| 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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