EFTA01598065

.S. Dtparionirot of II •land security Continuation Page for Form _ I -867A _ Alien's Name CBP rile scssecr SIMI& lest: Event lb 7 Date May 13, 2013 Q. Have you ever been arrested or convicted for say offense or crime, even though subject of a pardon, amnesty, or other such legal action, A. Never. Q. Attar • final decision in made in your case, you will be given the opportunity to communicate by telephone with a consular or dip:ratio 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)(i)(I) of the INA. You are 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 in 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 asst obtain a now United States visa from a United States Embassy or Consulate abroad before attempting travel to the United States. Do you understand? A. Yee. Signanue I lain 1.811 Rcv, 08/111/07) Title cap OTFICRR 6 6 01 Pages EFTA01598065