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

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? _________________________________________________

______________________________________________________________________________________________________________

ADDRESS IN THE USA WHERE APPLICANT INTENDS TO STAY OR MAKE HIS/HER HEADQUARTERS DURING

VISIT:

______________________________________________________________________________________________________________

LENGTH OF PROPOSED VISIT: ________________________________________________________________________________

PURPOSE OF PROPOSED VISIT: _______________________________________________________________________________

I, ______________________________, do solemnly and sincerely declare that the particulars given in this application are, to the

best of my knowledge and belief, true and complete. I do further declare that to the best of my knowledge and belief, US

Immigration does not debar me from entry into the United States. I further declare that I 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, and by virtue of the

________________________________

Signature of Applicant

A parent must sign this form if child is under 18 years of age.