Fillable form I-508 Request for Waiver of Certain Rights 05/26/17

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form I-508 Request for Waiver of Certain Rights 05/26/17

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U.S. Citizenship and Immigration Services (USCIS) is an office of the U.S. Branch of Homeland Security (DHS) that oversees the nation's naturalization and migration framework. It is a successor to the Immigration and Naturalization Service (INS), which was disintegrated by the Homeland Security Act of 2002 and supplanted by three segments inside the DHS: USCIS, Immigration and Customs Enforcement (ICE), and Customs and Border Protection (CBP).

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Request for 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 05/31/2019
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 Request
1.
2.
►
Form I-508F
executed
Exempt from U.S. taxes
Not exempt from U.S. taxes
For Government
Use Only
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
Requestor is a French
national paid by the
French Republic
Remarks
Form I-508 05/26/17 N Page 1 of 5
Part 3. Requestor's Statement, Contact Information, Certification, and Signature
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
Requestor's Statement Regarding the Interpreter
A.
1.
B.
Requestor's Statement Regarding the Preparer
I have requested the services of and consented to ,
who
is not an attorney or accredited representative, preparing this request for me.
2.
I, , believe that I have an
occupational status entitling me to nonimmigrant status under section 101(a)(15)(A), (E), or (G) of the Immigration and Nationality
Act (INA) as a government official, treaty trader or treaty investor, or international organization representative, respectively.
Part 2. Waiver Statement
Accordingly, as I seek to acquire or retain lawful permanent resident status, I hereby waive all diplomatic rights, privileges, exemptions,
and immunities that would otherwise accrue to me under any U.S. law or executive order because of my occupational status.
NOTE: French nationals receiving a salary from the French Republic are also required to complete Form I-508F. French nationals
must submit both Form I-508 and Form I-508F together to U.S. Citizenship and Immigration Services (USCIS).
I can read and understand English, and have read and understand every question and instruction on this request, as well
as my answer to every question.
to every question, in
The interpreter named in Part 4. has also read to me every question and instruction on this request, as well as my answer
, a language in which I am fluent.
I understand every question and instruction on this request as translated to me by my interpreter, and have provided
complete, true, and correct responses in the language indicated above.
Requestor's Certification
Requestor's Signature
Requestor's Signature Date of Signature (mm/dd/yyyy) 6.
I certify, under penalty of perjury, that the information in my request and any document submitted with my request were provided by
me and are complete, true, and correct.
I furthermore authorize release of information contained in this request, in supporting documents, and in my USCIS records to other
entities and persons where necessary for the administration and enforcement of U.S. immigration laws.
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.
Requestor's Daytime Telephone Number Requestor's Mobile Telephone Number (if any)
Requestor's Email Address (if any)
3. 4.
5.
Requestor's Contact Information
is
Form I-508 05/26/17 N Page 2 of 5
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.
Date of Signature (mm/dd/yyyy) Interpreter's Signature
The requestor has informed me that he or she understands every instruction and question on the request, as well as the answer to every
question, and the requestor verified the accuracy of every answer.
Interpreter's Certification
I certify that:
I am fluent in English and
, which is the same language provided
I have read to this requestor every question and instruction on this request, as well as the answer to every question, in the language
provided in Part 3., Item B. in Item Number 1.; and
6.
in Part 3., Item B. in Item Number 1.;
Interpreter's Signature
Interpreter's Contact Information
Interpreter's Daytime Telephone Number
Interpreter's Email Address (if any)4. 5.
Country
Ste. NumberFlr.Apt.Street Number and Name
Province Postal Code
ZIP CodeState
City or Town
Form I-508 05/26/17 N Page 3 of 5
3.
Preparer's Mailing Address
Part 5. Contact Information, Statement, Certification, and Signature of the Person Preparing this
Request, If Other Than the Requestor
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 concerning the preparer.
Preparer's Contact Information
Preparer's Daytime Telephone Number Preparer's Fax Number
Preparer's Email Address (if any)
4.
6.
5.
Preparer's Statement
Preparer's Signature Date of Signature (mm/dd/yyyy)
Preparer's Certification
Preparer's Signature
By my signature, I certify, swear, or affirm, under penalty of perjury, that I prepared this request on behalf of, at the request of, and
with the express consent of the requestor. I completed this request based only on responses the requestor provided to me. After
completing the request, I reviewed it and all of the requestor's responses with the requestor, who agreed with every answer on the
request. If the requestor supplied additional information concerning a question on the request, I recorded it on the request.
8.
I am an attorney or accredited representative and my representation of the requestor in this case
extends does not extend beyond the preparation of this request.
I am not an attorney or accredited representative but have prepared this request on behalf of the requestor and with the
requestor's consent.
7.
B.
NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this
request, you must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited
Representative, with this request.
A.
Country
Ste. NumberFlr.Apt.Street Number and Name
Province Postal Code
ZIP CodeState
City or Town
Form I-508 05/26/17 N Page 4 of 5
Part 6. Additional Information
If you need extra space to provide any additional information within this request, 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 request 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 answer 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.
Form I-508 05/26/17 N Page 5 of 5
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form I-508 Request for Waiver of Certain Rights 052617

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Completed 20 February 2020

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