Form I-508 - Request For Waiver Of Certain Rights, Privileges, Exemptions, And Immunities
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5Request for Waiver of Certain Rights, Privileges,
Exemptions, and Immunities
USCIS
Form I-508
Department of Homeland Security
OMB No. 1615-0025
U.S. Citizenship and Immigration Services
Expires 05/31/2019
Remarks
Requestor is a French
Form I-508F
Exempt from U.S. taxes
For Government
executed
national paid by the
Use Only
Not exempt from U.S. taxes
French Republic
►
START HERE - Please type or print in black ink.
Part 1. Information About the Person Filing This Request
Family Name (Last Name)
Given Name (First Name)
Middle Name
1.
2.
Alien Registration Number (A-Number) (if any)
3.
U.S. Social Security Number (if any)
4.
Date of Birth (mm/dd/yyyy)
► A-
►
5. U.S. State Department-Issued Personal Identification Number (PID)
6.
Mailing Address
In Care Of Name
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
Province
Postal Code
Country
7.
Is your current mailing address the same as your physical address?
Yes
No
If you answered "No," provide your physical address in Item Number 8.
8.
Physical Address
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
Province
Postal Code
Country
9.
Employment Information
Name of Mission or Organization
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
Province
Postal Code
Country
Form I-508 05/26/17 N
Page 1 of 5
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