Uscis Form I 508 – Fill Out and Use This PDF

	Waiver of Certain Rights, Privileges,
	Exemptions, and Immunities	USCIS
	Department of Homeland Security	Form I-508
		OMB No. 1615-0025
	U.S. Citizenship and Immigration Services	Expires 11/30/2021

►START HERE - Please type or print in black ink.

Part 1. Information About the Person Filing This Waiver Form

1.

Family Name (Last Name)

Given Name (First Name)

Middle Name

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

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 Edition 11/08/19

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Part 2. Waiver Statement

occupational status entitling me to nonimmigrant status under Immigration and Nationality Act (INA) section 101(a)(15)(A), (E), or (G) as a government official, treaty trader or treaty investor, other position covered under the E classification, or international organization representative, respectively.

Accordingly, as I seek to acquire or retain lawful permanent resident status, I hereby waive and understand that I will no longer be eligible for any and all diplomatic rights, privileges, exemptions, and immunities that would otherwise be granted to me under any law or executive order because of my occupational status.

Part 3. Statement, Contact Information, Certification, and Signature of the Person Executing This Waiver Form

NOTE: Select the box for either Item A. or Item B. in Item Number 1.

Statement

1.Statement Regarding the Interpreter

or selection for every question, in		, a language in which I am fluent,

and I understood everything.

NOTE: If applicable, select the box for Item Number 2.

2.Statement Regarding the Preparer

At my request, the preparer named in Part 5.,		,

prepared this waiver form for me based only upon information I provided or authorized.

Person's Executing This Waiver Form's Contact Information

3. Daytime Telephone Number		4. Mobile Telephone Number (if any)

5.Email Address (if any)

Certification

Although not required in order to submit this waiver form, if you have submitted any documents, you must certify the following: copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek.

I furthermore authorize release of information contained in this waiver form, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration law.

I certify, under penalty of perjury, that I provided or authorized all of the information on my waiver form, that I understand all of the information contained with, and submitted with my waiver form, and that all of the information is complete, true, and correct. I further certify that I am knowingly, intelligently, voluntarily waiving, and understand that I will no longer be eligible for any and all of the diplomatic rights, privileges, exemptions, and immunities that would otherwise accrue to me under any law or executive order because of my occupational status.

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Part 3. Statement, Contact Information, Certification, and Signature of the Person Executing This

Waiver Form (continued)

Signature

6. Signature			Date of Signature (mm/dd/yyyy)

Part 4. Interpreter's Contact Information, Certification, and Signature

Provide the following information concerning the interpreter.

Interpreter's Full Name

1. Interpreter's Family Name (Last Name)			Interpreter's Given Name (First Name)

2.Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address

3. Street Number and Name							Apt. Ste. Flr.		Number
	City or Town						State		ZIP Code
	Province		Postal Code		Country

Interpreter's Contact Information

4. Interpreter's Daytime Telephone Number		5. Interpreter's Mobile Telephone Number (if any)

6.Interpreter's Email Address (if any)

Interpreter's Certification

Part 3., Item B. in Item Number 1., and I have read to the person executing this waiver form every question, statement, and instruction on this waiver form, and his or her answer to every item in the identified language. The person executing this waiver form informed me that he or she understands every instruction, statement, question, and response to every item on this waiver form, including the Certification, and has verified the accuracy of every response.

Interpreter's Signature

6. Interpreter's Signature			Date of Signature (mm/dd/yyyy)

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Part 5. Contact Information, Declaration, and Signature of the Person Preparing this Waver Form, if Other Than the Person Executing this Waiver Form

Provide the following information about the preparer.

Preparer's Full Name

1. Preparer's Family Name (Last Name)			Preparer's Given Name (First Name)

2.Preparer's Business or Organization Name (if any)

Preparer's Mailing Address

3. Street Number and Name							Apt. Suite Floor		Number (if applicable)
	City or Town						State		ZIP Code
	Province		Postal Code		Country

Preparer's Contact Information

4. Preparer's Daytime Telephone Number		5. Preparer's Mobile Telephone Number (if any)

6.Preparer's Email Address (if any)

Preparer's Statement

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Part 5. Contact Information, Declaration, and Signature of the Person Preparing this Waver Form, if Other Than the Person Executing this Waiver Form (continued)

Preparer's Certification

By my signature, I certify, under penalty of perjury, that I prepared this waiver form at the request of the person executing this waiver form. The person executing this waiver form then reviewed the completed waiver form and informed me that he or she understands all of the information contained within, and submitted with, his or her waiver form, including the Certification, and that all of this information is complete, true, and correct. I completed this waiver form on behalf of the person executing this waiver form, based only on the information that the person executing this waiver form provided to me or authorized me to obtain or use. Although not required in order to submit this waiver form, if the requestor supplied additional information concerning a question on the request, I recorded it on the request.

Preparer's Signature

8. Preparer's Signature			Date of Signature (mm/dd/yyyy)

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Part 6. Additional Information

If you need extra space to provide any additional information within this waiver form, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this waiver form or attach a separate sheet of paper. Include your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your additional information refers; and sign and date each sheet.

1.

Family Name (Last Name)

Given Name (First Name)

Middle Name

2.

A-Number (if any)

► A-

3.

A. Page Number

B. Part Number

C. Item Number

D.

4. A. Page Number		B. Part Number		C. Item Number

D.

5. A. Page Number		B. Part Number		C. Item Number

D.

6. A. Page Number		B. Part Number		C. Item Number

D.

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