Affidavit For Travel To Cuba Template

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Affidavit for Travel to Cuba
I hereby understand and confirm that, under the current restrictions on travel to Cuba imposed by the
United States, certain travel transactions, including, but not limited to, visits solely for the purpose of recreational
tourism by citizens or residents of the United States, wheresoever located, or by any person actually within the
United States, are prohibited, with the exception of the categories of travel described below.
I hereby declare that
 A. I have a specific license that has been granted by OFAC before my trip. The number of my OFAC
license is: __________________ (copy attached)
 B. I am neither a citizen nor a resident of the United States.
or, if the above categories are not applicable, then I declare that I am traveling to Cuba for the purpose
marked below:
 1(a).
To visit a close relative.
 1(b).
I share a common dwelling with an authorized traveler who has a license to visit a close relative in
Cuba and am travelling with such authorized traveler to Cuba.
 2.
On official business for the United States government, a foreign government or a relevant
intergovernmental organization.
 3.
For journalistic purposes.
 4(a).
To conduct professional research related to my profession or education.
 4(b).
To attend a professional meeting or conference, the purpose of which is not related to the
promotion of tourism in Cuba.
 5(a).
To participate in educational activities.
 5(b).
To participate in educational exchange activities not related to the pursuit of an academic degree.
 6.
To engage in religious activities.
 7(a).
To participate in an athletic competition.
 7(b).
To participate in a public performance, clinic or workshop.
 8.
To provide various types of support to the Cuban people.
 9.
For a humanitarian project in or related to Cuba that is designed to directly benefit the Cuban
people.
 10.
To collect information related to Cuba for noncommercial purposes.
 11.
For reasons regarding the exportation, importation or transmission of information or informational
materials.
 12.
To conduct market research, commercial marketing, sales negotiation, accompanied delivery or
servicing of items in Cuba.
Name: _____________________________
Date of Birth: ________________________
Telephone Number: ___________________
Address: ____________________________
Passport Country of Issue: ______________
Passport Number: _____________________
Country of Citizenship: ________________
U.S. Permanent Resident card USCIS no. or U.S. Visa Control Number: _________________________
I hereby certify that all of the information contained in this Affidavit is true and correct as of the date hereof.
Signature: __________________________
Date: _______________________________
Americas 90398798

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