Form I-736 Guam-CNMI Visa Waiver Information

DEPARTMENT OF HOMELAND SECURITY

OMB No. 1651-0109
Expires 11/30/2015

U.S. Customs and Border Protection

GUAM - CNMI VISA WAIVER INFORMATION
Instructions: This form must be completed by every nonimmigrant visitor not in possession of a visitor’s visa, who is a citizen of one of
the eligible countries *enumerated in 8 CFR 212.1(q) and is applying to enter and remain on Guam or the CNMI for a maximum stay of
forty-five (45) days. This regulation applies only to entry into Guam or the CNMI; entry to any other part of the United States pursuant to
this regulation is prohibited. Print legibly with pen in ALL CAPITAL LETTERS. Use English. Complete items # 1-9; and sign and date
the bottom of this form after carefully reading all of the information. Children under the age of fourteen (14) must have their form signed
by a parent, guardian, or other responsible adult. When all items are completed, present this form to the U.S. Customs and Border
Protection Officer along with your completed CBP Form I-94, Arrival/Departure Record. * The airline can provide you with the current
list of eligible countries.

1. Surnames/Family Names (exactly as in passport)
2. First Name and Middle Name
3. Other Names Used
4. Date of Birth (Day/Month/Year)
5. Place of Birth (City and Country)
6. Passport Number
7. Date Passport Issued (Day/Month/Year)
8. Have you applied for an immigrant or nonimmigrant
U.S. visa before?
No
Yes (if yes, complete the following)

9. All applicants must read and answer the following:
A visa waiver is not available to persons who are within
specific categories defined by law as inadmissible to the
United States (except when a waiver is obtained in
advance). Complete information regarding these categories
and whether any may be applicable to you can be obtained
from U.S. Customs and Border Protection. Generally, they
include persons:
Afflicted with contagious diseases (e.g., tuberculosis) or
who have suffered serious mental illness;
Arrested or convicted for any offense or crime even
though subject of a pardon, amnesty, or other such legal
action;
Believed to be narcotic addicts or traffickers;
Previously removed from or unlawfully in, the United
States;

Place you applied

Who seek, have sought or have procured a visa, or
other documentation, or entry into the United States by
fraud or willful misrepresentation;

Date you applied (Day/Month/Year)

Who have engaged in any terrorist activity or are a
member of a terrorist organization;

Type of visa requested
Was visa issued?
No
Yes
Has your U.S. visa ever been cancelled?
No

Who ordered, incited, assisted, or otherwise participated
in the persecution of any person because of race,
religion, national origin, or political opinion under the
control, direct or indirect, of the Nazi Government, or of
the government of any area occupied by, or allied with,
the Nazi Government of Germany, or who participated
in genocide in any country.
Do any of these appear to apply to you?

Yes

No

(If yes, you may be denied entry into Guam or the CNMI)

Yes

Important Notice : Your admission into and stay on Guam or the CNMI is for maximum period of forty-five (45) days. You
may not apply for: (1) a change of nonimmigrant status; (2) adjustment of status to temporary or permanent resident; or
(3) an extension of stay.
Warning : You are ineligible for admission to Guam or the CNMI if you have previously violated the terms of any prior
admission to the United States under the Guam-CNMI Visa Waiver Program or the prior Guam Visa Waiver Program.
Violation of the terms of a current admission will render you subject to removal from Guam or the CNMI. A nonimmigrant
who accepts unauthorized employment is subject to removal.
Waiver of Rights: I hereby waive any rights to review or appeal a CBP Officer’s determination as to my admissibility, or
to contest, other than on the basis of an application for asylum, any action in removal proceedings.
Certification: I certify that I have read and understand all the questions and statements on this form. The answers I have
furnished are true and correct to the best of my knowledge and belief.
Signature

Date

Paperwork Reduction Act Notice: A person is not required to respond to a collection of information unless it displays a currently valid OMB control

number. This collection of information is estimated to average 5 minutes per response, including the time for reviewing instruction, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden
estimate or any aspect of this collection of information, including suggestions for reducing this burden to: U.S. Customs and Border Protection, Office of
Regulations and Rulings, 799 9th Street, NW., Washington DC 20229.

CBP Form I-736 (10/08)