Form I-408 - Application To Pay Off Or Discharge Alien Crewman - U.s. Department Of Justice

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OMB No. 1115-0073
Application to Pay Off or
U.S. Department of Justice
Discharge Alien Crewman
Immigration and Naturalization Service
(To be filed in triplicate. See Instructions on reverse)
I.
Carrier:
Arrival Manifest Filed at
(Port):
Date of Arrival:
PAY OFF/DISCHARGE
I hereby request authorization to
the alien crewmen listed below.
II.
Name in Full
Nationality and
Action by INS
Given Name and
Passport Number
Family Name
Middle Initial
(If additional space is required, attached list in triplicate)
III.
Reason for request:
IV.
Arrangements for departure from the U.S. of the listed crewmen are (date and port of departure, air carrier and
flight number or vessel).
Mailing Address of Carrier:
Signature
Title
FOR GOVERNMENT USE ONLY
Copy:
Date:
Application:
Mailed
Delivered
Granted
Denied
Signature:
Date:
Office:
Title:
Signature and Title:
Form I-408 (Rev. 05/17/00)Y

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