DEPARTMENT OF HOMELAND SECURITY

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DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
		OMB No. 1653-0024

GUARANTEE OF PAYMENT



Port of Entry


File No.

Pursuant to the provisions of section 253 of the Immigration and Nationality Act,

I, _______________________________________________________________________________________________
                            Name (First)                                                             (Initial)                                          (Last)

as _________________________________________________________________________________________________________
                                                            (Owner, agent, consignee, commanding officer, or master)

of the vessel or aircraft _______________________________________________________________________________________

employing the alien crewman _________________________________________________________________________________

who upon the arrival at the port of _____________________________________________________________________

on __________________________________________ was found to be afflicted with, or suspected of being afflicted with

_________________________________________________________________________________________________ 

________________________________________________________________________________________________ .

I hereby guarantee to pay any and all expenses incurred or to be incurred for the hospitalization, care, and treatment, and 

for burial in the event of death, of the said alien crewman.

Dated at ________________________________________this ______________ day of __________________________
                                                                                                                                                           (month/year)

                                                                                                      ______________________________________________
                                                                                                                                                      (Signature of guarantor)











Approved this ______ day of _________________________________________________________________________
                                                                                                                                             (month/year)

                                                                                     ______________________________________________________
                                                                                                                          (Signature of Officer)

                                                                                     ______________________________________________________
                                                                                                                                            (Title of Officer)



CBP Form I-510 (08/05)