ORDER FORM INSTRUCTIONS SENTRI PACKAGE …

1 * Initial review of your application entailsbackground checks by the US authorities* Once you have been conditionally approved, you canschedule an interview; you must schedule this interviewwithin 30 days of approval* Once you attend your interview and have been approved,your card will be mailed to you at the address you provide* Sending incomplete applications will delay processingCONSENT & DISCLAIMERThe applicant agrees to all of the following conditions:* SENTRI Pass is not responsible for applications sent by mail or improperly submitted by email or fax* SENTRI Pass is not responsible for applications that are denied* SENTRI Pass is not responsible for delays caused by incomplete applications* The service fee is non-refundable once applications are submitted to the government* Government fees are non-refundable in all cases* I assert that I understand I am using SENTRI Pass to apply for my SENTRI card * I agree the government fee to be charged to the credit card PASS APPLICATION * I assert that I have read and agreed to the terms and conditions SENTRI PASS APPLICATION SERVICEAVERAGE

2 PROCESSING TIME*8-10 WEEKS* Timeline refers to initial review by the government. Additional delays are possible if the government does additional $25 government fees on submission of the applicationORDER FORMUSD $ Service Fee * SENTRI PACKAGE CHECKLIST1. Please complete one (1) SENTRI application form per person. Complete the address and employment fields for the last five (5) years in full, leaving NO gaps. 3. Make clear copies of your valid citizenship and identity documents ( passport, birth / citizenship certificate, PR card, work / study permit, driver's license, etc.)4. Complete this ORDER form in full, ensuring you have included all requirements on the ' SENTRI Pass Checklist'.

3 5. Send your entire completed PACKAGE using one of the following methods:FAXthe entire application PACKAGE to (800) 544 8311 ORSCAN AND EMAIL your entire application PACKAGE to with the subject line: (Name of Applicant) SENTRI Application Include the following documents in your SENTRI packageAPPLICATIONS SUBMITTED WITHOUT THISORDER form WILL NOT BE PROCESSEDRead all INSTRUCTIONS and follow carefullyINSTRUCTIONSSENTRI APPLICATION form completed and signed- all forms must be included, even if blankSENTRI APPLICTION ORDER form (this page)- applications submitted without this form will notbe processedCOPY OF VALID CITIZENSHIP DOCUMENT- passport, citizenship certificate, birth certificate, OF VALID ADMISSIBILITY DOCUMENT- passport, PR card, work/study permit, OF VALID DRIVERS LICENSE- if applicableCOPY OF FRONT AND BACK OF EXPIRING SENTRICARD- renewals onlySENTRI Pass Fax: (800) 544 - 8311 Email.

4 Pay the service fee by clicking on the payment button on the website - your application will not be processed without this paymentADDITIONAL INFORMATION* Child applicants are free providing their application is sent in with a paid for adult applicationSign /Type to assert: I understand the terms & conditions of serviceUSD $80 US government system costsUSD $ fingerprint costsUSD $42 for additional vehiclesFees payable at the SENTRI interviewPAYMENT INFORMATIONPayPal Email AddressPlease read the following to ensure your application and payment are submitted correctly*The PayPal fee covers the cost of thorough application checks and processing. There is a further fee of $25 to cover background and security checks.

5 This fee is payable with your credit card - you will be asked for these details at the end of the application form * You may use your PayPal account to pay for applications of other people* If you do not have a PayPal account you may ask another person to pay using their PayPal account - you must have permission from the account holder* Open a PayPal account at the PayPal websiteWe need a PayPal account email address to match your payment to your application. We cannot process any applications without receiving the PayPal paymentSENTRI PASS APPLICATION Reason for application:Surname (current):First name:Middle name:Nickname:Eye :MaleFemaleFull name at birth:Other previous names (marriages, legal name changes, etc.)

6 :Date of birth (YYYY/MM/DD):Place of birthCityCountryFirst time applicantRenewal - Please provide your membership ID:Reconfirmation requiredCitizenship Information Are you a US citizen?Are you a permanent resident of the US?YesNoYesNoIf you are not a US citizen, please specify your citizenship:The following information is required if you have any of the documents below:PassportPassport (2)Citizenship documentBirth CertificateDocument numberCountry of IssuanceName as it appears on the document Expiry date (yyyy/mm/dd)Document numberCountry of IssuanceName as it appears on the document Expiry date (yyyy/mm/dd)Document numberCountry of IssuanceName as it appears on the documentDocument numberCountry of IssuanceName as it appears on the documentType of document.

7 Your contact informationHome phoneCell PhoneWork phoneEmailState/ ProvinceState/Province of Issuance Date Issued (yyyy/mm/dd)Membership ID (PASSID)If applicable, please provide your visa or a work permit detailsVisaDocument numberCountry of IssuanceName as it appears on the document Expiry date (yyyy/mm/dd)Work permitVisaDocument numberCountry of IssuanceName as it appears on the document Expiry date (yyyy/mm/dd)Work permitDo you have a valid driver's license?YesNo Driver's license numberCountry of issuanceName as it appears on the document Expiry date (yyyy/mm/dd)Province/ StateIs this an enhanced security driver's license?YesNo(An enhanced driver s license (EDL) is a driver s license that has been enhanced to denote both identity and citizenship.)

8 An EDL will include a flag icon identifying the license-holder s citizenship)Is this a a commercial driver's license?YesNoIs there a HAZMAT (hazardous material) endorsement on the CDL?YesNoPlease provide the last 5 years of your residential history leaving no gapsPermanent resident status document (for applicants who are not citizens of Canada or the US)Document numberCountry of IssuanceName as it appears on the document Expiry date (yyyy/mm/dd)Permanent resident cardFrom (YYYY/MM)To presentStreet numberStreet nameApt. numberCityProvince/StateCountryPostal/Zi p codeIs your mailing address same as your Residential address?NoYesIf not, please provide your current mailing address below:From (YYYY/MM)To presentStreet numberStreet nameApt.

9 NumberCityProvince/StateCountryPostal/Zi p codeFrom (YYYY/MM)Street numberStreet nameApt. numberCityProvince/StateCountryPostal/Zi p codePrevious address (if applicable):To (YYYY/MM)PO Box NumberPO Box NumberCurrent residential address:From (YYYY/MM)Street numberStreet nameApt. numberCityProvince/StateCountryPostal/Zi p codePrevious address (if applicable):To (YYYY/MM)From (YYYY/MM)Street numberStreet nameApt. numberCityProvince/StateCountryPostal/Zi p codePrevious address (if applicable):To (YYYY/MM)Please provide the last 5 years of your employment history leaving no gaps. Please specify the periods you were unemployed or a presentFrom (YYYY/MM)Current Employer's name:Postal/Zip codeCountryProvince/StateCityApt.

10 NumberStreet nameStreet numberEmployer's telephoneFrom (YYYY/MM)Employer's name:Postal/Zip codeCountryProvince/StateCityApt. numberStreet nameStreet numberEmployer's telephoneTo (YYYY/MM)Previous employment (if applicable)From (YYYY/MM)Employer's name:Postal/Zip codeCountryProvince/StateCityApt. numberStreet nameStreet numberEmployer's telephoneTo (YYYY/MM)Previous employment (if applicable)OccupationOccupationOccupatio nCurrent employment:Additional information:Have you ever been convicted of an offence in any country for which you have not received a pardon? _____YesNoHave you ever received a waiver of inadmissibility to the from a government agency? _____YesNoHave you ever been approved by Citizenship and Immigration Canada for rehabilitation because of past criminal activity?