Form with Proposed Revisions

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection

OMB No. 1651-0127

Expires1/31/2010

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 _______________________________________________________________________________________

(Name of vessel or aircraft)

employing the alien crewman _________________________________________________________________________________

who upon the arrival at the port of _____________________________________________________________________

(Name of port)

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

(Date of arrival)

_________________________________________________________________________________________________

(Name of disease or illness)

________________________________________________________________________________________________,

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)

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 1651- 0127. The estimated average time to complete this application is 5 minutes. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection, Office of Regulations and Rulings, 799 9^th Street, NW., Washington DC 20229.

CBP Form I-510 (12/09)