| 答字笔顺 |
1. Family Name 姓 | ||||||||||||||||||||||||
2. First (Gicen) Name 名 | 3. Birth Date (day/mo/yr) 出生日期（日/月/年） | |||||||||||||||||||||||
4. Country of Citizenship 国籍 | 5.Sex (Male or Female) 性别（男或女） | |||||||||||||||||||||||
C | H | I | N | E | S | E | ||||||||||||||||||
6.Passport Number 护照号 | 7.Airline and Flight Number航班号 | |||||||||||||||||||||||
| 就在这一瞬间 | ||||||||||||||||||||||||
8.Country Where You Live居住的国家 | 9.City Where You Boarded居住的城市 | |||||||||||||||||||||||
C | H | I | N | A | ||||||||||||||||||||
10.City Where Visa Was Issued获得签证的城市 | 11.Date Issued (day/mo/yr) 签证日期（日/月/年） | |||||||||||||||||||||||
12.Address While in the United States (Number and Street)在美地址（含街道和门牌号） | ||||||||||||||||||||||||
13.City and State（上述地址所在）城市和州 | ||||||||||||||||||||||||
1. Family Name 姓 | |||||||||||||||||||||||||||||||||
2. First (Gicen) Name 名 | 3. Birth Date (day/mo/yr) 出生日期（日/月/年） | ||||||||||||||||||||||||||||||||
4. Country of Citizenship 国籍 | |||||||||||||||||||||||||||||||||
C | H | I | N | E | S | E | |||||||||||||||||||||||||||
| 咳嗽能不能吃鸡蛋 | |||||||||||||||||||||||||||||||||
1.Family Name 姓 | |||||||||||||||||||
First (Given) 名 | Middle中间名 | ||||||||||||||||||
2.Birth date 出生日期 Day日 | Month月 | Year年亲人之间 | |||||||||||||||||
3.Number of Family Members traveling with you. 和你同行的家人人数 | |||||||||||||||||||
4.⒜U.S. Street Address(hotel name/destination).在美国的地址（酒店名/目的地） | |||||||||||||||||||
⒝City城市 | ⒞State州 | ||||||||||||||||||
5.Passport issued by (country)护照颁发国 | CHINA | ||||||||||||||||||
6.Passport number护照号 | |||||||||||||||||||
7.Country of Residence居住国 | CHINA | ||||||||||||||||||
8.Countries visited on this Trip prior to U.S. arrival | NONE | ||||||||||||||||||
此次到美国之前访问的国家 | |||||||||||||||||||
9. Airline/Flight No. or Vesl Name 航班或船班号 | |||||||||||||||||||
10.The primary purpo of thip is business:这次旅行主要的目的是工作 | Yes | No | |||||||||||||||||
11.I am (We are) bringing我（我们）携带了 | |||||||||||||||||||
⒜ fruits, plants, food, incts:水果，农产品，食品，昆虫 | Yes | No | |||||||||||||||||
⒝ meats, animals, animal/wildlife products:肉类，动物，动物/野生动物制品 | Yes | No | |||||||||||||||||
⒞ dia agents, cell cultures, snails: 蜜蜂制品，生物制品 | Yes | No | |||||||||||||||||
⒟soil or have been on a farm/ranch/pasture:来自农场/牧场/草原的土壤 | Yes | No | 好听的英文女名 | ||||||||||||||||
12.I have(we have) been in clo proximity of (such as touching or handing) livestock: | |||||||||||||||||||
我（我们）最近接近过牲畜。 | Yes | No | |||||||||||||||||
13.I am (We are) carrying currency or monetary instruments over $10,000 foreign equivalents (e definition of mone tary instruments on rever) | |||||||||||||||||||
我（我们）携带了超过10000美元或等值外币。 | Yes | No | |||||||||||||||||
14.I have (We have) commercial merchandi:（(articles for sale, samples ud for soliciting orders, or goods that are not considered personal effects) | |||||||||||||||||||
我（我们）有商务货品（商品、样品或非个人使用的物品） | Yes | No | |||||||||||||||||
15.Residents – the total value of all goods, including commercial merchandi I/we have purchad or acquired abroad, (including gifts for someone el, but not items mailed to the U.S.) and am/are bringing to the U.S. is: | |||||||||||||||||||
美国公民——从国外购买或获得的商品（包括礼品）的总价值： $ | |||||||||||||||||||
Visitors – the total value of all articles that will remain in the U.S., including commercial | |||||||||||||||||||
merchandi is:访问者——所有将留在美国的商品总价值： $ | |||||||||||||||||||
Read the instructions on the back of this form. Space is provided to list all the items you must | |||||||||||||||||||
declare.参见本表背面的说明，并在空白出列出物品的清单。 | |||||||||||||||||||
IHAVE READ THE IMPORTANT INFORMATION ON THE REVERSE SIDE OF THIS FORM AND HAVE MADE A TRUTHFUL DECLARATION. 我已阅读了本表背面的注意事项，并已如实申报。 | |||||||||||||||||||
(Signature)签名 Date (day/month/year)日期（日/月/年） | |||||||||||||||||||
| 拔萝卜教案小班 | |||||||||||||||||||
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