Embed Size (px)
Citation preview
NEXUS RENEWAL APPLICATION
INSTRUCTION
Read the following instructions before you start:
1. Download and save the application form on your computer.
2. Complete one application form per person. Fill out all the information that applys for you. Do not leave anygaps ( incl. unemployemnt or student).
4. Choose TrustedTravel Service and pay the fee via:
5. Send your complete application pack using one of the following methods:
e-mail adress: [email protected]
fax: (202) 688-5140
3. Make clear copies of your identity and citizenship documents. ( driver licence, passport, PR card)
4. You will receive an email at your email address informing you if you are eligible for NEXUS. If your statusis “Approved” you can schedule your interview.
PayPal- $95.99G2S - $95.99
NOTE: We do not accept postal applications
WHAT HAPPENS NEXT?
1. TrustedTravel carefully check your application form, email you regarding any omissions and submit yourinformation to the US & Canadian Border Authorities.
2. TrustedTravel pay the $50 government fee using the credit card provided by you.
5. You attend an interview, where your original documentation is checked and biometric data is collected.The interviewing officer informs you if you are admitted to the NEXUS program.
6. You will receive your NEXUS card by mail from CBP headquarters.
3. TrustedTravel send you access details for your profile on the Trusted Traveler database.
Signature
NOTE: We cannot use your credit card to pay for the TrustedTravel service fee.
TERMS OF USE
Check this box to agree to TrustedTravel terms & conditions
TrustedTravel is not a government agency and cannot influence the outcome of your NEXUS application.
Transaction e-mail
2. TrustedTravel is not responsible for applicants who are denied from the program for any reason
3. TrustedTravel does not give refunds for applications submitted in error.
4. TrustedTravel has the right to contact applicants for additional information
1. TrustedTravel is not responsible for any delays in the submission caused by incomplete information.
By submitting the application pack and paying the service fee, each applicant agrees to the terms and conditions
Read our website Terms & Conditions before submitting your application and paying our fees
5. TrustedTravel has the right to change the terms and conditions without any notice.
Email: [email protected]; Fax: (202) 688-5140
FEMALEMALE
PERSONAL INFORMATION
HEIGHT
D.O.B (YY/MM/DD)
MIDDLE NAMESURNAME
EYE COLOR
FIRST NAME
CITY OF BIRTH
BIRTH COUNTRY BIRTH STATE
OTHER NAME (first/ middle)
OTHER NAME (last/ middle)
CITIZENSHIP & NATIONALITY
US CITIZEN PERMANENT RESIDENTCANADIAN CITIZEN MEXICAN CITIZEN OTHER
ATTACH CLEAR SCANNED COPIES OF YOUR DOCUMENTSTO YOUR APPLICATION
PR CARD #
PASSPORT #
VISA #
EXPIRY
NAME ON PASSPORT / PR CARD
TYPE
(YY/MM/DD)
EXPIRY(YY/MM/DD)
EXPIRY(YY/MM/DD)
EXPIRY(YY/MM/DD)
COUNTRY
COUNTRY
COUNTRY
CONTACT DETAILS
HOME PHONE OR CELL #
EMAIL ADDRESS
List a contact information that will be cheched regularly for status updates. List ONLY 1 email.
DRIVERS LICENCE INFORMATION
NAME ON LICENCE
DRIVERS LICENCE NUMBER
Email: [email protected]; Fax: (202) 688-5140
MAKE
VEHICLE INFORMATION
MODEL YEAR
VIN NUMBER LICENCE PLATE
STATE WHERE LICENCE PLATE WAS ISSUED OWNER
OWNER ADDRESS
OWNER PHONE OWNER D.O.B
GOES ID PASSWORD EXPIRY DATE
NEXUS Renewal APPLICATION
ADDRESS HISTORY FOR THE LAST FIVE YEARS
Email: [email protected]; Fax: (202) 688-5140
Address
Address
City State Zip Code
Is this your mailing address?
FROM (YYYY/MM)
Address
Address
City State Zip Code FROM (YYYY/MM)
Address
Address
CityState Zip Code
CURRENT ADDRESS
MAILING ADDRESS IF DIFFERENT TO YOUR CURRENT ADDRESS
ADDRESS HISTORY FOR THE LAST 5 YEARS
TO FROM (YYYY/MM) (YYYY/MM)
Address
Address
CityState Zip Code
TO FROM (YYYY/MM) (YYYY/MM)
Address
Address
CityState Zip Code
TO FROM (YYYY/MM) (YYYY/MM)
Address
Address
CityState Zip Code
TO FROM (YYYY/MM) (YYYY/MM)
NEXUS Renewal APPLICATION
Email: [email protected]; Fax: (202) 688-5140
EMPLOYEMENT HISTORY FOR THE LAST FIVE YEARS
CURRENT EMPLOYEMENT STATUS
EMPLOYED UNEMPLOYEDSELF EMPLOYED CHILDRETIRED STUDENT
PHONE#
JOB TITLE:
Employer
Address
City State Zip Code
TO FROM (YYYY/MM) (YYYY/MM)
IF YOU ARE A STUDENT,CHILD, UNEMPLOYED OR RETIRED PLEASE CHECK THE RELEVANT BOX. YOU DO NOT HAVE TO FILL OUT MORE DETAILS OTHER THAN THE FROM AND TO DATES.
EMPLOYMENT HISTORY FOR THE LAST 5 YEARS
EMPLOYED UNEMPLOYEDSELF EMPLOYED CHILDRETIRED STUDENT
PHONE#
JOB TITLE:Employer
Address City State
TO FROM (YYYY/MM) (YYYY/MM)
EMPLOYED UNEMPLOYEDSELF EMPLOYED CHILDRETIRED STUDENT
PHONE#
JOB TITLE:Employer
Address City State
TO FROM (YYYY/MM) (YYYY/MM)
EMPLOYED UNEMPLOYEDSELF EMPLOYED CHILDRETIRED STUDENT
PHONE#
JOB TITLE:Employer
Address City State
TO FROM (YYYY/MM) (YYYY/MM)
EMPLOYED UNEMPLOYEDSELF EMPLOYED CHILDRETIRED STUDENT
PHONE#
JOB TITLE:Employer
Address City State
TO FROM (YYYY/MM) (YYYY/MM)
NEXUS Renewal APPLICATION
PHONE #
City State Zip CodeAddress
U.S. CONTACT:
FULL NAME:
AS OF DATE yyyy/mm:
MEXICAN CITIZENS MUST PROVIDE ALSO:
PARENT / GUARDIAN DETAILS FOR CHILD APPLICANTS (under 18 years of age)
Parent or Guardian Name
Address
City State Zip Code
Phone #
Date of Birth (yyyy/mm/dd)
Relationship to the applicant
Email: [email protected]; Fax: (202) 688-5140
TRAVEL HISTORY FOR THE LAST FIVE YEARS
List the countries you have traveled to; other than the United States, Canada, and Mexico within the past 5 years
ADDITIONAL INFORMATION
Have you ever been convicted of an criminal offense in the U.S. or any other country?
NO YES
NO YES
NO YES
NO YES
Have you ever received a waiver of inadmissibility to the U.S from a U.S government agency?
Have you ever been approved for rehabilitation because of past criminal activity/violation?
Have you ever been found in violation of customs or immigration laws ?
NEXUS Renewal APPLICATION
FEE PAYMENT
Your credit card details are required for the certification of your application with US Customs and Border Protection (CBP).
The government Fee is USD $50. TrustedTravel Service fee is payable via G2S or PayPal.
ALL CREDIT CARD INFORMATION IS DESTROYED ONCE GOVERNMENT FEES ARE PAID
EXPIRY
CVV CODE IS THE 3/4 DIGIT NUMBER PRINTED ON THE BACK OF YOUR CREDIT/DEBIT CARD
CVV CODECREDIT CARD #
NAME ON CARD
CERTIFICATION
I certify that all information given by me on this application form was provided voluntarily and is true and complete. I understand that all the information on this application, including the supporting documentation, background information and biometric data will be shared among customs and immigration authorities in both Canada and the US, and among law enforcement and other government agencies with applicable laws. I certify that I have read, understood and agree to all terms and conditions required for use of the NEXUS program, including all instructions and notices.
Signature PRINT NAME DATE
NOTE!WRITE CLEARLY AND LEGIBLY. WE CANNOT PROCESS YOUR APPLICATION IF WE DO NOT HAVE A FULL FIVE YEARS ADDRESS AND WORK HISTORY.
Your application MUST signed terms & conditions, which makes up the first and last pagesof the NEXUS application form .
Check Box to confirm that you have paid TrustedTravel Service fees via G2S
Check this box to agree to TrustedTravel terms & conditions
By submitting the application pack and paying the service fee, each applicant agrees to the terms and conditions
Email: [email protected]; Fax: (202) 688-5140
NEXUS Renewal APPLICATION
or PayPal
![RAK Customs · Customs Exit] Entry Certificate. Customs Exit/ Entry Certificate issuance. New company /lssue of trade license for clearing, shipping and forwarding companies. Renewal](https://img.pdfslide.net/doc/110x75/5fceef4193732f2ac2563fb9/rak-customs-customs-exit-entry-certificate-customs-exit-entry-certificate-issuance.jpg)
