OMB No. 1115-0073 Application to Pay Off or Discharge Alien Crewman U.S. Department of Justice Immigration and Naturalization Service (To be filed in triplicate. See Instructions on reverse) I. Arrival Manifest Filed at (Port): Carrier: Date of Arrival: I hereby request authorization to PAY OFF/DISCHARGEthe alien crewmen listed below. II. Name in Full Family Name Given Name and Middle Initial Nationality and Passport Number Action by INS (If additional space is required, attached list in triplicate) III. Reason for request: IV. Arrangements for departure from the U.S. of the listed crewmen are (date and port of departure, air carrier and flight number or vessel). Mailing Address of Carrier: Signature Title FOR GOVERNMENT USE ONLY Application: Office: Signature and Title: Granted Denied Date: Copy: Mailed Delivered Date: Signature: Title: Form I-408 (Rev. 05/17/00)Y American LegalNet, Inc. www.USCourtForms.com NOTICE SECTION 256 OF THE IMMIGRATION AND NATIONALITY ACT (8 USC 1286) It shall be unlawful for any person, including the owner, agent, consignee, charterer, master or commanding officer vessel or aircraft, to pay off or discharge an alien crewman, except an alien lawfully admitted for permanent residence, employed on board a vessel or aircraft arriving in the United States without first having obtained the consent of the Attorney General. If it shall appear to the satisfaction of the Attorney General that any alien crewman has been paid off or discharged in the United States in violation of the provisions of this section, such owner, agent, consignee, charterer, master, commanding officer or other person, shall pay to the Commissioner the sum of $3,000 for each such violation. No vessel or aircraft shall be granted clearance pending the determination of the question of the liability to the payment of such sums or while such sums remain unpaid, except that clearance may be granted prior to the determination of such question of the liability to the payment of such sums or while such sums remain unpaid, except that clearance may be granted prior to the determination of such question upon the deposit of an amount sufficient to cover such sums, or of a bond approved by the Commissioner with sufficient surety to secure the payment thereof. Such fine may, in the discretion of the Attorney General, be mitigated to not less than $1,500 for each violation, upon such terms as he shall think proper. INSTRUCTIONS 1. Filing: The application must be completed in triplicate and delivered or mailed to the nearest office of the Immigration and Naturalization Service. 2. Execution: The signature and title of either the owner, agent, consignee, charterer, master or commanding officer of the vessel or aircraft seeking authorization to pay off or discharge crewmen must be included on the application. 3. General: Inadequate or incomplete data required in items III, Reason for request, and IV, Arrangements for departure, may result in denial of the application. 4. Disposition: The original and one copy of the granted application will be returned to the applicant. The copy must be submitted with the departure manifest. One copy of the application will be retained by the Immigration and Naturalization Service with the arrival manifest. REPORTING BURDEN PUBLIC REPORTING BURDEN. Reporting burden for this collection of information is estimated to average 15 minutes per response. If you have comments regarding the accurancy of this estimate, or suggestions for making this form simpler, you can write to the U.S. Department of Justice, Immigration and Naturalization Service, HQPDI, 425 I Street N.W., Room 4034, Washington, DC 20536; OMB No. 1115-0073. DO NOT MAIL YOUR COMPLETED APPLICATION TO THIS ADDRESS. Form I-408 (Rev. 05/17/00)Y Page 2 American LegalNet, Inc. www.USCourtForms.com