Page 1 of 6Form I-508 Edition 11/08/19
Waiver of Certain Rights, Privileges,
Exemptions, and Immunities
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-508
OMB No. 1615-0025
Expires 11/30/2021
START HERE - Please type or print in black ink.
Alien Registration Number (A-Number) (if any)
5. U.S. State Department-Issued Personal Identification Number (PID)
Country
Ste. NumberFlr.Apt.
In Care Of Name
Province Postal Code
ZIP CodeState
City or Town
Mailing Address6.
4.U.S. Social Security Number (if any)3. Date of Birth (mm/dd/yyyy)
A-
Part 1. Information About the Person Filing This Waiver Form
1.
2.
Given Name (First Name) Family Name (Last Name) Middle Name
8. Physical Address
Is your current mailing address the same as your physical address?
If you answered "No," provide your physical address in Item Number 8.
7. Yes No
Employment Information9.
Name of Mission or Organization
Country
Ste. NumberFlr.Apt.Street Number and Name
Province Postal Code
ZIP CodeState
City or Town
Country
Ste. NumberFlr.Apt.Street Number and Name
Province Postal Code
ZIP CodeState
City or Town
Street Number and Name
Page 2 of 6Form I-508 Edition 11/08/19
Part 3. Statement, Contact Information, Certification, and Signature of the Person Executing This
Waiver Form
NOTE:
Select the box for either Item A. or Item B. in Item Number 1.
Statement Regarding the Interpreter
A.
1.
B.
Statement Regarding the Preparer
At my request, the preparer named in Part 5.,
,
prepared this waiver form for me based only upon information I provided or authorized.
2.
Part 2. Waiver Statement
Accordingly, as I seek to acquire or retain lawful permanent resident status, I hereby waive and understand that I will no longer be
eligible for any and all diplomatic rights, privileges, exemptions, and immunities that would otherwise be granted to me under any
law or executive order because of my occupational status.
I can read and understand English, and I have read and understand every question, statement, and instruction on this
waiver form, and my answer or selection for every item.
or selection for every question
, in
The interpreter named in Part 4. read to me every question, statement, and instruction on this waiver form, and my answer
, a language in which I am fluent,
and I understood everything.
1. I, , believe that I have an
occupational status entitling me to nonimmigrant status under Immigration and Nationality Act (INA) section 101(a)(15)(A), (E),
or (G) as a government official, treaty trader or treaty investor, other position covered under the E classification, or international
organization representative, respectively.
NOTE: If applicable, select the box for Item Number 2.
Daytime Telephone Number Mobile Telephone Number (if any)
Email Address (if any)
3. 4.
5.
Person's Executing This Waiver Form's Contact Information
Certification
Although not required in order to submit this waiver form, if you have submitted any documents, you must certify the following:
copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any
and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek.
I certify, under penalty of perjury, that I provided or authorized all of the information on my waiver form, that I understand all of the
information contained with, and submitted with my waiver form, and that all of the information is complete, true, and correct. I
further certify that I am knowingly, intelligently, voluntarily waiving, and understand that I will no longer be eligible for any and all of
the diplomatic rights, privileges, exemptions, and immunities that would otherwise accrue to me under any law or executive order
because of my occupational status.
I furthermore authorize release of information contained in this waiver form, in supporting documents, and in my USCIS records to
other entities and persons where necessary for the administration and enforcement of U.S. immigration law.
Statement
Page 3 of 6Form I-508 Edition 11/08/19
3.
Interpreter's Mailing Address
Part 4. Interpreter's Contact Information, Certification, and Signature
Interpreter's Given Name (First Name)Interpreter's Family Name (Last Name)1.
Interpreter's Full Name
Interpreter's Business or Organization Name (if any)2.
Provide the following information concerning the interpreter.
Country
Ste. NumberFlr.Apt.Street Number and Name
Province Postal Code
ZIP CodeState
City or Town
Interpreter's Contact Information
Interpreter's Daytime Telephone Number
Interpreter's Email Address (if any)
4.
6.
Interpreter's Mobile Telephone Number (if any)5.
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and , which is the same language specified in
Part 3., Item B. in Item Number 1., and I have read to the person executing this waiver form every question, statement, and
instruction on this waiver form, and his or her answer to every item in the identified language. The person executing this waiver form
informed me that he or she understands every instruction, statement, question, and response to every item on this waiver form,
including the Certification, and has verified the accuracy of every response.
Date of Signature (mm/dd/yyyy) Interpreter's Signature6.
Interpreter's Signature
Part 3. Statement, Contact Information, Certification, and Signature of the Person Executing This
Waiver Form (continued)
Signature
Signature Date of Signature (mm/dd/yyyy) 6.
Page 4 of 6Form I-508 Edition 11/08/19
Part 5. Contact Information, Declaration, and Signature of the Person Preparing this Waver Form,
if Other Than the Person Executing this Waiver Form
Preparer's Full Name
Preparer's Given Name (First Name)
Preparer's Family Name (Last Name)1.
Preparer's Business or Organization Name (if any)2.
Provide the following information about the preparer.
3.
Preparer's Mailing Address
Country
Suite Number (if applicable)FloorApt.Street Number and Name
Province Postal Code
ZIP CodeStateCity or Town
Preparer's Contact Information
Preparer's Daytime Telephone Number Preparer's Mobile Telephone Number (if any)
Preparer's Email Address (if any)
4.
6.
5.
Preparer's Statement
I am not an attorney or accredited representative but have prepared this waiver form on behalf of the person executing
this waiver form and with that person's consent.
7.
B.
NOTE: If you are an attorney or accredited representative, you may need to submit a completed Form G-28, Notice of
Entry of Appearance as Attorney or Accredited Representative, or Form G-28I, Notice of Entry of Appearance as
Attorney In Matters Outside the Geographical Confines of the United States, with this waiver form.
A.
I am an attorney or accredited representative and my representation of the person executing this waiver form
extends does not extend beyond the preparation of this waiver form.
Page 5 of 6Form I-508 Edition 11/08/19
Preparer's Signature Date of Signature (mm/dd/yyyy)
Preparer's Certification
Preparer's Signature
By my signature, I certify, under penalty of perjury, that I prepared this waiver form at the request of the person executing this waiver
form. The person executing this waiver form then reviewed the completed waiver form and informed me that he or she understands
all of the information contained within, and submitted with, his or her waiver form, including the Certification, and that all of this
information is complete, true, and correct. I completed this waiver form on behalf of the person executing this waiver form, based
only on the information that the person executing this waiver form provided to me or authorized me to obtain or use. Although not
required in order to submit this waiver form, if the requestor supplied additional information concerning a question on the request, I
recorded it on the request.
8.
Part 5. Contact Information, Declaration, and Signature of the Person Preparing this Waver Form,
if Other Than the Person Executing this Waiver Form (continued)
Page 6 of 6Form I-508 Edition 11/08/19
Part 6. Additional Information
If you need extra space to provide any additional information within this waiver form, use the space below. If you need more space
than what is provided, you may make copies of this page to complete and file with this waiver form or attach a separate sheet of paper.
Include your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to
which your additional information refers; and sign and date each sheet.
A-Number (if any)
A-
Page Number
Part Number Item Number
D.
Family Name (Last Name) Given Name (First Name) Middle Name
1.
2.
3.
D.
D.
D.
B. C.
Page Number
Part Number
Item Number4. B. C.
Page Number
Part Number Item Number
5. B. C.
Page Number
Part Number Item Number
6. B. C.
A.
A.
A.
A.