DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
OMB No. 1651-0109
Expires 08/31/2012
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 # 1-9; 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 items are completed, present this form to the U.S. Customs and Border
Protection Officer along with your completed CBP Form I-94, Arrival/Departure Record. * The airline can provide you with the current
list of eligible countries.
1. Surnames/Family Names (exactly as in passport)
2. First Name and Middle Name
3. Other Names Used
4. Date of Birth (Day/Month/Year)
5. Place of Birth (City and Country)
6. Passport Number
7. Date Passport Issued (Day/Month/Year)
8. Have you applied for an immigrant or nonimmigrant
U.S. visa before?
No
Yes (if yes, complete the following)
Place you applied
Date you applied (Day/Month/Year)
Type of visa requested
Was visa issued?
No
Yes
Has your U.S. visa ever been cancelled?
No
Yes
9. All applicants must read and answer the following:
A visa waiver is not available to persons who are within
specific categories defined by law as inadmissible to the
United States (except when a waiver is obtained in
advance). Complete information regarding these categories
and whether any may be applicable to you can be obtained
from U.S