of Stay in the United States *

I believe that I may be inadmissible to the United States for the following reason (s) and no others *

Have you previously applied for a U.S. Entry Waiver *

Yes No

Have you ever, in or outside the U.S., been arrested, cited, charged, indicted, fined or imprisoned for breaking or violating any law or ordinance, excluding minor traffic violations? Describe in detail. Include all offenses where impaired driving may have been an issue *

If "Yes", please indicate where and when *

Have you ever been in the United States for a period of 6 months or more *

If "Yes", when, for how long, and in what immigration status *

Have you ever filed an application or petition for immigration benefits with the U.S. Government *

Have you ever been denied or refused an immigration benefit by the U.S. Government, or had a benefit revoked or terminated (including visas) *

Have you read our Terms/Conditions & Privacy *

Yes No

What is the best time to call you *

May we leave a discreet message *

Yes No

I agree to the Terms & Conditions *

Yes No

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