Fillable Canada Consent Form printable pdf download

CONSENT FOR THE RELEASE OF POLICE INFORMATION AND DISCLOSURE OF PERSONAL INFORMATION

Current Surname (Last Name)

First Name

Second Name (Middle Name) – List All

Previous Surname(s) or Maiden Name(s) – List All

Place of Birth (If other than Canada, please also note date of entry to Canada)

Date of Birth (YY-MM-DD)

Sex

Phone #

Driver's Licence Number (required for driver record requests

Current Address

Number

Street

Apt/Unit

City

Province

Postal Code

Previous Address

Number

Street

Apt/Unit

City

Province

Postal Code

Have you ever been convicted of a criminal offence for which a Pardon has not been issued in

YES

Canada?

If yes, please complete and attach the Declaration of Criminal Record form

I HEREBY CONSENT TO THE SEARCH OF (check all that apply):

Driver Record/Abstract, Please specify Province _______

Check DL License Verification

Insurance History, Please specify Province _______

Consumer Credit Report

Employment References/Verifications

Education/Professional Verifications

Terrorism Check

-AND/OR-

I HEREBY CONSENT TO A CRIMINAL RECORD SEARCH (Adult) THROUGH (check all that apply):

RCMP National Repository of Criminal Records which will be conducted based on the name(s), date of birth and declared criminal record (as per Section 9.6.4 of the

CCRTIS Dissemination policy)

-AND-

Local Police Records which includes Police Information Portal (PIP) Firearms Interest Person (FIP) and Niche RMS

Authorization to Release Clearance Report or Any Police Information

I certify that the information I have supplied is correct and true to the best of my knowledge. I consent to the release of a Criminal Record or any Criminal Information to ISB Canada

and its partners, and to the Organization Requesting Search named below and its designated agents and/or partners. All data is subject to provincial, state, and federal privacy

legislation.

The criminal record search will be performed by a police service. I hereby release and forever discharge all members and employees of the Processing Police Service from any and all

actions, claims and demands for damages, loss or injury howsoever arising which may hereafter be sustained by myself or as a result of the disclosure of information by the Processing

Police Service to ISB Canada and its partners.

I hereby release and forever discharge all agents from any claims, actions, demands for damages, injury or loss which may arise as a result of the disclosure of information by any of the

information sources including but not limited the Credit Bureau or Department of Motor Vehicles to the designated agents and/or their partners and representatives.

I am aware and I give consent that the records named above may be transmitted electronically or in hard copy within Canada and to the country from where the search was requested, as

indicated below. By signing this waiver, I acknowledge full understanding of the content on this consent form.

2 PIECES OF ACCEPTABLE ID ATTACHED

ELECTRONIC IDENTIFICATION VERIFICATION USED

(mandatory if not using eID verifier)

(eID from Equifax)

By checking this box, you are giving your digital signature and certify that you

agree and consent to the terms and release of information listed on this consent

Applicants Signature -

(mandatory if not using eID verifier)

by signing this form you agree

form.

and consent to the terms and release of information listed on this consent form.