Electronic Travel Authorization (eTA) Liability Waiver Form
Please complete this form to request eTA-related assistance and acknowledge the liability waiver. All information is required for processing your request.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Country of Citizenship
*
Please Select
United States
Canada
United Kingdom
Australia
India
Germany
France
Japan
Brazil
Other
Destination Country
*
Please Select
Canada
United States
United Kingdom
Australia
Other
Purpose of Travel
*
Tourism
Business
Study
Transit
Other
Intended Date of Travel
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Have you previously applied for or received an eTA for this destination?
*
Yes
No
Please provide any additional information relevant to your eTA request.
Electronic Travel Authorization (eTA) Liability Waiver Form
By submitting this form, I acknowledge and agree that I am solely responsible for the accuracy and completeness of the information provided in connection with my eTA request. I understand that the organization assisting with my eTA application is not liable for any errors, omissions, delays, or outcomes related to my travel authorization. I have read and understood all instructions and consent to the terms of this liability waiver.
Signature
*
Submit Waiver
Submit Waiver
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