BELIZE DIGITAL BORDER CROSSING CARD APPLICATION FORM

Section 1.

Surname/Family name First & middle name National Status

Date of birth (day/month/ year) Place of birth (city & country)

/ /
Sex Marital Status: Maiden name (Of married women)
Male Single Married
Female
Divorce Widowed
Has name been changed (other than by marriage; e.g. deed poll)?
If so, state original name

Home address Phone no.

Occupation Colour of hair Height Colour of eyes

feet inches

Residence (country) Distinguishing marks/Special peculiarities

Section 2. Citizens by naturalization are to complete this section

Number of nationality document Date of issue of document Place of issue of document

Section 3. Declaration
TO: Director, Immigration and Nationality Services,
I hereby apply for digital border card for travelling to border towns and villages of Guatemala / Belize / Mexico. The information I have
given is complete and true to the best of my knowledge.
I declare that the form of identification submitted with this form is a true. I confirm that if, before this application is decided, there is a
material change in my circumstances or new information relevant to this application becomes available, I will inform the Department of
Immigration.
I am aware that it is an offence under the Immigration Act to make a statement which I know to be false, in order to obtain a digital
border card. I am also aware that I may be banned if I have breached Immigration law of Belize. I am further aware that should I use a
false document, lie or withhold relevant information my details may be passed to law enforcement agencies.
I declare that the documents that I have supplied with this application are genuine and the statements I have made with this application
are truthful.
I understand that Immigration authorities may make reasonable checks to confirm the accuracy and authenticity of evidence I have
provided and documents I have submitted with this application.
I am aware that the information I provide will be treated in confidence, but it may be disclosed to other government departments, agencies,
local authorities, foreign governments, and other bodies, to enable the Immigration authorities or those bodies to perform their functions.
I understand that I am required to provide a record of my fingerprints and a photograph of my face as part of my application. If I refuse
to do so, my application may be treated as invalid and, if so, will not be considered further.
I declare that the information given on this form is correct to the best of my knowledge and belief. I also consent to the processing of
information provided by me by the Immigration Department.
Signature: Date: ______/______/______
 FOR OFFICIAL USE ONLY

Ref Num: _______________________ Documents Submitted Card Number _________________

Applicant’s Birth Applicant’s Passport Applicant’s Nationality Certificate Marriage Certificate Other Documents
Certificate.
No. No. No. No.
District; Place of Issue: Place of Issue: Place of Issue:
Date of issue: Date of Issue: Date of Issue: Date of Issue:
Date of registration:

Form accepted by ________________________________________ Date:____/____/____

Cashier___________________________ Date:______/______/______ RCR No.__________________________ Amount $______________________

Data Entry___________________________ Date:______/______/______ Supervisor______________________________ Date:______/______/______

Delivered By_________________________ Card Received By________________________________________ Date:______/______/_______

This form is for use by Belizeans/Guatemalan and Mexicans only

NOTES:

1. This form must be completed in English, using blue or black ink only.
2. One (1) photograph (2 inches x 2 inches) signed by a justice of the peace.
3. The fee for a digital border card is BZ$20.00 per year; maximum of three (3) years and is non-
refundable.
4. The form must be submitted along with original copy of proof of identity
a) Original and photocopy of passport or
b) Original and photocopy of birth certificate and photo identification (social security or voter’s
ID card.) or
c) Original and photocopy of nationality certificate and photo identification (social security or
voter’s ID card.)
5. Applicants below the age of sixteen must be accompanied by a parent or legal guardian. That parent
or legal guardian must sign the form.
6. Your photograph will be taken at the Immigration Office at the time the application is submitted.