Page 2 of 6Form I-508 Edition 12/08/21
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
