Instructions For Application For Replacement/initial Nonimmigrant Arrival-Departure Document (Form I-102) Page 4


4. Receive an initial Form I-94 if you were not issued one when you were originally admitted into the United States due
to your military membership as described below (Select box "1.g." in Part 2.):
A. Nonimmigrant member of the U.S. Armed Forces;
B. Nonimmigrant member of the North Atlantic Treaty Organization (NATO) armed forces or civilian component; or
C. Nonimmigrant member of the Partnership for Peace military program under the Status of Forces Agreement (SOFA).
Part 3. Processing Information
Item Numbers 1.a. - 5. Provide all information requested in the spaces provided.
Part 4. Statement, Certification, Signature and Contact Information of the Applicant
Select the box that indicates if you filled out this form or if someone interpreted this form for you. If applicable, select the
box that indicates if someone filled out this form for you. Every application must contain the original signature of the
applicant. A photocopy of a signed application or a typewritten name in place of a signature is not acceptable. If you are
under 14 years of age, your parent or legal guardian may sign the application on your behalf. Sign and date the form and
provide your daytime telephone number, mobile telephone number, and e-mail address.
Part 5. Contact Information, Certification, and Signature of Interpreter
If you used an interpreter to read the instructions and complete the questions on this form, the interpreter must fill out this
section, provide the name of his or her business/organization, the business/organization's address, his or her daytime
telephone number, and his or her e-mail address. The interpreter must also sign and date the form.
Part 6. Contact Information, Declaration, and Signature of the Person Preparing This Application, If Other than
This section must contain the original signature of the person who completed this form, if other than the person named in
Part 4. If the person who completed this form is associated with a business or organization, the prepare should provide
the name of his or her business/organization name and address. If the person completing this form is an attorney or
accredited representative, he or she must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or
Accredited Representative, along with this application.
Submit Your Application
Your application must include the following items:
1. Your Signed and Completed Form I-102
Each application must be properly signed and filed with the correct fee. If you are under 14 years of age, your parent
or legal guardian may sign the application.
2. General Requirements
Initial Evidence. You must file your application with the required initial evidence. Attach copies, showing the
front and back of the documents you need to support your application. Do not send original documents unless
instructed to do so.
Lost or Stolen Form I-94, I-94W, or I-95. If you are applying to replace a lost or stolen Form I-94, I-94W, or
I-95, submit a copy of the biographic page from your passport and a copy of the page indicating admission as
claimed, or other evidence of your admission. If you are unable to provide this evidence, submit a full explanation
stating why you cannot give any of the above evidence, along with a copy of evidence of your identity and copies
of any evidence in your possession to substantiate your claim. If your Form I-94, I-94W, or I-95 was stolen,
submit a copy of the police report relating to the theft, if available. If a police report is unavailable or was not
made, submit an explanation describing the circumstances of the theft and why the police report is unavailable or
was not made.
Form I-102 Instructions 10/19/17 N
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