OMB N0. 1651-0114
DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
C R E W M AN ’S LA NDIN G PERMIT
Expires 10/31/2011
Family Name Given Name Initial
Home Address
Address in United States
Hair
Eyes
Ht.
Wt.
Date of Birth
Place of Birth
Passport Number/Nationality
Arrived by
Air
Sea
CBP Form I-95 (06/09)
Arrival
Date
Place of
Arrival
CBP Officer Signature
By accepting this conditional permit to land, the holder agrees to all the
conditions incident to the issuance thereof and to deportation from the United
States in accordance with the provisions of section 252(b) of the Immigration
and Nationality Act.
CBP Form I-95 (06/09)
FIN or “A” No.
CREWMAN’S LANDING PERMIT
Department of Homeland Security – U.S. Customs and Border Protection
Completion of this form is mandatory pursuant to 8 U.S. C. 1281. Data is used by DHS for
alien crewman control. By accepting this conditional permit to land, the holder agrees to all
the conditions incident to the issuance thereof, and to deportation from the United States
in accordance with the provisions of section 252(b) of the Immigration and Nationality Act.
Paperwork Reduction Act Statement: An agency may not conduct or sponsor an
information collection and a person is not required to respond to this information unless it
displays a current valid OMB control number and an expirati