I-94Form
SampleForm
Actual FormsWillBeDistributedIn-flight
Português
O formulário I-94, RegistrodeCh-
egada/Saída, deveserpreenchidopor
todasaspessoas, excetocidadãos
americanos, estrangeiros residentes
nosEstadosUnidos, estrangeiros com
vistosde imigrantee
cidadãos canadenses emvisitaouem
trânsito. Este formulário registraa
chegadae saídade
visitantesaosEstadosUnidos. Escreva
apenasnaparteda frente, em inglês e
em letrasmaiúsculas. Guardeeste
formulárioatéa sua saídadosEs-
tadosUnidos. Agradecemosa sua
colaboração.
1. Sobrenome
2. Nome
3. Datadenascimento (dia/mês/ano)
4. Paísdecidadania
5. Sexo (masculinoou feminino)
6. Datadeemissãodo
passaporte (dia/mês/ano)
7. Datadevencimentodo
passaporte (dia/mês/ano)
8. Númerodopassaporte
9. Companhiaaéreaenúmerodovôo
10. Paísde residência
11. Cidadedeembarque
12. Cidadedaemissãodovisto
13. Datadaemissão (dia/mês/ano)
14. Endereçoenquantoestiver nos
EstadosUnidos (Númeroe rua)
15. CidadeeEstado
16. Telefoneondepoderá ser
localizadonosEUA
17. Endereçodee-mail
18. Sobrenome
19. Nome
20. Datadenascimento (dia/mês/ano)
21. Paísdecidadania
Français
Tous les ressortissants étrangers, à
l’exceptiondes ressortissants améric-
ains, des résidentspermanentsde
retour auxEtats-Unis, des étrangers
enpossessiondevisad’immigration,
ainsi quedes ressortissants canadiens
envisiteouen transit, doivent com-
pléter le formulaired’Arrivéeet de
Départ I-94.
Ce formulaireenregistre l’arrivéeet
ledépart des
visiteurs auxEtats-Unis. Veuillez
remplir seulement lapremièrepagedu
formulaireenanglais et enmajuscules.
Veuillezgarder ce formulaire jusqu’à
votredépart des
Etats-Unis. Nous vous remercionsde
votre collaboration.
1. Nomde famille
2. Prénom
3. Datedenaissance (jour/mois/an)
4. Paysdenationalité
5. Sexe (masculinou féminin)
6. Datededélivrancedupasseport
(jour/mois/an)
7. Dated’ expirationdupasseport
(jour/mois/an)
8. Numérodepasseport
9. Ligneaérienneet numérodevol
10. Paysde résidence
11. Villeoùvous avez
embarqué
12. Villeoù levisaaétédélivré
13. Datededélivrance (jour/mois/an)
14. Adresse lorsdevotre séjour aux
Etats-Unis (Numéroet rue)
15. Villeet état
16. Numérode téléphoneauxÉtats-
Unispermettant deprendre
contact avecvous
17. Adresseélectronique
18. Nomde famille
19. Prénom
20. Datedenaissance (jour/mois/an)
21. Paysdenationalité
Español
El formulario I-94, Registrode
Llegada/Salida, debe ser llenadopor
todapersona (excepto ciudadanos
de losEstadosUnidos, extranjeros
residentesenEstadosUnidosqueestán
regresando, extranjeros convisade
inmigrante, y ciudadanos
deCanadádevisitaode tránsito).
Este formulario
registra la llegaday salidadevisi-
tantes a losEstadosUnidos. Escribaen
el anverso solamente, con letramayús-
culayen inglés. Guardeeste formu-
lariohast que salgade losEstados
Unidos, ygraciaspor su cooperación.
1. Apellidopaterno
2. Primer nombre
3. Fechadenacimiento (día/mes/
año)
4. Paísde ciudadanía
5. Sexo (masculinoo femenino)
6. Fechaenque seexpidióel
pasaporte (día/mes/año)
7. Fechaenqueexpirael pasaporte
(día/mes/año)
8. Númerodepasaporte
9. Líneaaéreaynúmerodevuelo
10. PaísdondeUd. vive
11. Ciudaddondeabordóel avión
12. Ciudaddonde seemitió suvisa
13. Fechaemitida (día/mes/año)
14. Sudirecciónmientras estéen los
EstadosUnidos (Númeroy calle)
15. CiudadyEstado
16. Número telefónicodónde
localizarloenEstadosUnidos
17. Direcciónelectrónica (email)
18. Apellidopaterno
19. Primer nombre
20. Fechadenacimiento (día/mes/
año)
21. Paísde ciudadanía
NOVEMBER 15 2009
AMERICANWAY 123
The I-94WNonimmigrantVisaWaiverArrival/Departure formmust be completedby every nonim-
migrant visitor not inpossessionof a valid visawho is anational of one of the following countries:
ANDORRA
AUSTRALIA
AUSTRIA
BELGIUM
BRUNEI
CZECHREPUBLIC
DENMARK
ESTONIA
FINLAND
FRANCE
GERMANY
HUNGARY
ICELAND
IRELAND
ITALY
JAPAN
LATVIA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MALTA
MONACO
NETHERLANDS
NEWZEALAND
NORWAY
PORTUGAL
SANMARINO
SINGAPORE
SLOVAKREPUBLIC
SLOVENIA
SOUTHKOREA
SPAIN
SWEDEN
SWITZERLAND
UNITEDKINGDOM
I-94WVisaWaiverForm
ImportRestrictions:
There are strict procedures and vet-
erinary controls on the introductionof products of animal
origin into theEuropeanUnion. Travelersmust surrender
these products toCustoms inorder to avoidfines and/or
criminal prosecution. Please checknotices in the baggage
hall for additional information.
Japanese
DEPARTMENTOFHOMELANDSECURITY
U.S.Customs andBorderProtection
OMBNo.1651-0111
OMBNo. 1651-0111
OMBNo. 1651-0111
CBPForm I-94 (05/08)
CBPForm I-94 (05/08)
CBPForm I-94 (05/08)
STAPLEHERE
SeeOtherSide
AdmissionNumber
ArrivalRecord
000000000 00
AdmissionNumber
DepartureRecord
000000000 00
1.FamilyName
2.First (Given)Name
3.BirthDate (DD/MM/YY)
4.CountryofCitizenship
5.Sex (MaleorFemale)
8.PassportNumber
9.Airline andFlightNumber
10.CountryWhereYouLive
11.CountryWhereYouBoarded
12.CityWhereVisaWas Issued
13.Date Issued (DD/MM/YY)
14.AddressWhile in theUnitedStates (Number andStreet)
16.TelephoneNumber in theU.S.WhereYouCanbeReached
17.EmailAddress
18.FamilyName
19.First (Given)Name
20.BirthDate (DD/MM/YY)
21.Country ofCitizenship
DEPARTMENTOFHOMELANDSECURITY
U.S.CustomsandBorderProtection
15.City andState
6.Passport IssueDate (DD/MM/YY)
7.PassportExpirationDate (DD/MM/YY)
Welcome to theUnitedStates
I-94Arrival/DepartureRecord
Instructions
This formmust be completed by all persons exceptU.S.Citizens, returning resident aliens,
alienswith immigrant visas, andCanadianCitizens visitingor in transit.
Type or print legiblywith pen inALLCAPITAL LETTERS.Use English.Do notwrite on the
back of this form.
This form is in two parts.Please complete both theArrivalRecord (Items 1 through 17) and
theDepartureRecord (Items 18 through 21).
Whenall itemsare completed, present this form to theCBPOfficer.
Item 9 - If you are entering theUnitedStates by land, enter LAND in this space. If you are
entering theUnitedStates by ship, enterSEA in this space.
5U.S.C. § 552a(e)(3)PrivacyActNotice: Information collected on this form is required byTitle 8 of theU.S.Code,
including the INA (8U.S.C. 1103, 1187), and 8CFR 235.1, 264, and 1235.1.The purposes for this collection are to
give the terms of admission and document the arrival and departure of nonimmigrant aliens to the U.S. The
information solicitedon this formmaybemade available toothergovernment agencies for law enforcementpurposes
or to assistDHS in determining your admissibility.All nonimmigrant aliens seeking admission to theU.S., unless
otherwise exempted,must provide this information. Failure to provide this informationmay deny you entry to the
UnitedStates and result in your removal.
English
