Fillable Printable Application Form for a US Visa Waiver
Fillable Printable Application Form for a US Visa Waiver
Application Form for a US Visa Waiver
THIS FORM MUST BE RETURNED TO THE PASSPORT & CORPORATE SERVICES OFFICE IN
ORDER FOR A U.S. VISA WAIVER TO BE ISSUED FOR ONE VISIT TO THE UNITED STATES
WHEN TRAVELLING DIRECT FROM THE CAYMAN ISLANDS
NAME: ______________________________________________________________________________________________________
POSTAL ADDRESS IN THE CAYMAN ISLANDS: ________________________________________________________________
TELEPHONE #: (DAYTIME #) _____________________ EMAIL ADDRESS: ________________________________________
(We may need to get in touch with you urgently)
ARE YOU OR HAVE YOU EVER BEEN ASSOCIATED WITH EITHER THE COMMUNIST, NAZI OR FASCIST PARTIES
OR WITH ANY AFFILIATES OF THOSE ORGANISATIONS?
______________________________________________________________________________________________________________
HAVE YOU EVER BEEN DENIED A U.S. VISA OR ENTRY INTO THE U.S. OR HAD A U.S. VISA CANCELLED?
YES or NO
IF YES, WHEN? ___________________________________ WHERE? _________________________________________________
HAVE YOU EVER BEEN ARRESTED OR CONVICTED OF A CRIMINAL OFFENSE?
YES or NO
IF YES, PLEASE PROVIDE FURTHER DETAIL AND DATE OF SUCH CONVICTION (S)
______________________________________________________________________________________________________________
ADDRESS IN THE USA WHERE APPLICANT INTENDS TO STAY OR MAKE HIS/HER HEADQUARTERS DURING
VISIT:
______________________________________________________________________________________________________________
LENGTH OF PROPOSED VISIT: ________________________________________________________________________________
PURPOSE OF PROPOSED VISIT: _______________________________________________________________________________
PROPOSED DATE AND TIME OF TRAVEL: _____________________________________________________________________
INTENDED ADDRESS OF APPLICANT AFTER LEAVING THE USA AT THE END OF THE PROPOSED VISIT:
______________________________________________________________________________________________________________
I, ______________________________, do solemnly and sincerely declare thatthe particulars given in this application are, tothe
best of my knowledge and belief, true and complete. I do further declare that to the best ofmy knowledge and belief, US
Immigration does not debarme from entry intothe United States. I further declare thatI WILL NOT, during the period of my
visit to the United States of America, perform any skilled or unskilled labor or take any form of employment whether in exchange
for a wage or otherwise, and I make this solemn declaration conscientiously believing the same to be true, andby virtue of the
voluntary declaration law.
Taken and acknowledged this _____ day of __________ 20 ___.
________________________________
Signature of Applicant
A parent must sign this form if child is under 18 years of age.
Prepared by: Passport & Corporate Services Office, Immigration Department - 2011-04-11
APPLICATION FORM FOR A
UNITED STATES VISA WAIVER
APPLYING FOR A VISA WAIVER TO VISIT THE UNITED STATES
TO APPLY FOR A VISA WAIVER YOU WILL NEED TO SUBMIT:-
a)Your valid Cayman Islands (CI) Passport;
b)Completed application form for a US Visa waiver (overleaf);
c)CI$25.00 cash/cheque 3-4 business days or CI$50.00 Express Service;
d)A recent Police Clearance Certificate for applicants 13 years of age or older.
REQUIREMENTS:-
CI Passports must be valid for at least 6 months beyond the date of intended departure from the USA.
CI Passports must be machine readable for a U.S. visa waiver to be issued.
You should submit yourcompletedapplication at least 4 business days prior to your departure date. If you
require a waiver prior to this, you may be required to submit supporting documents to verify your travel plans.
A Police clearance certificate is valid for 3 months but may only be used for one entry into the U.S.
INFORMATION:-
If your police certificate lists any convictions, a U.S. Visa waiver cannot be issued.
If you have applied for a U.S. Visa and was unsuccessful with obtaining a U.S. Visa, a U.S. Visa waiver cannot be
issued.
A U.S. Visa waiver is issued for visiting purposes only.
Under the Western Hemisphere Travel Initiative with effect from 23
rd
Jan, 2007, all persons, including U.S.
citizens, traveling by air from the Cayman Islands to the U.S. will be required to present a valid passport. If you
are a born U.S. citizen you should travel on yourU.S. Passport. The issuance of a Visa Waiver by the C.I.
Passport Office and a Police ClearanceCertificate accompanying your B.O.T.C. (Cayman Islands) Passport does
not guarantee you admission into the United States.
THE PASSPORT & CORPORATE SERVICES OFFICE OPENING HOURS:
MONDAY –FRIDAY, 9:00AM – 3:00PM
Once your travel documents have been filed with the Passport & Corporate Services Office and a date/time arranged
for collection, you must ensure that they are collected prior to the closure of this office.
If you forget to collect your travel document(s) before your scheduled travel time, staff will not be in the position to
assist you by coming into the Passport & Corporate Services Office after hours or on weekends.
Prepared by: Passport & Corporate Services Office, Immigration Department - 2011-04-11
