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

• Legal Form Number: I-508
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

Page 1 of 6Form I-508 Edition 12/08/21

Waiver of Certain Rights, Privileges,

Exemptions, and Immunities

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-508

OMB No. 1615-0025

Expires 12/31/2023

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

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

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

Country

Ste. NumberFlr.Apt.

In Care Of Name

Province Postal Code

ZIP CodeStateCity or Town

Mailing Address6.

4.U.S. Social Security Number (if any)3. Date of Birth (mm/dd/yyyy)

►A-

Part 1. Information About the Person Filing This Waiver Form

1.

2.

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Given Name (First Name) Family Name (Last Name) Middle Name

8. Physical Address

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

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

7. Yes No

Employment Information9.

Name of Mission or Organization

Country

Ste. NumberFlr.Apt.Street Number and Name

Province Postal Code

ZIP CodeStateCity or Town

Country

Ste. NumberFlr.Apt.Street Number and Name

Province Postal Code

ZIP CodeState

City or Town

Street Number and Name