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

Waiver of Certain Rights, Privileges,
Exemptions, and Immunities

USCIS
Form I-508

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

OMB No. 1615-0025
Expires 12/31/2023

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

Part 1. Information About the Person Filing This Waiver Form

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1.

Family Name (Last Name)

2.

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

Given Name (First Name)

3.

Middle Name

U.S. Social Security Number (if any)

4.

Date of Birth (mm/dd/yyyy)

►

5.

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

6.

Mailing Address

In Care Of Name

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

7.

Postal Code

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 Edition 12/08/21

Postal Code

ZIP Code

Country

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Part 2. Waiver Statement
1.

I,

, believe that I have an

occupational status entitling me to nonimmigrant status under Immigration and Nationality Act (INA) section 101(a)(15)(A), (E),
or (G) as a government official, treaty trader or treaty investor, other position covered under the E classification, or international
organization representative, respectively.

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Accordingly, as I seek to acquire or retain lawful permanent resident status, I hereby waive and understand that I will no longer be
eligible for any and all diplomatic rights, privileges, exemptions, and immunities that would otherwise be granted to me under any
law or executive order because of my occupational status.

Part 3. Contact Information, Certification, and Signature of the Person Executing This Waiver Form
Provide your daytime telephone number, mobile telephone number (if any), and email address (if any).

Person Executing This Waiver Form's Contact Information
1.

Person Executing this Waiver Form's Daytime Telephone Number

2.

Person Executing this Waiver Form's Mobile Telephone Number (if any)

3.

Person Executing this Waiver Form's Email Address (if any)

Certification and Signature

I certify, under penalty of perjury, that I provided or authorized all of the responses and information contained in and submitted with
my waiver form, I read and understand or, if interpreted to me in a language in which I am fluent by the interpreter listed in Part 4.,
understood, all of the responses and information contained in, and submitted with, my waiver form, and that all of the responses and
the information is complete, true, and correct. Furthermore, I authorize the release of any information from any and all of my records
that USCIS may need to determine my eligibility for an immigration request and to other entities and persons where necessary for the
administration and enforcement of U.S. immigration law.
4. Person Executing This Waiver Form's Signature
Date of Signature (mm/dd/yyyy)

Part 4. Interpreter's Contact Information, Certification, and Signature
Interpreter's Full Name
1.

Interpreter's Family Name (Last Name)

2.

Interpreter's Business or Organization Name

Interpreter's Given Name (First Name)

Interpreter's Contact Information
3.

Interpreter's Daytime Telephone Number

5.

Interpreter's Email Address (if any)

Form I-508 Edition 12/08/21

4.

Interpreter's Mobile Telephone Number (if any)

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Part 4. Interpreter's Contact Information, Certification, and Signature (continued)
Interpreter's Certification and Signature
I certify, under penalty of perjury, that I am fluent in English and

,

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and I have interpreted every question on this waiver form and Instructions and interpreted the person executing this waiver form's
answers to the questions in that language, and the person executing this waiver form informed me that they understood every
instruction, question, and answer on the waiver form.
6.

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

Part 5. Contact Information, Declaration, and Signature of the Person Preparing this Waver Form,
if Other Than the Person Executing this Waiver Form
Preparer's Full Name
1.

Preparer's Family Name (Last Name)

2.

Preparer's Business or Organization Name

Preparer's Given Name (First Name)

Preparer's Contact Information
3.

Preparer's Daytime Telephone Number

5.

Preparer's Email Address (if any)

4.

Preparer's Mobile Telephone Number (if any)

Preparer's Certification and Signature

I certify, under penalty of perjury, that I prepared this waiver form for the person executing this waiver form at their request and with
express consent and that all of the responses and information contained in and submitted with the waiver form is complete, true, and
correct and reflects only information provided by the person executing this waiver form. The person executing this waiver form
reviewed the responses and information and informed me that they understand the responses and information in or submitted with the
waiver form.
6.

Preparer's Signature

Form I-508 Edition 12/08/21

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 waiver form, 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 waiver form 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 additional information refers; and sign and date each sheet.

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1.

Family Name (Last Name)

2.

A-Number (if any)

3.

A. Page Number

D.

4.

5.

Middle Name

► A-

A. Page Number

D.

Given Name (First Name)

A. Page Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

D.

6.

A. Page Number

D.

Form I-508 Edition 12/08/21

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