美国海关出入境登记表 ( I-94 FORM )

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

697385031 01 登记号码 (*举例说明)

697385031 01

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

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.

Form I-94(10-01-85)N I-94表 (10-01-85)N

Admission Number

697385031 01 登记号码

697385031 01

Immigration and Naturalization Service 移民局

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. 你在那个城市降落

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)

Departure Number

697385031 01 离境号码

697385031 01

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 16. Birth Date(Day/Mo/Yr) 15. 名 16. 生日(日/月/年)

17. County of Citizenship 17. 哪个国家公民