canada trusted traveler nexus family pass application · nexus family pass application . 1. specify...
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NEXUS FAMILY PASS APPLICATION
1. Specify the number of family membersHOW TO APPLY
2. Pay the IVT service fee via PayPal Please note: We cannot use your credit card to pay for the IVT service fee Your credit card will be used to pay the CBP fee for background and security checks for adult applicants 3. Fill out this application form and save as a separate file on your desktop ready to email OR print off this application form and fill out by hand in clear bold capitals.
4. Email your application package to us at: [email protected] OR fax toll free to 1-877-770-7096 Please note: We do not accept postal applications
# Adults # Children
IVT TERMS & CONDITIONS
5. IVT is not responsible for applicants who are denied from the program for any reason
2. IVT and the US customs and border authorities do not give refunds for applications submitted in error, filled out illegibly or denied participation to any of the CBP low risk traveler programs3. IVT is not responsible for any delays in the submission of an application caused by incomplete information
By submitting an application and paying our service fee, each applicant agrees to the following terms and conditions:Please read our website Terms & Conditions before submitting your application and paying our fees
4. I assert that I understand I am using IVT to apply for a NEXUS card
1. IVT is not a government agency and cannot influence the outcome of your Trusted Traveler application
Fax to 1-877-770-7096 or email to [email protected]
2. IVT pay the $50 (per adult) government fee using the credit card provided on your application form
5. You attend a 30 minute interview, where biometric data is collected (fingerprints and a digital photo). Additional fees are paid to the interviewing officer (see below). The interviewing officer informs you regrading your approval or denial to the NEXUS program6. You receive your nexus card by mail from CBP headquarters in Vermont 7 - 10 days after your interview
WHAT HAPPENS NEXT?1. IVT carefully check your data, email you regarding any omissions and submit your information and government fees to the United States Border Authorities for stringent security and background checks
3. IVT send you access details for your profile on the Trusted Traveler database along with information on how to monitor your profile and schedule your compulsory interview4. You receive an email at your designated primary email address informing you of your eligibility for NEXUS. If your status is 'Conditionally Approved' you can schedule your interview.
Sign / type name here
PayPal email address used to pay IVT fee
I assert that I understand IVT's Terms and Conditions The PayPal email address used to pay the IVT service fee is needed to match your application with your payment. You may attach a copy of your payment receipt to the application form.
YOUR APPLICATION WILL NOT BE PROCESSED WITHOUT THIS PAGE OR WITHOUT PAYPAL PAYMENT.
Note: We cannot take IVT service fees from your credit card
CANADA TRUSTED TRAVELER
NEXUS CARD FAMILY APPLICATION ADULT 1US TRUSTED TRAVELER
PERSONAL DATA
List an email address which will be checked regularly for status updates. It does not have to be your personal email.
LAST NAME
FIRST NAME
MIDDLE NAME GENDER
EYE COLOR
HEIGHT
OTHER FIRST NAMES
OTHER LAST NAMES
DATE & PLACE OF BIRTH
DATE OF BIRTHYYYY/MM/DD
COUNTRY
CITY
STATE / PROVINCE
NOTE 1: ALL DATA MUST BE WRITTEN EXACTLY AS IT APPEARS ON YOUR OFFICIAL DOCUMENTS (PASSPORT, DRIVERS LICENSE, VISA, RESIDENCE CARD, BIRTH CERTIFICATE ETC)
YOU MAY SUBMIT COPIES OF YOUR DOCUMENTS IF YOU WISHNOTE 2: WRITE CLEARLY AND LEGIBLY IN BLOCK CAPITALS OR TYPE YOUR DATA INTO THE FORM AND SAVE TO YOUR DESKTOP
CONTACT DETAILS
HOME PHONE NUMBER
CITIZENSHIP & NATIONALITY
CHECK IF YOU ARE A US LAWFUL PERMANENT RESIDENT (GREEN CARD HOLDER)
PRIMARY CITIZENSHIP
PRIMARY PASSPORT NUMBER
EXPIRY DATE YYYY/MM/DD
PR CARD NUMBER
EXACT NAME ON PASSPORT
EXPIRY DATE YYYY/MM/DD
COUNTRY OF ISSUANCE
EXACT NAME ON PR CARD
SECONDARY CITIZENSHIP
EXACT NAME ON PASSPORT
SECONDARY PASSPORT NUMBER
CITIZENSHIP CERTIFICATE NUMBER
COUNTRY OF ISSUE
ISSUE DATE YYYY/MM/DD
EXPIRY DATE YYYY/MM/DD
BIRTH CERTIFICATE NUMBER
STATE / PROVINCE
COUNTRY OF ISSUE
EXACT NAME ON CERTIFICATE
VISA NUMBER
VISA TYPE
EXPIRY DATE YYYY/MM/DD
ISSUING COUNTRY
VISA REQUIREMENTS If you are not a citizen of the USA or Canada you may need a valid visa to enter the United States.
EXACT NAME ON CERTIFICATE
ALTERNATIVE DOCUMENTATION WHEN NO PASSPORT EXISTS
Citizenship Certificate Birth Certificate
Permanent Residence
You must give the EXACT details as they appear on your official documents. You may attach copies of your documents if you wish.
ADDRESS
STATE / PROVINCE
ZIP / POSTAL CODE
CITY
ADDRESS
YOUR CURRENT ADDRESS
CHECK IF THIS IS ALSO YOUR MAILING ADDRESS
WHEN DID YOU START LIVING HERE FROM YYYY/MM
If you have lived at this address for 5 years or more, you do NOT have to fill out the address history
MAILING ADDRESS IF DIFFERENT TO YOUR CURRENT ADDRESS
WHEN DID YOU START USING THIS ADDRESS? FROM YYYY/MM
ADDRESS
STATE / PROVINCE
ZIP / POSTAL CODE
CITY
ADDRESS
DRIVER LICENSE DETAILS
LICENSE NUMBER
COUNTRY OF DRIVERS LICENSE
STATE WHERE DRIVERS LICENSE WAS ISSUED
You must give the EXACT details as they appear on your drivers license
EXPIRY DATE
EXACT NAME ON LICENSE
CHECK IF THIS IS AN ENHANCED LICENSE?
CHECK IF THIS LICENSE HAS HAZARDOUS MATERIAL ENDORSEMENT
CHECK IF THIS IS A COMMERICAL DRIVERS LICENCE
Please answer the questions below about your drivers license
ADDRESS HISTORY FOR THE LAST 5 YEARS
FROM YYYY/MMPlease list every address you have had during the last 5 years. We cannot process your application if there are any gaps. Use supplementary sheets if necessary.
ADDRESS
STATE / PROVINCE
ZIP / POSTAL CODE
CITY
ADDRESS
FROM YYYY/MM TO YYYY/MM
ADDRESS
STATE / PROVINCE
ZIP / POSTAL CODE
CITY
ADDRESS
FROM YYYY/MM TO YYYY/MM
ADDRESS
STATE / PROVINCE
ZIP / POSTAL CODE
CITY
ADDRESS
FROM YYYY/MM TO YYYY/MM
ADDRESS
STATE / PROVINCE
ZIP / POSTAL CODE
CITY
ADDRESS
TO YYYY/MM
INFORMATION ABOUT YOUR CURRENT WORKEMPLOYED UNEMPLOYEDSELF EMPLOYED CHILDRETIRED STUDENT
If you are a Student, Child, Unemployed or Retired you only have to check the box, you do not need to fill out any other details
FROM YYYY/MM
ADDRESS
ADDRESS
EMPLOYER
OCCUPATION
EMPLOYERS PHONE #
CITY
STATE / PROVINCE
ZIP / POSTAL CODE
EMPLOYMENT HISTORY FOR THE LAST 5 YEARSEMPLOYED UNEMPLOYEDSELF EMPLOYED CHILDRETIRED STUDENT
FROM YYYY/MM TO YYYY/MM
ADDRESS
STATE / PROVINCE
CITY
ADDRESS
EMPLOYER
OCCUPATION
EMPLOYERS PHONE #
ZIP / POSTAL CODE
If you are a Student, Child, Unemployed or Retired you only have to check the box, you do not need to fill out any other details. Use supplementary sheets if necessary.
EMPLOYED UNEMPLOYEDSELF EMPLOYED CHILDRETIRED STUDENT
TO YYYY/MMFROM YYYY/MM
ADDRESS
STATE / PROVINCE
CITY
ADDRESS
EMPLOYER
OCCUPATION
EMPLOYERS PHONE #
ZIP / POSTAL CODE
TRAVEL HISTORYList all of the countries visited in the last 5 years excluding Mexico, USA & Canada
ADDITIONAL INFORMATION
Have you ever been convicted of a criminal offense in any country for which you have not received a pardon?
NO YES
NO YES
Have you ever received a waiver of inadmissibility to the USA from a US government agency?
Have you ever been found in violation of customs or immigration laws or other federal import laws?
NO YES
Have you ever been approved by Citizenship and Immigration Canada for rehabilitation because of past criminal activity?
NO YES
IF YOU HAVE ANSWERED YES TO ANY OF THE ABOVE QUESTIONS PLEASE GIVE EXACT DETAILS BELOW:
FEE PAYMENTYour credit card details are required for the certification of your application with US Customs and Border Protection (CBP). The government fee for this is $50.
CERTIFICATIONBy submitting this form, you certify that the information provided on this form was given voluntarily and is true and complete. You are also certifying that you understand that this information will be shared with law enforcement agencies, Customs and border protection. government immigration agencies and other government bodies with applicable laws.
ALL CREDIT CARD INFORMATION IS DESTROYED ONCE GOVERNMENT FEES ARE PAID
CVV CODECREDIT CARD TYPE CREDIT CARD #
NAME ON CARD
EXPIRY DATE YY/MMThe CVV code is the 3 digit number printed on
the back of your credit card where you sign
your name. Amex CVV code is 4 digits on the
front of the card above the card number
NEXUS CARD FAMILY APPLICATION ADULT 2
PERSONAL DATA
List an email address which will be checked regularly for status updates. It does not have to be your personal email.
LAST NAME
FIRST NAME
MIDDLE NAME GENDER
EYE COLOR
HEIGHT
OTHER FIRST NAMES
OTHER LAST NAMES
CHECK IF THIS IS THE SAME AS ADULT 1
DATE & PLACE OF BIRTH
DATE OF BIRTHYYYY/MM/DD
COUNTRY
CITY
STATE / PROVINCE
NOTE 1: ALL DATA MUST BE WRITTEN EXACTLY AS IT APPEARS ON YOUR OFFICIAL DOCUMENTS (PASSPORT, DRIVERS LICENSE, VISA, RESIDENCE CARD, BIRTH CERTIFICATE ETC)
YOU MAY SUBMIT COPIES OF YOUR DOCUMENTS IF YOU WISHNOTE 2: WRITE CLEARLY AND LEGIBLY IN BLOCK CAPITALS OR TYPE YOUR DATA INTO THE FORM AND SAVE TO YOUR DESKTOP
CONTACT DETAILS
HOME PHONE #
CHECK IF THIS IS THE SAME AS ADULT 1
CITIZENSHIP & NATIONALITY
CHECK IF YOU ARE A US LAWFUL PERMANENT RESIDENT (GREEN CARD HOLDER)
PRIMARY CITIZENSHIP
PRIMARY PASSPORT NUMBER
EXPIRY DATE YYYY/MM/DD
PR CARD NUMBER
EXACT NAME ON PASSPORT
EXPIRY DATE YYYY/MM/DD
COUNTRY OF ISSUANCE
EXACT NAME ON PR CARD
SECONDARY CITIZENSHIP
EXACT NAME ON PASSPORT
SECONDARY PASSPORT NUMBER
CITIZENSHIP CERTIFICATE NUMBER
COUNTRY OF ISSUE
ISSUE DATE YYYY/MM/DD
EXPIRY DATE YYYY/MM/DD
BIRTH CERTIFICATE NUMBER
STATE / PROVINCE
COUNTRY OF ISSUE
EXACT NAME ON CERTIFICATE
VISA NUMBER
VISA TYPE
EXPIRY DATE YYYY/MM/DD
ISSUING COUNTRY
VISA REQUIREMENTS If you are not a citizen of the USA or Canada you may need a valid visa to enter the United States.
EXACT NAME ON CERTIFICATE
ALTERNATIVE DOCUMENTATION WHEN NO PASSPORT EXISTS
Citizenship Certificate Birth Certificate
Permanent Residence
You must give the EXACT details as they appear on your official documents. You may attach copies of your documents if you wish.
ADDRESS
STATE / PROVINCE
ZIP / POSTAL CODE
CITY
ADDRESS
YOUR CURRENT ADDRESS
CHECK IF THIS IS ALSO YOUR MAILING ADDRESS
WHEN DID YOU START USING THIS ADDRESS? FROM YYYY/MM
If you have lived at this address for 5 years or more, you do NOT have to fill out the address history
CHECK IF THIS IS THE SAME AS ADULT 1. YOU MAY LEAVE THIS SECTION BLANK IF IT IS THE SAME
MAILING ADDRESS IF DIFFERENT TO YOUR CURRENT ADDRESS
WHEN DID YOU START LIVING HERE FROM YYYY/MM
ADDRESS
STATE / PROVINCE
ZIP / POSTAL CODE
CITY
ADDRESS
CHECK IF THIS IS THE SAME AS ADULT 1. YOU MAY LEAVE THIS SECTION BLANK IF IT IS THE SAME
DRIVER LICENSE DETAILS
LICENSE NUMBER
COUNTRY OF DRIVERS LICENSE
STATE WHERE DRIVERS LICENSE WAS ISSUED
You must give the EXACT details as they appear on your drivers license
EXPIRY DATE
EXACT NAME ON LICENSE
CHECK IF THIS IS AN ENHANCED LICENSE?
CHECK IF THIS LICENSE HAS HAZARDOUS MATERIAL ENDORSEMENT
CHECK IF THIS IS A COMMERICAL DRIVERS LICENCE
Please answer the questions below about your drivers license
ADDRESS HISTORY FOR THE LAST 5 YEARS
FROM YYYY/MMPlease list every address you have had during the last 5 years. We cannot process your application if there are any gaps. Use supplementary sheets if necessary.
ADDRESS
STATE / PROVINCE
ZIP / POSTAL CODE
CITY
ADDRESS
FROM YYYY/MM TO YYYY/MM
ADDRESS
STATE / PROVINCE
ZIP / POSTAL CODE
CITY
ADDRESS
FROM YYYY/MM TO YYYY/MM
ADDRESS
STATE / PROVINCE
ZIP / POSTAL CODE
CITY
ADDRESS
FROM YYYY/MM TO YYYY/MM
ADDRESS
STATE / PROVINCE
ZIP / POSTAL CODE
CITY
ADDRESS
TO YYYY/MM
CHECK IF THIS IS THE SAME AS ADULT 1. YOU MAY LEAVE THIS SECTION BLANK IF IT IS THE SAME
INFORMATION ABOUT YOUR CURRENT WORKEMPLOYED UNEMPLOYEDSELF EMPLOYED CHILDRETIRED STUDENT
If you are a Student, Child, Unemployed or Retired you only have to check the box, you do not need to fill out any other details
FROM YYYY/MM
ADDRESS
ADDRESS
EMPLOYER
OCCUPATION
EMPLOYERS PHONE #
CITY
STATE / PROVINCE
ZIP / POSTAL CODE
EMPLOYMENT HISTORY FOR THE LAST 5 YEARSEMPLOYED UNEMPLOYEDSELF EMPLOYED CHILDRETIRED STUDENT
FROM YYYY/MM TO YYYY/MM
ADDRESS
STATE / PROVINCE
CITY
ADDRESS
EMPLOYER
OCCUPATION
EMPLOYERS PHONE #
ZIP / POSTAL CODE
If you are a Student, Child, Unemployed or Retired you only have to check the box, you do not need to fill out any other details. Use supplementary sheets if necessary.
EMPLOYED UNEMPLOYEDSELF EMPLOYED CHILDRETIRED STUDENT
TO YYYY/MMFROM YYYY/MM
ADDRESS
STATE / PROVINCE
CITY
ADDRESS
EMPLOYER
OCCUPATION
EMPLOYERS PHONE #
ZIP / POSTAL CODE
TRAVEL HISTORYList all of the countries visited in the last 5 years excluding Mexico, USA & Canada
CHECK IF THIS IS THE SAME AS ADULT 1. YOU MAY LEAVE THIS SECTION BLANK IF IT IS THE SAME
ADDITIONAL INFORMATION
Have you ever been convicted of a criminal offense in any country for which you have not received a pardon?
NO YES
NO YES
Have you ever received a waiver of inadmissibility to the USA from a US government agency?
Have you ever been found in violation of customs or immigration laws or other federal import laws?
NO YES
Have you ever been approved by Citizenship and Immigration Canada for rehabilitation because of past criminal activity?
NO YES
IF YOU HAVE ANSWERED YES TO ANY OF THE ABOVE QUESTIONS PLEASE GIVE EXACT DETAILS BELOW:
FEE PAYMENT
Your credit card details are required for the certification of your application with US Customs and Border Protection (CBP). The government fee for this is $50.
ALL CREDIT CARD INFORMATION IS DESTROYED ONCE GOVERNMENT FEES ARE PAID
CVV CODECREDIT CARD TYPE CREDIT CARD #
NAME ON CARD
EXPIRY DATE YY/MMThe CVV code is the 3 digit number printed on
the back of your credit card where you sign
your name. Amex CVV code is 4 digits on the
front of the card above the card number
CERTIFICATIONBy submitting this form, you certify that the information provided on this form was given voluntarily and is true and complete. You are also certifying that you understand that this information will be shared with law enforcement agencies, Customs and border protection. government immigration agencies and other government bodies with applicable laws.
CHECK IF THIS IS THE SAME AS ADULT 1. YOU MAY LEAVE THIS SECTION BLANK IF IT IS THE SAME
NEXUS CARD FAMILY APPLICATION CHILD 1
PERSONAL DATA
List an email address which will be checked regularly for status updates. It does not have to be your personal email.
LAST NAME
FIRST NAME
MIDDLE NAME GENDER
EYE COLOR
HEIGHT
OTHER NAME
OTHER NAME
CHECK IF THIS IS THE SAME AS ADULT 1 LEAVE THIS FIELD BLANK
DATE & PLACE OF BIRTH
DATE OF BIRTHYYYY/MM/DD
COUNTRY
CITY
STATE / PROVINCE
PARENT / GUARDIAN DETAILS FOR CHILD APPLICANTS (under 18 years of age)
PARENT / GUARDIAN NAME
THEIR DATE OR BIRTH YYYY/MM/DD
GENDER
NOTE 1: ALL DATA MUST BE WRITTEN EXACTLY AS IT APPEARS ON YOUR OFFICIAL DOCUMENTS (PASSPORT, DRIVERS LICENSE, VISA, RESIDENCE CARD, BIRTH CERTIFICATE ETC)
YOU MAY SUBMIT COPIES OF YOUR DOCUMENTS IF YOU WISHNOTE 2: WRITE CLEARLY AND LEGIBLY IN BLOCK CAPITALS OR TYPE YOUR DATA INTO THE FORM AND SAVE TO YOUR DESKTOP
CONTACT DETAILS If the child's contact details are different to that of the adults please use the ADULT application form downloadable here
CHECK IF THIS IS SAME AS PARENTS ADDRESS
CITIZENSHIP & NATIONALITY
CHECK IF YOU ARE A US LAWFUL PERMANENT RESIDENT (GREEN CARD HOLDER)
PRIMARY CITIZENSHIP
PRIMARY PASSPORT NUMBER
EXPIRY DATE YYYY/MM/DD
PR CARD NUMBER
EXACT NAME ON PASSPORT
EXPIRY DATE YYYY/MM/DD
COUNTRY OF ISSUANCE
EXACT NAME ON PR CARD
SECONDARY CITIZENSHIP
EXACT NAME ON PASSPORT
SECONDARY PASSPORT NUMBER
CITIZENSHIP CERTIFICATE NUMBER
COUNTRY OF ISSUE
ISSUE DATE YYYY/MM/DD
EXPIRY DATE YYYY/MM/DD
BIRTH CERTIFICATE NUMBER
STATE / PROVINCE
COUNTRY OF ISSUE
EXACT NAME ON CERTIFICATE
VISA NUMBER
VISA TYPE
EXPIRY DATE YYYY/MM/DD
ISSUING COUNTRY
VISA REQUIREMENTS If you are not a citizen of the USA or Canada you may need a valid visa to enter the United States.
EXACT NAME ON CERTIFICATE
ALTERNATIVE DOCUMENTATION WHEN NO PASSPORT EXISTS
Citizenship Certificate Birth Certificate
Permanent Residence
You must give the EXACT details as they appear on your official documents. You may attach copies of your documents if you wish.
CHILD'S CURRENT ADDRESS
CHECK IF THIS IS SAME AS PARENTS ADDRESS
If the address is different to that of the parents please use the ADULT application form downloadable here
MAILING ADDRESS IF DIFFERENT TO YOUR CURRENT ADDRESS CHECK IF THIS IS SAME AS PARENTS ADDRESS If the address is different to that of the parents please use
the ADULT application form downloadable here
ADDRESS HISTORY FOR THE LAST 5 YEARS
CHECK IF THIS IS SAME AS PARENTS ADDRESS If the address history is different to that of the parents please use the ADULT application form downloadable here
EMPLOYMENT INFORMATION Please use the ADULT application form downloadable here if your child is in paid employment with a bone fide employer
TRAVEL HISTORYList all of the countries visited in the last 5 years excluding Mexico, USA & Canada
CHECK IF THIS IS THE SAME AS ADULT 1. YOU MAY LEAVE THIS SECTION BLANK IF IT IS THE SAME
CRIMINAL INFORMATION
Please use the ADULT application form downloadable here if your child has any form of criminal misdemeanors or immigration violations
DRIVER LICENSE DETAILS
LICENSE NUMBER
COUNTRY OF DRIVERS LICENSE
STATE WHERE DRIVERS LICENSE WAS ISSUED
You must give the EXACT details as they appear on your drivers license
EXPIRY DATE
EXACT NAME ON LICENSE
CHECK IF THIS IS AN ENHANCED LICENSE?
CHECK IF THIS LICENSE HAS HAZARDOUS MATERIAL ENDORSEMENT
CHECK IF THIS IS A COMMERICAL DRIVERS LICENCE
Please answer the questions below about your drivers license
NEXUS CARD FAMILY APPLICATION CHILD 2
PERSONAL DATA
List an email address which will be checked regularly for status updates. It does not have to be your personal email.
LAST NAME
FIRST NAME
MIDDLE NAME GENDER
EYE COLOR
HEIGHT
OTHER NAME
OTHER NAME
CHECK IF THIS IS THE SAME AS ADULT 1 LEAVE THIS FIELD BLANK
DATE & PLACE OF BIRTH
DATE OF BIRTHYYYY/MM/DD
COUNTRY
CITY
STATE / PROVINCE
PARENT / GUARDIAN DETAILS FOR CHILD APPLICANTS (under 18 years of age)
PARENT / GUARDIAN NAME
THEIR DATE OR BIRTH YYYY/MM/DD
GENDER
CHECK IF THIS IS THE SAME AS CHILD 1 LEAVE THIS FIELD BLANK
NOTE 1: ALL DATA MUST BE WRITTEN EXACTLY AS IT APPEARS ON YOUR OFFICIAL DOCUMENTS (PASSPORT, DRIVERS LICENSE, VISA, RESIDENCE CARD, BIRTH CERTIFICATE ETC)
YOU MAY SUBMIT COPIES OF YOUR DOCUMENTS IF YOU WISHNOTE 2: WRITE CLEARLY AND LEGIBLY IN BLOCK CAPITALS OR TYPE YOUR DATA INTO THE FORM AND SAVE TO YOUR DESKTOP
CONTACT DETAILS If the child's contact details are different to that of the adults please use the ADULT application form downloadable here
CHECK IF THIS IS SAME AS PARENTS ADDRESS
CITIZENSHIP & NATIONALITY
CHECK IF YOU ARE A US LAWFUL PERMANENT RESIDENT (GREEN CARD HOLDER)
PRIMARY CITIZENSHIP
PRIMARY PASSPORT NUMBER
EXPIRY DATE YYYY/MM/DD
PR CARD NUMBER
EXACT NAME ON PASSPORT
EXPIRY DATE YYYY/MM/DD
COUNTRY OF ISSUANCE
EXACT NAME ON PR CARD
SECONDARY CITIZENSHIP
EXACT NAME ON PASSPORT
SECONDARY PASSPORT NUMBER
CITIZENSHIP CERTIFICATE NUMBER
COUNTRY OF ISSUE
ISSUE DATE YYYY/MM/DD
EXPIRY DATE YYYY/MM/DD
BIRTH CERTIFICATE NUMBER
STATE / PROVINCE
COUNTRY OF ISSUE
EXACT NAME ON CERTIFICATE
VISA NUMBER
VISA TYPE
EXPIRY DATE YYYY/MM/DD
ISSUING COUNTRY
VISA REQUIREMENTS If you are not a citizen of the USA or Canada you may need a valid visa to enter the United States.
EXACT NAME ON CERTIFICATE
ALTERNATIVE DOCUMENTATION WHEN NO PASSPORT EXISTS
Citizenship Certificate Birth Certificate
Permanent Residence
You must give the EXACT details as they appear on your official documents. You may attach copies of your documents if you wish.
CHILD'S CURRENT ADDRESS
CHECK IF THIS IS SAME AS PARENTS ADDRESS
If the address is different to that of the parents please use the ADULT application form downloadable here
MAILING ADDRESS IF DIFFERENT TO YOUR CURRENT ADDRESS CHECK IF THIS IS SAME AS PARENTS ADDRESS If the address is different to that of the parents please use
the ADULT application form downloadable here
ADDRESS HISTORY FOR THE LAST 5 YEARS
CHECK IF THIS IS SAME AS PARENTS ADDRESS If the address history is different to that of the parents please use the ADULT application form downloadable here
EMPLOYMENT INFORMATION Please use the ADULT application form downloadable here if your child is in paid employment with a bone fide employer
TRAVEL HISTORYList all of the countries visited in the last 5 years excluding Mexico, USA & Canada CHECK IF THIS IS THE SAME AS ADULT 1 LEAVE
THIS FIELD BLANK
CRIMINAL INFORMATION
Please use the ADULT application form downloadable here if your child has any form of criminal misdemeanors or immigration violations
DRIVER LICENSE DETAILS
LICENSE NUMBER
COUNTRY OF DRIVERS LICENSE
STATE WHERE DRIVERS LICENSE WAS ISSUED
You must give the EXACT details as they appear on your drivers license
EXPIRY DATE
EXACT NAME ON LICENSE
CHECK IF THIS IS AN ENHANCED LICENSE?
CHECK IF THIS LICENSE HAS HAZARDOUS MATERIAL ENDORSEMENT
CHECK IF THIS IS A COMMERICAL DRIVERS LICENCE
Please answer the questions below about your drivers license
NEXUS CARD FAMILY APPLICATION CHILD 3
PERSONAL DATA
List an email address which will be checked regularly for status updates. It does not have to be your personal email.
LAST NAME
FIRST NAME
MIDDLE NAME GENDER
EYE COLOR
HEIGHT
OTHER NAME
OTHER NAME
CHECK IF THIS IS THE SAME AS ADULT 1 LEAVE THIS FIELD BLANK
DATE & PLACE OF BIRTH
DATE OF BIRTHYYYY/MM/DD
COUNTRY
CITY
STATE / PROVINCE
PARENT / GUARDIAN DETAILS FOR CHILD APPLICANTS (under 18 years of age)
PARENT / GUARDIAN NAME
THEIR DATE OR BIRTH YYYY/MM/DD
GENDER
CHECK IF THIS IS THE SAME AS CHILD 1 LEAVE THIS FIELD BLANK
NOTE 1: ALL DATA MUST BE WRITTEN EXACTLY AS IT APPEARS ON YOUR OFFICIAL DOCUMENTS (PASSPORT, DRIVERS LICENSE, VISA, RESIDENCE CARD, BIRTH CERTIFICATE ETC)
YOU MAY SUBMIT COPIES OF YOUR DOCUMENTS IF YOU WISHNOTE 2: WRITE CLEARLY AND LEGIBLY IN BLOCK CAPITALS OR TYPE YOUR DATA INTO THE FORM AND SAVE TO YOUR DESKTOP
CONTACT DETAILS If the child's contact details are different to that of the adults please use the ADULT application form downloadable here
CHECK IF THIS IS SAME AS PARENTS ADDRESS
CITIZENSHIP & NATIONALITY
CHECK IF YOU ARE A US LAWFUL PERMANENT RESIDENT (GREEN CARD HOLDER)
PRIMARY CITIZENSHIP
PRIMARY PASSPORT NUMBER
EXPIRY DATE YYYY/MM/DD
PR CARD NUMBER
EXACT NAME ON PASSPORT
EXPIRY DATE YYYY/MM/DD
COUNTRY OF ISSUANCE
EXACT NAME ON PR CARD
SECONDARY CITIZENSHIP
EXACT NAME ON PASSPORT
SECONDARY PASSPORT NUMBER
CITIZENSHIP CERTIFICATE NUMBER
COUNTRY OF ISSUE
ISSUE DATE YYYY/MM/DD
EXPIRY DATE YYYY/MM/DD
BIRTH CERTIFICATE NUMBER
STATE / PROVINCE
COUNTRY OF ISSUE
EXACT NAME ON CERTIFICATE
VISA NUMBER
VISA TYPE
EXPIRY DATE YYYY/MM/DD
ISSUING COUNTRY
VISA REQUIREMENTS If you are not a citizen of the USA or Canada you may need a valid visa to enter the United States.
EXACT NAME ON CERTIFICATE
ALTERNATIVE DOCUMENTATION WHEN NO PASSPORT EXISTS
Citizenship Certificate Birth Certificate
Permanent Residence
You must give the EXACT details as they appear on your official documents. You may attach copies of your documents if you wish.
CHILD'S CURRENT ADDRESS
CHECK IF THIS IS SAME AS PARENTS ADDRESS
If the address is different to that of the parents please use the ADULT application form downloadable here
MAILING ADDRESS IF DIFFERENT TO YOUR CURRENT ADDRESS CHECK IF THIS IS SAME AS PARENTS ADDRESS If the address is different to that of the parents please use
the ADULT application form downloadable here
ADDRESS HISTORY FOR THE LAST 5 YEARS
CHECK IF THIS IS SAME AS PARENTS ADDRESS If the address history is different to that of the parents please use the ADULT application form downloadable here
EMPLOYMENT INFORMATION Please use the ADULT application form downloadable here if your child is in paid employment with a bone fide employer
TRAVEL HISTORYList all of the countries visited in the last 5 years excluding Mexico, USA & Canada
CHECK IF THIS IS THE SAME AS ADULT 1 LEAVE THIS FIELD BLANK
CRIMINAL INFORMATION
Please use the ADULT application form downloadable here if your child has any form of criminal misdemeanors or immigration violations
DRIVER LICENSE DETAILS
LICENSE NUMBER
COUNTRY OF DRIVERS LICENSE
STATE WHERE DRIVERS LICENSE WAS ISSUED
You must give the EXACT details as they appear on your drivers license
EXPIRY DATE
EXACT NAME ON LICENSE
CHECK IF THIS IS AN ENHANCED LICENSE?
CHECK IF THIS LICENSE HAS HAZARDOUS MATERIAL ENDORSEMENT
CHECK IF THIS IS A COMMERICAL DRIVERS LICENCE
Please answer the questions below about your drivers license
NEXUS CARD FAMILY APPLICATION CHILD 4
PERSONAL DATA
List an email address which will be checked regularly for status updates. It does not have to be your personal email.
LAST NAME
FIRST NAME
MIDDLE NAME GENDER
EYE COLOR
HEIGHT
OTHER NAME
OTHER NAME
CHECK IF THIS IS THE SAME AS ADULT 1 LEAVE THIS FIELD BLANK
DATE & PLACE OF BIRTH
DATE OF BIRTHYYYY/MM/DD
COUNTRY
CITY
STATE / PROVINCE
PARENT / GUARDIAN DETAILS FOR CHILD APPLICANTS (under 18 years of age)
PARENT / GUARDIAN NAME
THEIR DATE OR BIRTH YYYY/MM/DD
GENDER
CHECK IF THIS IS THE SAME AS CHILD 1 LEAVE THIS FIELD BLANK
NOTE 1: ALL DATA MUST BE WRITTEN EXACTLY AS IT APPEARS ON YOUR OFFICIAL DOCUMENTS (PASSPORT, DRIVERS LICENSE, VISA, RESIDENCE CARD, BIRTH CERTIFICATE ETC)
YOU MAY SUBMIT COPIES OF YOUR DOCUMENTS IF YOU WISHNOTE 2: WRITE CLEARLY AND LEGIBLY IN BLOCK CAPITALS OR TYPE YOUR DATA INTO THE FORM AND SAVE TO YOUR DESKTOP
CONTACT DETAILS If the child's contact details are different to that of the adults please use the ADULT application form downloadable here
CHECK IF THIS IS SAME AS PARENTS ADDRESS
CITIZENSHIP & NATIONALITY
CHECK IF YOU ARE A US LAWFUL PERMANENT RESIDENT (GREEN CARD HOLDER)
PRIMARY CITIZENSHIP
PRIMARY PASSPORT NUMBER
EXPIRY DATE YYYY/MM/DD
PR CARD NUMBER
EXACT NAME ON PASSPORT
EXPIRY DATE YYYY/MM/DD
COUNTRY OF ISSUANCE
EXACT NAME ON PR CARD
SECONDARY CITIZENSHIP
EXACT NAME ON PASSPORT
SECONDARY PASSPORT NUMBER
CITIZENSHIP CERTIFICATE NUMBER
COUNTRY OF ISSUE
ISSUE DATE YYYY/MM/DD
EXPIRY DATE YYYY/MM/DD
BIRTH CERTIFICATE NUMBER
STATE / PROVINCE
COUNTRY OF ISSUE
EXACT NAME ON CERTIFICATE
VISA NUMBER
VISA TYPE
EXPIRY DATE YYYY/MM/DD
ISSUING COUNTRY
VISA REQUIREMENTS If you are not a citizen of the USA or Canada you may need a valid visa to enter the United States.
EXACT NAME ON CERTIFICATE
ALTERNATIVE DOCUMENTATION WHEN NO PASSPORT EXISTS
Citizenship Certificate Birth Certificate
Permanent Residence
You must give the EXACT details as they appear on your official documents. You may attach copies of your documents if you wish.
CHILD'S CURRENT ADDRESS
CHECK IF THIS IS SAME AS PARENTS ADDRESS
If the address is different to that of the parents please use the ADULT application form downloadable here
MAILING ADDRESS IF DIFFERENT TO YOUR CURRENT ADDRESS CHECK IF THIS IS SAME AS PARENTS ADDRESS If the address is different to that of the parents please use
the ADULT application form downloadable here
ADDRESS HISTORY FOR THE LAST 5 YEARS
CHECK IF THIS IS SAME AS PARENTS ADDRESS If the address history is different to that of the parents please use the ADULT application form downloadable here
EMPLOYMENT INFORMATION Please use the ADULT application form downloadable here if your child is in paid employment with a bone fide employer
TRAVEL HISTORYList all of the countries visited in the last 5 years excluding Mexico, USA & Canada
CHECK IF THIS IS THE SAME AS ADULT 1 LEAVE THIS FIELD BLANK
CRIMINAL INFORMATION
Please use the ADULT application form downloadable here if your child has any form of criminal misdemeanors or immigration violations
Email your application package to us at: [email protected] OR fax toll free to 1-877-770-7096 Please note: We do not accept postal applications
DRIVER LICENSE DETAILS
LICENSE NUMBER
COUNTRY OF DRIVERS LICENSE
STATE WHERE DRIVERS LICENSE WAS ISSUED
You must give the EXACT details as they appear on your drivers license
EXPIRY DATE
EXACT NAME ON LICENSE
CHECK IF THIS IS AN ENHANCED LICENSE?
CHECK IF THIS LICENSE HAS HAZARDOUS MATERIAL ENDORSEMENT
CHECK IF THIS IS A COMMERICAL DRIVERS LICENCE
Please answer the questions below about your drivers license