CBP Form I-736 Guam-CNMI Visa Waiver Information

DEPARTMENT OF HOMELAND SECURITY

OMB CONTROL NUMBER 1651-0109
EXPIRATION DATE 12/31/2020

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 # 1-30; 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 sections are completed, you must
review for accuracy, read the certification section and sign or certify the form as applicable. This paper form must be presented to the U.S. Customs and
Border Protection Officer until the electronic equivalent is required. * The airline can provide you with the current list of eligible countries.
Important Message: If you are a citizen or a national of any of the following countries: Australia, Brunei, Japan, New Zealand, South Korea,
Singapore, United Kingdom or the geographical area of Taiwan with an approved and unexpired Electronic System for Travel Authorization,
commonly known as ESTA, or a U.S. visa, you do not need to complete this form.
Are you a citizen/national of the People’s Republic of China (PRC)?
No
Yes
Warning: The maximum stay for PRC nationals/citizens is 14 days.
1. Surname/Family Name (exactly as in passport)
2. First (Given) Name and Middle Name (exactly as in passport)
3. Are you known by any other names or aliases?

Yes

No

If yes: Alias Surname/Family Name:

Alias First (Given) Name:
Alias First (Given) Name:

Alias Surname/Family Name:
4. Date of Birth (mm/dd/yyyy)
7. Gender

5. City of Birth

6. Country of Birth
9. What is your National Identification Number?

8. Country of Citizenship

10. Passport Number

Issuing Country

Passport Issuing Date
(mm/dd/yyyy)

11. Have you ever been a citizen or a national of any other country?

Yes

Passport Expire
Date (mm/dd/yyyy)

No

If yes, provide the country of Citizenship/Nationality:
Yes

12. Have you ever been issued a passport or national identity card for travel by any other country?
If yes, then:

Personal

Official

No

Diplomatic

Issuing Country

Document Type

Document Number

Expiration Date
(mm/dd/yyyy)

Issuing Country

Document Type

Document Number

Expiration Date
(mm/dd/yyyy)

Yes

13. Are you now a citizen or national of any other country?

No

If yes, then provide the country of citizenship/nationality:
14. How did you acquire citizenship/nationality from this country?

15. Have you ever applied for an immigrant or nonimmigrant U.S. visa before?
Place you applied
Was Visa issued?

Date you applied (mm/dd/yyyy)
Yes

No

Yes

No

If yes, then:

Type of Visa requested?

If no, then, was application withdrawn or denied?

Yes

No

If yes, has your Visa ever been cancelled?

Yes

No

16. Are you a member of the CBP Global Entry Program?

Yes

No

If yes, provide the PASSID/Membership Number:
17. Are you under the age of 14?

Yes

No

If yes:

Father First (Given) Name

Father Surname/Family Name

Mother First (Given) Name

Mother Surname/Family Name

CBP Form I-736 (9/22)

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18. Personal Contact Information
Email

Country Code and Phone Number

Home Address

City

State/Province/Region

Country

19. Address while in Guam or CNMI
Address

City

Guam

Phone Number

CNMI
20. Emergency Contact Information In or Out of the United States
Family Name
First (Given) Name

Email Address
Country Name

Phone Number

Country Code

21. Do you have a physical or mental disorder; or are you a drug abuser or addict; or do you currently have any of the following diseases?
Communicable diseases are specified pursuant to section 361(b) of the Public Health Service Act: Cholera, Diphtheria, Tuberculosis infectious, Plague,
Smallpox, Yellow Fever, Viral Hemorrhagic Fevers, including Ebola, Lassa, Marburg, Crimean-Congo, severe acute respiratory illnesses capable of
transmission to other persons and likely to cause mortality.
Yes
No
22. Have you ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another person or
government authority?
Yes
No
23. Have you ever violated any law related to possessing, using, or distributing illegal drugs?

Yes

No

24. Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide?

Yes

No

25. Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to obtain, a visa or entry into the United States?
Yes
No
26. Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government?
Yes

No

27. Are you currently seeking employment in Guam or CNMI?

Yes

No

28. Were you previously employed in the United States without prior permission from the U.S. government?

Yes

No

29. Have you traveled to, or been present in Iraq, Syria, Iran, Sudan, Libya, Somalia, North Korea or Yemen on or after March 1, 2011?
Yes
No
30. Valid Email Address
31. OPTIONAL
Social Media Identifier (user name/screen name/information associated to your social
media profile)
Social Media Provider/Platform ( i.e., Facebook, Twitter, LinkedIn, Instagram, YouTube, websites you use to collaborate/share information, etc.)
Other
Important Notice: Your admission into and stay on Guam or the CNMI is for maximum period of forty-five (45) days. The maximum stay for PRC
nationals/citizens into CNMI is 14 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 19 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, 90K Street, NE., Washington DC 20229.

CBP Form I-736 (9/22)

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