Form I-95 Alien Crewmen Landing Permit

OMB N0. 1651-0114

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection
CREWMAN’S LANDING PERMIT
Family Name
Home Address

FIN or “A” No.

Given Name

Initial

Address in United States
Hair

Eyes

Ht.

Wt.

Date of Birth
Place of Birth
Passport Number/Nationality
Arrived by

Air

Sea

CBP Form I-95 (06/08)

Arrival
Date

Place of
Arrival

CBP Officer Signature

CREWMAN’S LANDING PERMIT
By accepting this conditional permit to land, the holder agrees to all the
conditions incident to the issuance thereof and to deportation from the United
States in accordance with the provisions of section 252(b) of the Immigration
and Nationality Act.

CBP Form I-95 (06/08)

Department of Homeland Security – U.S. Customs and Border Protection
Completion of this form is mandatory pursuant to 8 U.S. C. 1281. Data is used by DHS for alien
crewman control. By accepting this conditional permit to land, the holder agrees to all the
conditions incident to the issuance thereof, and to deportation from the United States in
accordance with the provisions of section 252(b) of the Immigration and Nationality Act.
Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information
collection and a person is not required to respond to this information unless it displays a current
valid OMB control number and an expiration date. The control number for this collection is 16510114. The estimated average time to complete this application is 5 minutes per respondent. If you
have any comments regarding the burden estimate you can write to U.S. Customs and Border
Protection, Information Services Division,1300 Pennsylvania Avenue, NW, Washington DC 20229
Note: Form must be typed or printed legibly.

CBP Form I-95 (06/08)