Form I-193 - Application For Waiver Of Passport And/or Visa
Download a blank fillable Form I-193 - Application For Waiver Of Passport And/or Visa in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form I-193 - Application For Waiver Of Passport And/or Visa with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2OMB No. 1651-0107
Expires 11/30/2017
FEE STAMP
DEPARTMENT OF HOMELAND SECURITY
APPLICATION FOR WAIVER
OF PASSPORT AND/OR VISA
FILE NUMBER
1. MY NAME IS: (LAST)
(FIRST)
(MIDDLE)
2. MY UNITED STATES DESTINATION IS: (NUMBER AND STREET, APT. NO., CITY, STATE, ZIP CODE)
3. MY PERMANENT ADDRESS ABROAD IS:
4. THE COUNTRY OF WHICH I AM A CITIZEN, SUBJECT OR NATIONAL IS:
5. PLACE OF BIRTH
DATE OF BIRTH (MM/DD/YYYY):
6. DATE OF ARRIVAL:
PORT OF ARRIVAL:
7. MANNER OF ARRIVAL (NAME OF VESSEL, AIRLINE, ETC.)
8. PLACE VISA PREVIOUSLY ISSUED:
NUMBER:
VALID TO:
DATE:
CLASSIFICATION:
9. PLACE PASSPORT ISSUED:
DATE:
NUMBER:
VALID TO:
10. THE REASON I AM NOT IN POSSESSION OF
PASSPORT
VISA
IS AS FOLLOWS: (CONTINUE ON REVERSE, IF NECESSARY)
DATE OF THIS APPLICATION:
I CERTIFY THAT THE ABOVE IS TRUE AND CORRECT.
CITY AND STATE:
SIGNATURE OF APPLICANT
SIGNATURE OF PERSON PREPARING FORM, IF OTHER THAN APPLICANT.
I DECLARE THAT THIS DOCUMENT WAS PREPARED BY ME AT THE REQUEST OF THE APPLICANT AND IS BASED ON ALL INFORMATION OF
WHICH I HAVE ANY KNOWLEDGE.
SIGNATURE
ADDRESS
DATE
APPLICANT - DO NOT WRITE BELOW THIS LINE
APPLICATION APPROVED. WAIVER GRANTED
APPLICATION DISAPPROVED.
UNDER SECTION 211(b)
DATE
BY AUTHORITY OF
(DHS)
OF
ACTION
UNDER SECTION 212(d)(4)
BY AUTHORITY OF
(DHS)
DFO
OR
ADMITTED AS
UNTIL
PD
OFFICE
NONIMMIGRANT CLASS
DHS Form I-193 (12/14)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form I-601 - Application For Waiver Of Grounds Of Inadmissibility - U.s. Citizenship And Immigration Services
Legal
Form I-612 - Application For Waiver Of The Foreign Residence Requirement (under Section 212(e) Of The Immigration And Nationality Act, As Amended)
Legal
Instructions For Form I-612 - Application For Waiver Of The Foreign Residence Requirement (under Section 212(e) Of The Immigration And Nationality Act, As Amended)
Legal
Instructions For Form I-601 - Application For Waiver Of Grounds Of Inadmissibility - Department Of Homeland Security - U.s. Citizenship And Immigration Services
Legal
Related Categories
Parent category: Legal