Cbp Form I-736 - Guam - Cnmi Visa Waiver Information
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1DEPARTMENT OF HOMELAND SECURITY
OMB No. 1651-0109
Expires 11/30/2015
U.S. Customs and Border Protection
GUAM - CNMI VISA WAIVER INFORMATION
Instructions: This form must be completed by every nonimmigrant visitor not in possession of a visitor’s visa, who is a citizen of one of
the eligible countries *enumerated in 8 CFR 212.1(q) and is applying to enter and remain on Guam or the CNMI for a maximum stay of
forty-five (45) days. This regulation applies only to entry into Guam or the CNMI; entry to any other part of the United States pursuant to
this regulation is prohibited. Print legibly with pen in ALL CAPITAL LETTERS. Use English. Complete items # 1-9; and sign and date
the bottom of this form after carefully reading all of the information. Children under the age of fourteen (14) must have their form signed
by a parent, guardian, or other responsible adult. When all items are completed, present this form to the U.S. Customs and Border
Protection Officer along with your completed CBP Form I-94, Arrival/Departure Record. * The airline can provide you with the current
list of eligible countries.
1. Surnames/Family Names
9. All applicants must read and answer the following:
(exactly as in passport)
A visa waiver is not available to persons who are within
specific categories defined by law as inadmissible to the
2. First Name and Middle Name
United States (except when a waiver is obtained in
advance). Complete information regarding these categories
3. Other Names Used
and whether any may be applicable to you can be obtained
from U.S. Customs and Border Protection. Generally, they
4. Date of Birth
(Day/Month/Year)
include persons:
Afflicted with contagious diseases (e.g., tuberculosis) or
5. Place of Birth
(City and Country)
who have suffered serious mental illness;
Arrested or convicted for any offense or crime even
6. Passport Number
though subject of a pardon, amnesty, or other such legal
action;
7. Date Passport Issued
(Day/Month/Year)
Believed to be narcotic addicts or traffickers;
8. Have you applied for an immigrant or nonimmigrant
Previously removed from or unlawfully in, the United
U.S. visa before?
States;
No
Yes
(if yes, complete the following)
Who seek, have sought or have procured a visa, or
other documentation, or entry into the United States by
Place you applied
fraud or willful misrepresentation;
Who have engaged in any terrorist activity or are a
Date you applied
(Day/Month/Year)
member of a terrorist organization;
Who ordered, incited, assisted, or otherwise participated
Type of visa requested
in the persecution of any person because of race,
religion, national origin, or political opinion under the
Was visa issued?
control, direct or indirect, of the Nazi Government, or of
the government of any area occupied by, or allied with,
No
Yes
the Nazi Government of Germany, or who participated
in genocide in any country.
Has your U.S. visa ever been cancelled?
Do any of these appear to apply to you?
No
Yes
No
Yes
(If yes, you may be denied entry into Guam or the CNMI)
Important Notice : Your admission into and stay on Guam or the CNMI is for maximum period of forty-five (45) days. You
may not apply for: (1) a change of nonimmigrant status; (2) adjustment of status to temporary or permanent resident; or
(3) an extension of stay.
Warning : You are ineligible for admission to Guam or the CNMI if you have previously violated the terms of any prior
admission to the United States under the Guam-CNMI Visa Waiver Program or the prior Guam Visa Waiver Program.
Violation of the terms of a current admission will render you subject to removal from Guam or the CNMI. A nonimmigrant
who accepts unauthorized employment is subject to removal.
Waiver of Rights: I hereby waive any rights to review or appeal a CBP Officer’s determination as to my admissibility, or
to contest, other than on the basis of an application for asylum, any action in removal proceedings.
Certification: I certify that I have read and understand all the questions and statements on this form. The answers I have
furnished are true and correct to the best of my knowledge and belief.
Signature
Date
Paperwork Reduction Act Notice:
A person is not required to respond to a collection of information unless it displays a currently valid OMB control
number. This collection of information is estimated to average 5 minutes per response, including the time for reviewing instruction, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden
estimate or any aspect of this collection of information, including suggestions for reducing this burden to: U.S. Customs and Border Protection, Office of
Regulations and Rulings, 799 9th Street, NW., Washington DC 20229.
CBP Form I-736 (10/08)
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