Cannabis (Small Amount) Possession Conviction Application Form

Ministry of Legal Affairs - Cannabis (Small Amount) Possession Conviction Expungement Application
Per Expungement of Convictions Act 2020 – Section 6
By submitting this Form, the Applicant hereby authorizes the Minister of Legal Affairs to obtain the Applicant’s criminal records from the Bermuda Police Service (BPS) and the Bermuda Courts, and to share with same this application and any and all other information resulting from making this application. Where the Applicant applies on behalf of another person, this authorization is given by the Applicant to likewise obtain and deal with the criminal records of that other person.

Where the Applicant is applying to expunge the record of a deceased person or on behalf of someone with a physical or mental disability per section 6(4), a copy of all documentation verifying relationship and authorizing making application on behalf of the party seeking expungement, must be attached or otherwise delivered to the Ministry of Legal Affairs, before the application will be processed.

Information provided in and with this application, is collected under the authority of the Expungement of Convictions Act 2020 for the purpose of processing the Applicant’s request for an Expungement Order pursuant to section 6.

Please see guidance notes for further information
1. Are you completing this expungement order on behalf of someone else?
Document(s) verifing death of person
Filename
Size
Process
Status
Add Files
Document(s) verifying disability of person
Filename
Size
Process
Status
Add Files
Document(s) proving relationship to the party applied for
Filename
Size
Process
Status
Add Files
Document(s) authorizing the Applicant to make this application on behalf of the person for whom the Order is sought
Filename
Size
Process
Status
Add Files
Any additional document(s)
Filename
Size
Process
Status
Add Files
2a. First name (of person making this application)
2b. Middle name if any (of the person making this application)
2c. Last name (of person making this application)
2d. First name (Name of person for whom an expungement order is sought)
2e. Middle name (of the person for whom an expungement order is sought)
2f. Last Name (of the person for whom an expungement order is sought)
2g. Reason why this application is being made on someone else’s behalf – chose 1 or more boxes below
3. For what offence is expungement being sought? (Taken from criminal record)
4. What was the date of the conviction?
Day - Month - Year
5. Do you object to this completed form being provided to the BPS and Magistrates Court for their records and to verify information provided?
5a. Please explain why you object to this form being provided to the BPS and Magistrates Court.
6. Have you ever used another name other than your legal name (e.g. nicknames)?
6a. How many other names have you had?
Full Name (1)
Full Name (2)
Full Name (3)
Full Name (4)
Full Name (5)
7. Gender
8. Date of birth
Day - Month - Year
Section B: Correspondence and residence information
9. Applicant Email

10. Applicant Current Mailing Address

Street Address
Street Address 2
Parish/City	Region
Postal/Zip Code	Country

11. Have you lived anywhere else in the last 10 years?
11a. How many locations have you lived in the past 10 years?

Previous Address Start (1)
Day - Month - Year
Previous Address End (1)
Day - Month - Year

Previous Address (2)

Street Address
Street Address 2
Parish/City	Region
Postal/Zip Code	Country

Previous Address Start (2)
Day - Month - Year
Previous Address End (2)
Day - Month - Year

Previous Address Start (3)
Day - Month - Year
Previous Address End (3)
Day - Month - Year

Previous Address (4)

Street Address
Street Address 2
Parish/City	Region
Postal/Zip Code	Country

Previous Address Start (4)
Day - Month - Year
Previous Address End (4)
Day - Month - Year
Contact Information (of Applicant)
12. Phone
12a. Can we leave a voicemail message?

Yes No

12b. If you do not have a phone, provide a mailing address:

Street Address
Street Address 2
Parish/City	Region
Postal/Zip Code	Country

13. If the Applicant is making this application on his/her own behalf can the Ministry contact someone else about your application?
Contact Full Name:
Relationship to Applicant

Contact Address

Street Address
Street Address 2
Parish	Region
Postal Code	Country

Contact Phone Number:
Conviction information
14. Do you have any other convictions that do not appear on your criminal record, including convictions in another country?
14a. How many other convictions do not appear on your criminal record, including convictions in another country?
Offence (1)
Sentence (1)
Date (1)
Day - Month - Year
Country/State/Province (1)
Offence (2)
Sentence (2)
Date (2)
Day - Month - Year
Country/State/Province (2)
Offence (3)
Sentence (3)
Date (3)
Day - Month - Year
Country/State/Province (3)
Offence (4)
Sentence (4)
Date (4)
Month - Day - Year
Country/State/Province (4)
The information you provide in this application is collected under the authority of the Expungement of Convictions Act 2020 for the purpose of processing your request for an Expungement Order pursuant to section 6.
Any other information he/she wishes to be considered
Checkbox

I certify that the statements made by me in this application are true and complete.

Ministry of Legal Affairs - Cannabis (Small Amount) Possession Conviction Expungement Application

Information provided in and with this application, is collected under the authority of the Expungement of Convictions Act 2020 for the purpose of processing the Applicant’s request for an Expungement Order pursuant to section 6.

Please see guidance notes for further information

Section B: Correspondence and residence information

Contact Information (of Applicant)

Conviction information