Form CBP Form I-736 CBP Form I-736 Guam-CNMI Visa Waiver Information

DEPARTMENT OF HOMELAND SECURITY

OMB Approval No: 1651-0109
Expiration Date: 03/31/2019
Estimated Burden: 19 Min.

U.S. Customs and Border Protection

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 sections are completed, you must review for accuracy, read the certification
section and sign or certify the form as applicable. This paper form must be presented to the U.S. Customs and Border Protection Officer
until the electronic equivalent is required. * The airline can provide you with the current list of eligible countries.
Important Message: If you are a citizen or a national of any of the following countries: Australia, Brunei, Japan, New Zealand,
South Korea, Singapore, United Kingdom or the geographical area of Taiwan with an approved and unexpired Electronic
System for Travel Authorization, commonly known as ESTA, you do not need to complete this form.
1. Surname/Family Name (exactly as in passport)
3. Are you known by any other names or aliases?

2. First (Given) Name and Middle Name (exactly as in passport)
Yes

No

If yes: Alias Surname/Family Name:

Alias First (Given) Name:

Alias Surname/Family Name:

Alias First (Given) Name:

4. Date of Birth (mm/dd/yyyy)
7. Gender
10. Passport Number

5. City of Birth

6. Country of Birth
9. What is your National Identification Number?

8. Country of Citizenship
Issuing Country

Passport Issuing Date Passport Expire
(mm/dd/yyyy)
Date (mm/dd/yyyy)

11. Have you ever been a citizen or a national of any other country?

Yes

No

If yes, provide the country of Citizenship/Nationality:
12. Have you ever been issued a passport or national identity card for travel by any other country?

Yes

No

If yes, then:
Issuing Country

Document Type

Document Number

Expiration Date
(mm/dd/yyyy)

Issuing Country

Document Type

Document Number

Expiration Date
(mm/dd/yyyy)

13. Are you now a citizen or national of any other country?

Yes

No

If yes, then provide the country of citizenship/nationality:
14. How did you acquire citizenship/nationality from this country?

15. Have you ever applied for an immigrant or nonimmigrant U.S. visa before?
Place you applied

Was Visa issued?

CBP Form I-736 (5/18)

Date you applied (mm/dd/yyyy)

Yes

No

Yes

No

If yes, then:

Type of Visa requested?

If no, then, was application withdrawn or denied?

Yes

No

If yes, has your Visa ever been cancelled?

Yes

No
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16. Are you a member of the CBP Global Entry Program?

Yes

No

If yes, provide the PASSID/Membership Number:
17. Are you under the age of 14?

Yes

No

If yes:

Father First (Given) Name

Father Surname/Family Name

Mother First (Given) Name

Mother Surname/Family Name

18. Personal Contact Information
Email

Country Code and Phone Number

Home Address

City

State/Province/Region

Country

19. Address while in Guam or CNMI
Address

Guam

City

Phone Number

CNMI
20. Emergency Contact Information In or Out of the United States
Family Name

First (Given) Name

Email Address

Country Code

Phone Number

Country Name

21. Do you have a physical or mental disorder; or are you a drug abuser or addict; or do you currently have any of the following
diseases? Communicable diseases are specified pursuant to section 361(b) of the Public Health Service Act: Cholera, Diphtheria,
Tuberculosis infectious, Plague, Smallpox, Yellow Fever, Viral Hemorrhagic Fevers, including Ebola, Lassa, Marburg, Crimean-Congo,
severe acute respiratory illnesses capable of transmission to other persons and likely to cause mortality.
Yes
No
22. Have you ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another
Yes
No
person or government authority?
23. Have you ever violated any law related to possessing, using, or distributing illegal drugs?

Yes

No

24. Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide?

Yes

No

25. Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to obtain, a visa or entry into the
Yes
No
United States?
26. Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government?
Yes

No

27. Are you currently seeking employment in Guam or CNMI?

Yes

No

28. Were you previously employed in the United States without prior permission from the U.S. government?

Yes

No

29. Have you traveled to, or been present in Iraq, Syria, Iran, Sudan, Libya, Somalia, or Yemen on or after March 1, 2011?
Yes

No

CBP Form I-736 (5/18)

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Important Notice : Your admission into and stay on Guam or the CNMI is for maximum period of forty-five (45) days. You may not
apply for: (1) a change of nonimmigrant status; (2) adjustment of status to temporary or permanent resident; or (3) an extension of stay.
Warning : You are ineligible for admission to Guam or the CNMI if you have previously violated the terms of any prior admission to the
United States under the Guam-CNMI Visa Waiver Program or the prior Guam Visa Waiver Program. Violation of the terms of a current
admission will render you subject to removal from Guam or the CNMI. A nonimmigrant who accepts unauthorized employment is
subject to removal.
Waiver of Rights: I hereby waive any rights to review or appeal a CBP Officer’s determination as to my admissibility, or to contest,
other than on the basis of an application for asylum, any action in removal proceedings.
Certification: I certify that I have read and understand all the questions and statements on this form. The answers I have furnished
are true and correct to the best of my knowledge and belief.

Signature

Date

Paperwork Reduction Act Notice: A person is not required to respond to a collection of information unless it displays a currently valid
OMB control number. This collection of information is estimated to average 19 minutes per response, including the time for reviewing
instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any aspect of this collection of information, including suggestions for
reducing this burden to: U.S. Customs and Border Protection, Office of Regulations and Rulings, 90K Street, NE., Washington DC 20229.

CBP Form I-736 (5/18)

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