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
233414639 09

登记号码 (*举例说明)
233414639 09

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
233414639 09

登记号码
233414639 09

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. 你在那个城市登机

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
233414639 09

离境号码
233414639 09

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

WELCOME TO THE UNITED STATES

欢迎来到美国

DEPARTMENT OF THE TREASURY
UNITED STATES CUSTOMS SERVICE

财政部
美国海关署

CUSTOM DECLARATION

海关申报

Each arriving traveler or head of family must provide the following information (only ONE written declaration per family is required):

每个入关的旅游者或一家之主必须提供如下资料 (一个家庭只须申报一份):

1. Family Name:

1. 姓:

2. First Name

2. 名

3. Middle Initial

3. 中间名

4. Date of Birth: (Day/Month/Year)

4. 出生日期: 日/月/年

5. Airline/Flight No. :

5. 航空公司/航班号:

6. Number of family members traveling with you

6. 与你同 行的家庭成员人数:

7. (a)Country of Citizenship:

7.(a)国籍:

7. (b)Country of Residence:

7. (b)所居住国家:

8. (a) U.S. Address (Street Number/Hotel/Mailing Address to U.S.):

8.(a)在美国地址（街道地址/旅馆/在美国的通讯地址）:

8. (b) U.S. Address (City):

8.(b)在美国地址（城市）:

8. (c) U.S. Address (State):

8.(c)在美国地址（州）:

9. Countries visited on this trip prior to U.S. arrival

9. 在到达美国之前此行所访问过的国家

10. The purpose of my trip is or was
BUSINESS Personal

10. 此次旅程的目的是
商务 个人

14. The total value of all goods I/we purchased or
acquired abroad and am/are bringing to the U.S.
is (see instructions under Merchandise on
reverse side; visitors should report value of gifts
only): $___________________ U.S. Dollars

14. 我（我们）在国外购买或获得并带入美国所有物品总价值(参看 背面商品栏目; 访问者只须申报礼品价值):
$ _____________________________ 美元

SIGN ON RESERSE SIDE AFTER YOU READ WARNING.(Do not write below this line.)

在你阅读警告之后请在背面签字
(不要在此线下面签字)

INSPECTOR’S NAME STAMP AREA

检察员姓名 盖章区域

BADGE NO

徽章号码