Request for Waiver of Certain Rights, Privileges, Exemptions, and Immunities Department of Homeland Security U.S. Citizenship and Immigration Services Form I-508F executed USCIS Form I-508 OMB No. 1615-0025 Expires 03/31/2017 For Government Use Only Requestor is a French national paid by the French Republic Exempt from U.S. taxes Not exempt from U.S. taxes Remarks START HERE - Please type or print in black ink. Part 1. Information About the Person Filing This Request 1. Family Name (Last Name) Given Name (First Name) Middle Name 2. Alien Registration Number (A-Number) (if any) A- 3. U.S. Social Security Number (if any) 4. Date of Birth (mm/dd/yyyy) 5. U.S. State Department-Issued Personal Identification Number (PID) 6. Mailing Address In Care Of Name Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country 7. Is your current mailing address the same as your physical address? If you answered "No," provide your physical address in Item Number 8. Yes No 8. Physical Address Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country 9. Employment Information Name of Mission or Organization Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country Form I-508 03/31/15 N Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Part 2. Waiver Statement I, , believe that I have an occupational status entitling me to nonimmigrant status under section 101(a)(15)(A), (E), or (G) of the Immigration and Nationality Act (INA) as a government official, treaty trader or treaty investor, or international organization representative, respectively. Accordingly, as I seek to acquire or retain lawful permanent resident status, I hereby waive all diplomatic rights, privileges, exemptions, and immunities that would otherwise accrue to me under any U.S. law or executive order because of my occupational status. NOTE: French nationals receiving a salary from the French Republic are also required to complete Form I-508F. French nationals must submit both Form I-508 and Form I-508F together to U.S. Citizenship and Immigration Services (USCIS). Part 3. Requestor's Statement, Contact Information, Certification, and Signature NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2. 1. Requestor's Statement Regarding the Interpreter A. B. I can read and understand English, and have read and understand every question and instruction on this request, as well as my answer to every question. The interpreter named in Part 4. has also read to me every question and instruction on this request, as well as my answer to every question, in , a language in which I am fluent. I understand every question and instruction on this request as translated to me by my interpreter, and have provided complete, true, and correct responses in the language indicated above. 2. Requestor's Statement Regarding the Preparer I have requested the services of and consented to is not an attorney or accredited representative, preparing this request for me. who is , Requestor's Contact Information 3. Requestor's Daytime Telephone Number 4. Requestor's Mobile Telephone Number (if any) 5. Requestor's Email Address (if any) Requestor's Certification Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek. I furthermore authorize release of information contained in this request, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws. I certify, under penalty of perjury, that the information in my request and any document submitted with my request were provided by me and are complete, true, and correct. Requestor's Signature 6. Requestor's Signature Date of Signature (mm/dd/yyyy) Form I-508 03/31/15 N Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Part 4. Interpreter's Contact Information, Certification, and Signature Provide the following information concerning the interpreter. Interpreter's Full Name 1. Interpreter's Family Name (Last Name) Interpreter's Given Name (First Name) 2. Interpreter's Business or Organization Name (if any) Interpreter's Mailing Address 3. Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country Interpreter's Contact Information 4. Interpreter's Daytime Telephone Number 5. Interpreter's Email Address (if any) Interpreter's Certification I certify that: I am fluent in English and in Part 3., Item B. in Item Number 1.; , which is the same language provided I have read to this requestor every question and instruction on this request, as well as the answer to every question, in the language provided in Part 3., Item B. in Item Number 1.; and The requestor has informed me that he or she understands every instruction and question on the request, as well as the answer to every question, and the requestor verified the accuracy of every answer. Interpreter's Signature 6. Interpreter's Signature Date of Signature (mm/dd/yyyy) Form I-508 03/31/15 N Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Part 5. Contact Information, Statement, Certification, and Signature of the Person Preparing this Request, If Other Than the Requestor Provide the following information concerning the preparer. Preparer's Full Name 1. Preparer's Family Name (Last Name) Preparer's Given Name (First Name) 2. Preparer's Business or Organization Name (if any) Preparer's Mailing Address 3. Street Number and Name Apt. Ste. Flr. Number City or Town State ZIP Code Province Postal Code Country Preparer's Contact Information 4. Preparer's Daytime Telephone Number 5. Preparer's Fax Number 6. Preparer's Email Address (if any) Preparer's Statement 7. A. B. I am not an attorney or accredited representative but have prepared this request on behalf of the requestor and with the requestor's consent. I am an attorney or accredited representative and my representation of the requestor in this case extends does not extend beyond the preparation of this request. NOTE: If you are an attorney or accredited representati