I-94入离境记录表 | | 请您预先填写 |
U.S. Department of Justice OMR 1115-4077 Immigration and Naturalization service | 美国司法部 OMR 1115-407 移民局 | |
Welcome to the United State | 欢迎来到美国 | |
Admission Number 233414639 09 | 登记号码 (*举例说明) 233414639 09 | |
I-94 Arrival/Departure Record-Instructions | I-94 入境/离境记录说明 | |
This form must be completed by all persons except U.S. citizens, returning resident aliens with immigrant visas, and Canadian Citizens visiting or in transit. | 除了美国公民,美国海外侨民,永久居民和加拿大公民外,所有访问或过路的人士都必须填写此表
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Type or print legibly with pen in ALL CAPITAL LETTERS. Use English. Do not write on the back of this form. | 请用大写字母打字或用钢笔或用圆珠笔清楚填写. 请用英文填写. 不要在此表背面填写任何东西. | |
This form is in two parts. Please complete both the Arrival Record (Item 1 through 13) and the Departure Record (Item 14 through 17). | 此表包括两部分,请填写入境记录 (第1项至第13项)和离境记录(第 14项至第17项)两部分. | |
When all items are completed, present this form to the U.S. Immigration and Naturalization Service Inspector. | 填写完毕后, 请将此表交给美国移民局官员. | |
Item 7– If you are entering the United States by land, enter LAND in this space. If you are entering the United States by ship, enter SEA in this space. | 第7项内容说明,如果你从陆地进入美国,请在空格内填写LAND,如果你乘船进入美国,请在空格内填写SEA. | |
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Form I-94(10-01-85)N | I-94表 (10-01-85)N | |
Admission Number 233414639 09 | 登记号码 233414639 09 | |
Immigration and Naturalization Service | 移民局 | |
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I-94 Arrival Record | I-94 入境记录 | |
1. Family Name | 1. 姓 | |
2. First (Given) Name | 2. 名 | |
3. Birth Date(Day/Mo/Yr) | 3. 生日(月/日/年) | |
4. Country of Citizenship | 4. 哪个国家公民 | |
5. Sex (Male or Female) | 5. 性别(男填MALE或女填FEMALE) | |
6. Passport Number | 6. 护照号码 | |
7. Airline & Flight Number | 7. 航空公司和航班号 | |
8. Country Where You Live | 8. 你在哪个国家生活 | |
9. City Where You Boarded | 9. 你在那个城市登机 | |
10. City Where Visa Was Issued | 10. 在哪个城市得到签证 | |
11. Date Issued (Day/Mo/Yr) | 11. 得到签证的日期(日/月/年) | |
12. Address While in the United State (Number and Street) | 12. 在美国的住址(门牌号及街名) | |
13. City and State | 13. 在美国的住址(市名及州名) | |
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Departure Number 233414639 09 | 离境号码 233414639 09 | |
Immigration and Naturalization Service | 移民局 | |
I-94 Departure Record | I-94离境记录 | |
14. Family Name | 14. 姓 | |
15. First (Given) Name | 15. 名 | |
16. Birth Date(Day/Mo/Yr) | 16. 生日(日/月/年) | |
17. County of Citizenship | 17. 哪个国家公民 |
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| 蓝色的报关单(Customs Declaration) | 请您预先填写 |
1 | Family Name (姓) | |
| First (Given) (名) | |
| Middle (中间名) | (此处不填) |
2 | Birth date (出生日期)(日/月/年) | |
3 | Number of Family numbers traveling with you (随行家庭成员人数) | 5 |
4 | (a)U.S. Street Address(hotel name/destination) (在美国的地址街名(目的地) | |
| (b)City (市) | |
(b) City(市) | (c) State (州) | |
5 | Passport issued by (country) (发照地(国家)) | CHINA |
6 | Passport number (护照号码) | |
7 | Country of Residence (居住国) | China |
8 | Country visited on this trip prior to U.S. arrival (这次抵达美国之前曾去过的国家) | |
9 | Airline/Flight No. or Vessel Name (航空公司 / 航班号码或船名) | |
10 | The primary purpose of this trip is business (这次旅行的主要目的去业务出差) | No |
11 | I am (We are) (我 (我们) 携带) ? | No |
| (a) 水果,蔬菜,植物,种子,食品,昆虫 Yes(是):No(否): | No |
| (b) 肉类,动物,动物/野生动物产品 Yes(是):No(否): | No |
| (c) 疾病媒体,细胞培养提,蜗牛 Yes(是):No(否): | No |
| (d) 土壤,或曾经到过农场/牧场/饲养场 Yes(是):No(否): | No |
12 | 我 (我们) 曾经非常接近 (如摸过或者处理过) 牲畜 Yes(是):No(否): | No |
13 | 我 (我们) 携带超过10000美元或相等数额的外国货币的现金或代金 (代金的定义见背面说明) Yes(是):No(否): | No |
14 | 我 (我们) 携带超过11(可供销售的物品,用于招揽订单的样品,或不属于个人用品的物品)Yes(是):No(否): | No |
15 | 选择“Visitor 来访者 ” ?来访者将留在美国的所有物品 (或者商品) 的总价值为 | _$100___ |
15 | 本人已经读过本申报单背面的重要说明,并且已如实申报。(在X 后面用中文签名) | |
| X | |
| Signature (签名) Date (day/month/year) (日期 (日/月/年) ) |
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