EFTA01598031

U.S. Deportment or II land Security Nance Continuation Page for Form _ 1-867A _ Date May 13, 2013 Q. Nave you over been arrested or convicted tee any offense or crime, even though subject of a pardon, amnesty, or other much legal attics/ A. Never. Q. After • final decision in made in your cue_ you will be given the opportunity to communicate by telephone with a consular or diplomatic official of your country. Do you wish to do so? A. No. Q. At this time, you are inadmissible pursuant to section 212(a)(7)(A)(1.)(I) of the INA. You aro an intended immigrant without an immigrant visa. Do you understand? A. Yes. Q. In accordance with the provisions of Section 212(a)(9) of the INA. you are prohibited from entering, attempting to enter, or being it the United States for a period of 5 years from the date of your departure from the United States. Do you understand? A. Yes. Q. After the five year period has passed, you mist obtain a now United States visa from a United States Embassy or Consulate abroad before attempting travel to the United Status. Do you understand? A. Yes. Signature NI QUaU► I 'UM 1.831 ('iminitiolitni Page (Rev. 08/)1,07) Title CRP OPTICIIR 6 6 el Pages EFTA01598031