Form I-508 Waiver of Rights, Privileges, Exemptions and Immunities

Request for Waiver of Certain Rights, Privileges,
Exemptions, and Immunities

USCIS
Form I-508

Department of Homeland Security
U.S. Citizenship and Immigration Services

For Government
Use Only

Form I-508F
executed

Requestor is a French
national paid by the
French Republic

OMB No. 1615-0025
Expires 03/31/2017

Remarks

Exempt from U.S. taxes
Not exempt from U.S. taxes

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

Part 1. Information About the Person Filing This Request
1.

Family Name (Last Name)

Given Name (First Name)

2.

Alien Registration Number (A-Number) (if any)
► A-

3.

U.S. Social Security Number (if any)
►

5.

U.S. State Department-Issued Personal Identification Number (PID)

6.

Mailing Address
In Care Of Name

Apt. Ste. Flr. Number

Province

7.

Middle Name

4.

Date of Birth (mm/dd/yyyy)

Street Number and Name

City or Town

Postal Code

State

ZIP Code

Country

Is your current mailing address the same as your physical address?

Yes

No

If you answered "No," provide your physical address in Item Number 8.
8.

Physical Address
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

9.

Postal Code

ZIP Code

Country

Employment Information
Name of Mission or Organization

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Form I-508 03/31/15 N

Postal Code

ZIP Code

Country

Page 1 of 5

Part 2. Waiver Statement
I,
, believe that I have an
occupational status entitling me to nonimmigrant status under section 101(a)(15)(A), (E), or (G) of the Immigration and Nationality
Act (INA) as a government official, treaty trader or treaty investor, or international organization representative, respectively.
Accordingly, as I seek to acquire or retain lawful permanent resident status, I hereby waive all diplomatic rights, privileges, exemptions,
and immunities that would otherwise accrue to me under any U.S. law or executive order because of my occupational status.
NOTE: French nationals receiving a salary from the French Republic are also required to complete Form I-508F. French nationals
must submit both Form I-508 and Form I-508F together to U.S. Citizenship and Immigration Services (USCIS).

Part 3. Requestor's Statement, Contact Information, Certification, and Signature
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1.

2.

Requestor's Statement Regarding the Interpreter
A.

I can read and understand English, and have read and understand every question and instruction on this request, as well
as my answer to every question.

B.

The interpreter named in Part 4. has also read to me every question and instruction on this request, as well as my answer
to every question, in
, a language in which I am fluent.
I understand every question and instruction on this request as translated to me by my interpreter, and have provided
complete, true, and correct responses in the language indicated above.

Requestor's Statement Regarding the Preparer
I have requested the services of and consented to
is not an attorney or accredited representative, preparing this request for me.
who
is

,

Requestor's Contact Information
3.

Requestor's Daytime Telephone Number

5.

Requestor's Email Address (if any)

4.

Requestor's Mobile Telephone Number (if any)

Requestor's Certification
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 request, in supporting documents, and in my USCIS records to other
entities and persons where necessary for the administration and enforcement of U.S. immigration laws.
I certify, under penalty of perjury, that the information in my request and any document submitted with my request were provided by
me and are complete, true, and correct.

Requestor's Signature
6.

Requestor's Signature

Form I-508 03/31/15 N

Date of Signature (mm/dd/yyyy)

Page 2 of 5

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

Province

Postal Code

ZIP Code

Country

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

5.

Interpreter's Email Address (if any)

Interpreter's Certification
I certify that:
I am fluent in English and
in Part 3., Item B. in Item Number 1.;

, which is the same language provided

I have read to this requestor every question and instruction on this request, as well as the answer to every question, in the language
provided in Part 3., Item B. in Item Number 1.; and
The requestor has informed me that he or she understands every instruction and question on the request, as well as the answer to every
question, and the requestor verified the accuracy of every answer.

Interpreter's Signature
6.

Interpreter's Signature

Form I-508 03/31/15 N

Date of Signature (mm/dd/yyyy)

Page 3 of 5

Part 5. Contact Information, Statement, Certification, and Signature of the Person Preparing this
Request, If Other Than the Requestor
Provide the following information concerning the preparer.

Preparer's Full Name
1.

Preparer's Family Name (Last Name)

2.

Preparer's Business or Organization Name (if any)

Preparer's Given Name (First Name)

Preparer's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

ZIP Code

Country

Postal Code

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

6.

Preparer's Email Address (if any)

5.

Preparer's Fax Number

Preparer's Statement
7.

A.

I am not an attorney or accredited representative but have prepared this request on behalf of the requestor and with the
requestor's consent.

B.

I am an attorney or accredited representative and my representation of the requestor in this case
extends
does not extend beyond the preparation of this request.
NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this
request, you must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited
Representative, with this request.

Preparer's Certification
By my signature, I certify, swear, or affirm, under penalty of perjury, that I prepared this request on behalf of, at the request of, and
with the express consent of the requestor. I completed this request based only on responses the requestor provided to me. After
completing the request, I reviewed it and all of the requestor's responses with the requestor, who agreed with every answer on the
request. 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

Form I-508 03/31/15 N

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 request, 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 request 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 answer refers; and sign and date each sheet.
1.

Family Name (Last Name)

2.

A-Number (if any)

3.

A. Page Number

Given Name (First Name)

Middle Name

► AB. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

D.

4.

A. Page Number

D.

5.

A. Page Number

D.

6.

A. Page Number

D.

Form I-508 03/31/15 N

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