Form I-131a - Application For Travel Document (Carrier Documentation)
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5Application for Travel Document (Carrier Documentation)
USCIS
Form I-131A
Department of Homeland Security
OMB No. 1615-0135
U.S. Citizenship and Immigration Services
Expires 08/31/2018
Receipt
Action Block
For
USCIS
Document Issued
Use
Transportation Letter
Boarding Foil
Only
Document Hand Delivered
By:
Date:
(mm/dd/yyyy)
Select this box if
Attorney State Bar Number
Attorney or Accredited Representative
To be completed by an
Form G-28 or
(if applicable)
USCIS Online Account Number (if any)
attorney or accredited
Form G-28I is
representative (if any).
attached.
►
START HERE - Type or print in black ink.
4.
Is your current mailing address the same as your U.S.
Part 1. Information About You
physical address?
Yes
No
1.a. Family Name
If you answered "No" to Item Number 4., provide your U.S.
(Last Name)
physical address in Item Numbers 5.a. - 5.e.
1.b.
Given Name
(First Name)
U.S. Physical Address
1.c.
Middle Name
Street Number
5.a.
2.
Has your name changed since the issuance of your last
and Name
Permanent Resident Card (Form I-551)?
Yes
No
5.b.
Apt.
Ste.
Flr.
NOTE: If you answered "Yes" to Item Number 2., attach
evidence of your legal name change with this application.
5.c. City or Town
Current Mailing Address
5.d. State
5.e. ZIP Code
3.a. In Care Of Name (if any)
Other Information
6.
Alien Registration Number (A-Number)
3.b.
Street Number
►
A-
and Name
3.c.
Apt.
Ste.
Flr.
7.
USCIS Online Account Number (if any)
►
3.d. City or Town
8.
U.S. Social Security Number (if any)
3.e. State
3.f.
ZIP Code
►
3.g.
Province
9.
Date of Birth (mm/dd/yyyy)
3.h.
Postal Code
10.
Sex
Male
Female
3.i.
Country
Form I-131A 12/23/16 N
Page 1 of 5
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