Parole Board
of Canada
Commission des
libérations conditionnelles
du Canada
Parole Board of Canada
Record Suspension
Application Guide
Step-by-step instructions
and application forms
DO YOU NEED HELP TO APPLY?
Contact the Parole Board of Canada at:
Toll-free Info Line: 1-800-874-2652
suspension@pbc-clcc.gc.ca
Canada.ca/record-suspensions
Did You Know?
The Parole Board of Canada is the ofcial and only federal agency responsible for making
record suspension decisions under the Criminal Records Act. Under this act, the
Parole Board of Canada can order, refuse to order, and revoke a record suspension.
You can apply directly for a record suspension (or pardon*) to the Parole Board of Canada.
You do not need a lawyer or representative to apply.
All you need to do is follow the step-by-step instructions in this guide
and pay the Application Processing Fee of $50.00 (CDN).
Please note that you are also responsible for any additional fees required
as part of your application, such as ngerprints, copies of your criminal record,
court documents and police checks.
IMPORTANT!
❯You must answer all questions truthfully and completely. Hiding information or making false
statements could cause your application to be returned to you or your record suspension to
be revoked or ceased at a later date.
❯A record suspension does not erase the fact that you were convicted of a crime, but keeps the record
separate and apart from other records. A new conviction or other evidence establishing
to the satisfaction of the Parole Board of Canada you are no longer of good conduct may lead to the
reactivation of your criminal record.
❯You do not need a record suspension to obtain a passport. A record suspension does not guarantee
you entry or visa privileges to another country. Before you go, contact the authorities of any country
you wish to visit to nd out what you need to do to enter that country.
❯The Parole Board of Canada does not give preferential treatment to any application. All applications
are treated the same.
* Your application will be processed using the Criminal Records Act eligibility criteria in place at the time of the rst offence. Consult page 2 of this guide to
see which eligibility criteria apply to you.
1
Record Suspension Application Guide
Parole Board of Canada (PBC)
1-800-874-2652 (Toll-free) Canada.ca/record-suspensions
Do you need to apply for
a record suspension?
You MAY apply for a record suspension if you:
❯ were convicted of an offence in Canada under a federal act or regulation of Canada as an adult; and/or
❯ were convicted of a crime in another country and were transferred to Canada under the Transfer
of Offenders Act or the International Transfer of Offenders Act.
You DO NOT need to apply for a record suspension if you:
❯ have only received an absolute or conditional discharge*; or
❯ were only convicted in a youth court or youth justice court**.
* For more information, contact the Royal Canadian Mounted Police Pardon & Purge Services.
** Your record(s) will be destroyed or archived once all applicable time periods have elapsed under the
Young Offenders Act or the Youth Criminal Justice Act.
You MAY NOT be eligible for a record suspension if your rst offence was committed on or after
March 13, 2012 and you:
❯ have been convicted to a prison term of 2 years or more for more than three indictable offences; or
❯ were convicted of an offence found in Schedule I of the Criminal Records Act and do not meet
the exception criteria (consult Step 6 of this guide).
IMPORTANT!
❯ A record suspension will have no effect on your driving or weapons prohibition orders.
❯ The Parole Board of Canada has no jurisdiction over youth offences recorded before 1996 that
are not listed on your criminal record, even if you were subsequently convicted as an adult. You
must contact the court and police agency directly and request them to put those records aside.
2
Parole Board of Canada (PBC) 1-800-874-2652 (Toll-free) Canada.ca/record-suspensions
Record Suspension Application Guide
Are you eligible to apply for a record suspension?
IMPORTANT!
❯ If you were convicted of simple possession of cannabis, please consult the Special Instructions
found on the next page.
1. Check that you have completed all of your sentences, which includes:
❯ all nes, surcharges
1
, costs, restitution and compensation orders
2
;
❯ all sentences of imprisonment, conditional sentences, including parole and statutory release; and
❯ any probation order(s).
Important: Your weapons or driving prohibition order do not need to be expired before the waiting period begins.
2. Check that you have completed the appropriate waiting period by referring to the table below.
In order to do so:
❯ identify when you have committed your rst offence (not the date of sentencing); and
❯ identify if you were convicted of a summary or indictable conviction.
Tip: You may contact the court to obtain this information.
Important:
❯ If the court cannot conrm the method of trial, the longest waiting period will apply.
❯ The waiting period starts after you have completed all of your sentences.
Your rst offence was
committed before or on
June 28, 2010:
Your rst offence was
committed between
June 29, 2010 and March 12, 2012:
Your rst offence was
committed on or after
March 13, 2012:
Pardon Pardon Record Suspension
Summary offences: 3 years Summary offences: 3 years Summary offences: 5 years
Indictable offences: 5 years Indictable offences: 5 years Indictable offences: 10 years
10 years for serious personal injury
offences
3
for which you were sentenced
to a prison term of 2 years or more or
an indictable offence found in
Schedule I of the Criminal Records Act.
1
Victim surcharges imposed under section 737 of the Criminal Code on or after October 24, 2013 and on or before December 13, 2018 will not be considered in
determining eligibility for a record suspension.
2
If you were ordered to pay restitution to an individual or entity, courts may not be able to conrm payment (if this is the case, call the Parole Board of Canada
at 1-800-874-2652).
3
As per section 752 of the Criminal Code.
3
Record Suspension Application Guide
Parole Board of Canada (PBC)
1-800-874-2652 (Toll-free) Canada.ca/record-suspensions
Special instructions if you were
convicted of simple possession of
cannabis and other offences
❯ A simple possession of cannabis conviction will not be included in your waiting period calculation
and will not be considered by Board members in their assessment.
❯ You are eligible to apply even if you have not paid the ne or victim surcharge that was imposed for the
simple possession of cannabis conviction only. Any unpaid nes will not be forgiven and provincial and
federal governments may choose to enforce their payment later, even if you receive a record suspension.
❯ You must have completed all other parts of the sentence (i.e., imprisonment and probation,
restitution and compensation orders) for both simple possession of cannabis and any other offences.
You must clearly demonstrate to the Parole Board of Canada that you were convicted of simple possession
of cannabis by obtaining ofcial documentation from the court that heard your case and/or the police service
that has jurisdiction in the location where you were arrested.
It must be clear that any unpaid ne is for the simple possession of cannabis conviction only. If the ne
or surcharge
1
was imposed for multiple offences on the same day, it must be paid in full as a condition
of eligibility and the applicable waiting period applies.
You must review the ofcial documentation you have obtained carefully to determine if it clearly demonstrates
that the substance was cannabis.
If you are unable to demonstrate to the Parole Board of Canada that the substance was cannabis, you
must complete the entire sentence, including payment of nes and victim surcharges before applying.
The conviction will also be included in your waiting period calculation.
Please note that you have to complete Step 1 to Step 9 of the Record Suspension Application Guide
if you were convicted of simple possession of cannabis and any other offence.
IMPORTANT!
❯ If you were only convicted of simple possession of cannabis, please use the Cannabis Record
Suspension Guide found at Canada.ca/record-suspensions.
❯ If you were convicted of simple possession of cannabis AND another offence(s), please use this
guide and carefully read the following special instructions.
1
Victim surcharges imposed under section 737 of the Criminal Code on or after October 24, 2013 and on or before December 13, 2018 will not be
considered in determining eligibility for a record suspension.
4
Parole Board of Canada (PBC) 1-800-874-2652 (Toll-free) Canada.ca/record-suspensions
Record Suspension Application Guide
STEP
2
STEP
3
STEP
4
STEP
7
STEP
6
STEP
5
STEP
8
STEP
9
Steps to apply for a record suspension
If you are eligible, have completed all of your sentences, and it is past the waiting period, you can now
apply for a record suspension (see pages 1 and 2). Here are the steps to follow and the pages where you
can nd instructions on how to do each step:
Get your criminal record (convictions, conditional and absolute
discharges form) from the Royal Canadian Mounted Police or your
Proof of Conviction documents, if required.
Get your court information
using the Court Information Form.
Get your Military Conduct Sheet
(if you are a current and former member of the Canadian Forces).
Get your local police records check(s)
using the Local Police Records Check Form.
Fill in the Record Suspension Application Form.
Fill in the Schedule 1 Exception Form
(if applicable).
Provide a photocopy of your document to support your identication.
Fill in the Measurable Benet/Sustained Rehabilitation Form
(if applicable).
Provide the payment of the Application Processing Fee.
Page 5
Page 6
Page 7
Page 8
Page 10
Page 9
Page 9
Page 11
Page 11
STEP
1
5
Record Suspension Application Guide
Parole Board of Canada (PBC)
1-800-874-2652 (Toll-free) Canada.ca/record-suspensions
Get your criminal record
STEP
1
If you have convictions outside of Canada, you MUST also submit information
to the Parole Board of Canada on these convictions, along with your criminal record.
When you receive your criminal record, check it to ensure all of your convictions are included.
It is your responsibility to report all of your convictions to the Parole Board of Canada.
Get your ngerprints taken. Visit an accredited ngerprinting company or a police service that can submit
your ngerprints electronically.
Ask your local police service if they offer this service or visit
www.rcmp-grc.gc.ca/en/where-do-get-a-criminal-record-check for more information.
Your electronicngerprint submission must clearly state you are applying for a record suspension.
Wait to receive your criminal record (criminal convictions, conditional and absolute discharges)
or a Certication of No Criminal Record from the Royal Canadian Mounted Police. Any documents
provided by the Royal Canadian Mounted Police must be included with your application.
If ALL your convictions are
included, go to Step 2
(next page).
If any of your conviction(s)
is/are missing, see below.
If any of your convictions are missing from your criminal record, you must
get a Proof of Conviction for each one. To get this, contact the court that heard your case
and/or the police service that arrested you.
The Proof of Conviction must include:
❯ Date and court where you were sentenced;
❯ Offence that resulted in your conviction;
❯ Sentence you received; and
❯ Arresting police force.
If the court and/or police service do not have a record of your convictions, call the Parole Board
of Canada’s toll-free info line: 1-800-874-2652.
6
Parole Board of Canada (PBC) 1-800-874-2652 (Toll-free) Canada.ca/record-suspensions
Record Suspension Application Guide
¼You must get court information for each of your convictions. This MUST include proof and date of
last payment for any nes, victim surcharges*, restitution, and compensation**.
Get your court information
STEP
2
Answer questions 1 to 6 on the Court Information Form at the end of this guide.
Tip: Make copies of the form in case you need to provide the same information to another court.
Contact the court that heard your case
If you were sentenced in more than one court, you must ask each of them to complete the form.
Give each court a copy of your criminal record and ask them to ll in the section For Court Use Only.
IMPORTANT!
Make sure each court:
❯ Fills in all of the For Court Use Only section of the form;
❯ Includes proof and date of last payment for any nes, victim surcharges*, restitution, and compensation**;
❯ Includes the method of trial for each conviction (either summary, indictable or unknown);
❯ Includes all of your convictions from that court;
❯ Signs and dates the form; and
❯ Includes an ofcial court seal or stamp on the form.
Tip: Ask for extra copies of all court documents. You may need them in the future. It will be easier
to get copies now as they may not be available if your record suspension is ordered.
Check that the information on the Court Information Form is the same as your criminal record.
❯ If the information on the Court Information Form and criminal record do not match, or if the court has a
record of conviction that is not on your criminal record, you must ask the court for a Proof of Conviction
(consult Step 1).
*
Victim surcharges imposed under section 737 of the Criminal Code on or after October 24, 2013 and on or before December 13, 2018 will not be considered
in determining eligibility for a record suspension.
**
If you were ordered to pay restitution to an individual or entity, courts may not be able to conrm payment (if this is the case, call the Parole Board of Canada
at 1-800-874-2652).
7
Record Suspension Application Guide
Parole Board of Canada (PBC)
1-800-874-2652 (Toll-free) Canada.ca/record-suspensions
¼IF YOU ARE NOT a current or past member of the Canadian Forces, go to Step 4 on the next page.
¼IF YOU ARE a current or past member of the Canadian Forces (Regular or Reserve), you must get a
certied, signed and dated copy of your Military Conduct Sheet by contacting the appropriate organization
below. If no conduct sheet exists, you must provide a letter from your Commanding Ofcer or the
appropriate organization, which indicates that no information is available.
IMPORTANT!
❯
Include all correspondence from your Commanding Ofcer, National Defence or Library and Archives Canada with your application.
❯ Make sure that your request for your Military Conduct Sheet includes the following information:
✓ Shows that the reason for the request is for a Record Suspension Application;
✓ Your rst and last name (if it has since changed, it must state your name at the time);
✓ Your date of birth;
✓ Your Military Identication Number or Service Number;
✓ Your signature; and
✓ Enlistment and discharge dates.
FOR FORMER REGULAR MEMBERS:
❯ If you left on or after January 1, 1998, contact the
Department of National Defence Access to Information
and Privacy (ATIP) Section under the Privacy Act:
Director, Access to Information and Privacy
National Defence Headquarters
Major-General George R. Pearkes Bldg.
101 Colonel By Drive
Ottawa, Ontario K1A 0K2
www.canada.ca/content/dam/dnd-mdn/migration/asset s/
FORCES_Internet/docs/en/transparency/d2797-em-1-.pdf
❯ If youleft before January 1, 1998, contact the Library and
Archives Canada ATIP Section:
Access to Information, Privacy and
Personnel Records Coordinator
Library and Archives Canada
395 Wellington Street
Ottawa, Ontario K1A 0N4
www.bac-lac.gc.ca/eng/transparency/atippr/Pages/
Online-requests-forms.aspx
FOR FORMER RESERVE MEMBERS:
❯ If you left on or after March 1, 2008, contact the
Department of National Defence Access to Information
and Privacy (ATIP) Section under the Privacy Act:
Director, Access to Information and Privacy
National Defence Headquarters
Major-General George R. Pearkes Bldg.
101 Colonel By Drive
Ottawa, Ontario K1A 0K2
www.canada.ca/content/dam/dnd-mdn/migration/assets/
FORCES_Internet/docs/en/transparency/d2797-em-1-.pdf
❯ If youleft before March 1, 2008, contact the Library and
Archives Canada ATIP Section:
Access to Information, Privacy and
Personnel Records Coordinator
Library and Archives Canada
395 Wellington Street
Ottawa, Ontario K1A 0N4
www.bac-lac.gc.ca/eng/transparency/atippr/Pages/
Online-requests-forms.aspx
STEP
3
Get your Military Conduct Sheet
(current and former members of the Canadian Forces only)
FOR CURRENT REGULAR OR RESERVE MEMBERS:
You must request a Military Conduct Sheet from your Commanding Ofcer.
8
Parole Board of Canada (PBC) 1-800-874-2652 (Toll-free) Canada.ca/record-suspensions
Record Suspension Application Guide
¼You must get a local police records check for:
❯ The city or town where you live now (your current address); AND
❯ Each city or town where you lived during the last 5 years (if you lived in that place for 3 months
or more).
Important: Each local police records check is only valid for 12 months from the date it was issued.
How to get a local police records check
Fill in all questions on page 1 of the Local Police Records Check Form at the end of this guide.
Tip: Photocopy it for each local police service you contact.
Get your local police records check(s)
STEP
4
Contact the local police service for the address where you live now. If you have lived in different places
during the last 5 years, you must contact the police service for each place. If you are not sure who to
contact, ask your local police service.
If you lived outside of Canada you still need to contact the local police service where you lived. If the
police service outside Canada will not give you a local police records check, a signed letter from the
police service stating that you have been law-abiding will be accepted. If it is in a foreign language,
you must have it translated into English or French and submit both the original and the translated
version with your application form.
Show your criminal record to each local police service and ask them to ll in the section
on the Local Police Records Check Form called For Police Use Only (page 2).
You will need to show them a current photo ID and a second piece of ID.
Tip: Contact the local police service in advance to nd out the types of ID they accept.
IMPORTANT!
The Parole Board of Canada will return your application if your Local Police Records Check Form does not
include the following information:
❯ All information required in the For Police Use Only section on page 2;
❯ Signature and date stamp of the local police service; and
❯ Local police service ofcial seal or stamp.
9
Record Suspension Application Guide
Parole Board of Canada (PBC)
1-800-874-2652 (Toll-free) Canada.ca/record-suspensions
You need to provide a clear photocopy of a document which supports your identity with your application.
This valid government issued (Federal, Provincial or Municipal) document must include your name, date of
birth and signature.
Get a copy of your document
to support your identity
STEP
5
Complete the Schedule 1
Exception Form
STEP
6
¼Please note that this step is only required if:
❯ You have a conviction for a Schedule 1 offence and your rst offence was
committed on or after March 13, 2012 (see page 1); or
❯ Your Schedule 1 offence was committed on or after March 13, 2012.
Under Section 4(2) of the Criminal Records Act, a person is ineligible to apply for a record suspension
if he or she has been convicted of an offence referred to in Schedule 1 (sexual offence involving a child)
of the Act with certain exceptions. For more information, refer to www.laws-lois.justice.gc.ca.
¼ If you have NOT been convicted of a Schedule 1 offence under the Criminal Records Act,
skip to Step 7.
¼ If you HAVE been convicted of a Schedule 1 offence, you MUST complete the Exception
Form. Under Section 4(3) of the Criminal Records Act, a person who has been convicted of an
offence referred to in Schedule 1 may apply for a record suspension IF the Parole Board of Canada
is satised that the convicted person:
❯ was not in a position of trust or authority towards the victim of the offence and the victim
was not in a relationship of dependency with him or her;
❯ did not use, threaten to use or attempt to use violence, intimidation or coercion in relation
to the victim; and
❯ was less than ve years older than the victim.
IMPORTANT!
Fill in ALL sections of the Exception Form. If the form is incomplete, the Parole Board of Canada will
return your application to you. If you do not have enough room to include all the requested information,
attach additional pages to the form.
10
Parole Board of Canada (PBC) 1-800-874-2652 (Toll-free) Canada.ca/record-suspensions
Record Suspension Application Guide
Fill in the Record Suspension
Application Form
STEP
7
Answer all the questions in the Record Suspension Application Form found at the end of this guide.
Print in BLOCK letters using black and blue ink only.
Tip: If you need more space to include all the information, attach additional pages to your application.
Important: The form is only valid for 12 months from the date you sign it.
Make sure that you have:
❯ Answered all questions on both sides of the form;
❯ Answered all questions truthfully and completely; and
❯ Signed and dated the form within the last year. As the applicant, you must sign the form.
Important: If you do not answer all the questions on both sides of the form or do not sign the form,
the Parole Board of Canada will return your application and documents.
IMPORTANT!
The Parole Board of Canada must be able to contact you now and in the future. If we cannot contact
you or verify your information, your application may not be processed. If your mailing address changes,
you must send the Parole Board of Canada a letter with your new mailing address. This letter must include:
❯ Your name; ❯ Your Record Suspension Application Personal Reference Number;
❯ You new mailing address; ❯ Your signature. As the applicant, you must sign the letter.
Send the letter to the address found on page 12.
Important: Even after you receive a record suspension, you must continue to advise the Parole Board
of Canada of any changes in your address.
11
Record Suspension Application Guide
Parole Board of Canada (PBC)
1-800-874-2652 (Toll-free) Canada.ca/record-suspensions
Provide the payment of the Application
Processing Fee
STEP
9
Please include the Record Suspension Application Processing Fee with your application.
Important: If the fee is missing, incomplete or inaccurate, your application
may not be processed and may be returned to you.
The current Record Suspension Application Processing Fee is:
$50.00 (CDN [Canadian dollars])
Important: In order to include the current fee, consult the updated Record Suspension
Application Guide at Canada.ca/record-suspensions or contact the Parole Board of
Canada at 1-800-874-2652 or suspension@pbc-clcc.gc.ca.
The following payment types are accepted:
❯ Credit card (use the Record Suspension Application Processing Fee Credit Card Payment
Form found at end of this guide);
❯ Certied cheque;
❯ Money order; and
❯ Bank draft payable to the Receiver General for Canada.
The Parole Board of Canada will not accept a personal cheque or cash.
Complete the Measurable Benet/
Sustained Rehabilitation Form
¼Please note that this Step is only required if your rst offence was committed on or after
June 29, 2010. You may wish to include information on the circumstances of your offence(s)
to help with the processing of your application.
As per section 4.1 of the Criminal Records Act, you must clearly describe how receiving a record
suspension would provide you with a measurable benet AND sustain your rehabilitation into society as
a law-abiding citizen. Fill in all sections of the Measurable Benet/Sustained Rehabilitation Form. If you
do not ll in all sections, the Parole Board of Canada will return your application to you. If you do not
have enough room to include all the requested information, attach additional pages to the form.
STEP
8
12
Parole Board of Canada (PBC) 1-800-874-2652 (Toll-free) Canada.ca/record-suspensions
Record Suspension Application Guide
RECORD SUSPENSION APPLICATION CHECKLIST
1. Original criminal record or Certication of No Criminal Record AND
Proof of Conviction documents, as required (explained in Step 1)
2. Original Court Information Form(s) (explained in Step 2)
3. Original Military Conduct Sheet, if required (explained in Step 3)
4. Original Local Police Records Check Form(s) (explained in Step 4)
5. Photocopy of your identication document (explained in Step 5)
6. Original Schedule 1 Exception Form, if required (explained in Step 6)
7. Original Record Suspension Application Form (explained in Step 7)
8. Measurable Benet/Sustained Rehabilitation Form, if required (explained in Step 8)
9. Application Processing Fee (explained in Step 9)
¼Mail your Application Form, the Application Processing Fee, and all official documents
(originals only, with the exception of your identification document) to this address:
Parole Board of Canada
Clemency and Record Suspension Division
410 Laurier Avenue West, 5
th
Floor
Ottawa, Ontario K1A 0R1
Before you submit your application
IMPORTANT!
❯ You must provide the original documents with the original signature and ofcial seal and/or
stamp from the courts and the police. Failure to do so, will result in your application being returned
to you. Forms that have been tampered with will also be returned.
❯ Before you mail your application, make sure to keep a photocopy of your documents,
including the forms to keep for future reference.
Ź
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PBC/CLCC 003e (R-2021-05)
Page 1 of 2
Parole Board of Canada (PBC) - 1-800-874-2652 (Toll free) - Canada.ca/record-suspensions
ONCE COMPLETED
B
PROTECTED
RECORD SUSPENSION APPLICATION FORM
Please print clearly using black or blue ink. You must answer all questions.
SECTION A: PERSONAL INFORMATION - You must answer all questions.all questions.
1. What is your full legal name? (You must fill in your name and date of birth at the top of page 2 as well.)
Last Name
Given Name(s)
2. Have you ever used another name other than your legal name above (include nicknames)?
No Yes If YES, please write the other names below or your application will be returned to you.
Previous Last Name(s) Previous Given Name(s)
3. What is your gender? Male Female
Another
Gender
4. What is your date of
birth?
Y Y Y Y M M
D
D
5. Were you born in Canada? Yes No
6. Do you have a Driver's Licence? Yes No
If YES, what is your
Driver’s Licence number?
Province/
Territory
7. Are you
employed?
Yes
No
If YES, who is your employer?
If you are self employed please indicate the name and/or number of your company.
Employer Name
Company name and/or number
SECTION B: CORRESPONDENCE AND RESIDENCE INFORMATION - You must answer all questions.
8. What is your mailing address? (Please specify if this is the address of a representative)
All information about a decision will be sent to this address, except, in cases where the Board must contact you directly (e.g. a
proposal to refuse).
Apartment/House Number and Street Address
City/Town
Province/Territory Postal Code Country
9. Do you want information in English or French? (This will include all official
letters and the Record Suspension document).
English
French
10. What addresses have you lived at in the last 10 years? Include your current address. P.O. Boxes will not be accepted.
Apartment/House
Number and Street
Address
City/Town
Province/
Territory
Country
Postal
Code
From To
Y
Y Y Y MM
Present
Y Y Y Y MMY Y Y Y
M
M
Y
Y Y Y MMY Y Y Y MM
Y Y Y Y MM
Y
Y Y Y MM
Please turn this form over 
PBC/CLCC 003e (R-2021-05)
Page 2 of 2
Parole Board of Canada (PBC) - 1-800-874-2652 (Toll free) - Canada.ca/record-suspensions
APPLICANT INFORMATION - You must fill in this information.
Indicate the full legal name and date of birth of the applicant provided on the front of this form:
Full legal name
Date of birth (YYYY-MM-DD):
CONTACT INFORMATION - You must answer all questions. The Parole Board will need to contact you directly..
11. Telephone Number Can we leave a voicemail message? Yes No
If you do not have a telephone, provide a mailing address:
12. Can we contact someone else about your application? Yes No If YES, give us their name and telephone number:
Name Telephone Number
13. Have you ever been a member of the Canadian Forces? If YES, see Step 3 of the Record Suspension Application Guide
and fill in the information below:
No YES – Former YES – Current
YES – Former or current
reserve member
Military Service ID
Date of Enrolment
Y Y Y Y M M D D
Date of Discharge
Y Y Y Y M M DD
Provide the complete mailing address of your unit (your commanding officer may be contacted)
Unit Name
Sub-Unit Name Street Address or P.O. Box Number City/Town Province/Territory Postal Code
CONVICTION INFORMATION - You must answer all questions.
14. Do you have any other convictions that do not appear on your
Criminal Record, including convictions in another country?
Yes No If YES, provide details below:
Offence Arresting Police Sentence Date (YYYY-MM-DD) Court (Street/City/Province)
APPLICANT AUTHORIZATION
15. The information you provide in this application is collected under the authority of the Criminal Records Act for the purpose of
processing your request for a record suspension. You have the right to the correction of, access to and protection of, your
personal information under the Privacy Act. Personal information collected during the investigation of your application will be
stored in Personal Information Bank Number PBC PPU 010 and can be accessed and assessed for accuracy by sending a written
request to the Access to Information and Privacy Coordinator, Parole Board of Canada, 410 Laurier Avenue West, Ottawa, ON
K1A 0R1. Exempt personal information obtained from external partners in the course of processing this application cannot be
provided upon request. You must sign and date this form to confirm the following: I understand that the information may be used
in a record suspension decision, to conduct inquiries, and may be used in summary form for reporting, quality control,
performance measurement, evaluation, research purposes and to establish an inventory of record suspensions. I grant permission
for the disclosure of relevant personal information about me with justice system participants as defined in the Criminal Code, as
may be deemed necessary for the purpose of the investigation related to this application and for the purpose of any record
suspension decision.
I certify that the statements made by me in this application are true and complete. Failure to sign this authorization will
result in your application being returned to you as incomplete.
Sign here:
(Applicant’s Signature)
Date:
Y Y Y Y M M DD
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Criminal Records Act
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Notes
NEED ASSISTANCE?
Contact the Parole Board of Canada at:
1-800-874-2652 (toll-free)
suspension@pbc-clcc.gc.ca
Canada.ca/record-suspensions
ISBN: PS94-9E-PDF