Form G-28I Notice of Entry of Appearance as Attorney In matters Out

Notice of Entry of Appearance as Attorney
In Matters Outside the Geographical Confines
of the United States

DHS
Form G-28I

Department of Homeland Security

OMB No. 1615-0105
Expires 02/28/2017

Part 1. Information About Attorney
1.

USCIS ELIS Account Number (if any)
►

2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)

2.a.

Name of Law Firm (if applicable)

USCIS

Flr.

4.c. City or Town
4.d. Province

ICE

2.b. List the specific matter in which appearance is entered

3.a.

4.a. Street Number
and Name

Ste.

1.a.

1.b. List the form numbers

2.c. Middle Name

4.b. Apt.

This appearance relates to immigration matters before
(select only one box):

DRAFT
NOT
FOR
PRODUCTION
02/27/2015

Name and Address of Attorney

3.

Part 2. Notice of Appearance as Attorney
Admitted to Practice Outside the United States

CBP

3.b. List the specific matter in which appearance is entered

I enter my appearance as attorney at the request of:
4.
Select only one box:
Applicant

Petitioner

Respondent (ICE, CBP)

4.e. Postal Code
4.f.

Country

Information About Applicant, Petitioner, or
Respondent

5.

Telephone Number

6.

Fax Number

5.a. Family Name
(Last Name)
5.b. Given Name
(First Name)

5.c. Middle Name

7.

E-Mail Address (if any)

6.

Name of Company or Organization (if applicable)

8.

Mobile Telephone Number (if any)

7.

USCIS ELIS Account Number (if any)
►

8.

Alien Registration Number (A-Number) or Receipt Number (if any)

9.

Telephone Number

10.

E-Mail Address (if any)

Form G-28I 02/25/15 N

Page 1 of 3

Part 2. Notice of Appearance as Attorney
Admitted to Practice Outside the United States
(continued)

2.

,
the attorney of record who previously filed Form G-28I
in this case, and my appearance as an attorney is at his
or her request.

Mailing Address

NOTE: If you select this item, also complete Item
Numbers 1.a. - 1.c.

NOTE: Provide the mailing address of the applicant, petitioner,
or respondent. If the applicant, petitioner, or respondent has used
a safe mailing address on the application or petition being filed
with this Form G-28I, provide it in these spaces.

DRAFT
NOT
FOR
PRODUCTION
02/27/2015

11.a. Street Number
and Name
11.b. Apt.

I am associated with

Ste.

Flr.

11.c. City or Town

Part 4. Applicant, Petitioner, or Respondent
Consent to Representation, Contact Information,
and Signature

11.d. Province

Consent to Representation and Release of
Information

11.e. Postal Code

1.

11.f. Country

Part 3. Eligibility Information for Attorney

When you (the applicant, petitioner, requestor, or
respondent) are represented, DHS will send notices to
both you and your attorney either through mail or
electronic delivery.

Select all applicable boxes.
1.a.

I am licensed and authorized to practice law in the
following countries. (If you need additional space,
use Part 6.)

DHS will also send the Form I-94, Arrival Departure
Record, to you unless you select Item Number 2.a. in
Part 4. All secure identity documents and Travel
Documents will be sent to you (the applicant, petitioner,
requestor, or respondent) unless you ask us to send those
documents to your attorney of record.

Licensing Authority

1.b. Bar Number (if applicable)

1.c.

I am in good standing in a court of general
jurisdiction in the following countries where I reside
and am engaged in the practice of law. (If you need
additional space, use Part 6.)

1.d. I (choose one)
am not
am
subject to any order of any court or administrative agency
disbarring, suspending, enjoining, restraining, or otherwise
restricting me in the practice of law. If you are subject to
any orders, explain in the space below. (If you need
additional space, use Part 6.)

Form G-28I 02/25/15 N

I have requested the representation of and consented to
being represented by the attorney named in Part 1. of this
form. According to the Privacy Act of 1974 and DHS
policy, I also consent to the disclosure to the named
attorney of any record pertaining to me that appears in
any system of records of USCIS, ICE, or CBP.

If you do not want to receive original notices or secure
identity documents directly, but would rather have such
notices and documents sent to your attorney of record,
please select all applicable boxes below:

2.a.

I request that DHS send any notice (including Form
I-94) on an application, petition, or request that I
have filed with DHS to the business address of my
attorney of record as listed in this form. I understand
that I may change this election at any future date
through written notice to DHS.

Page 2 of 3

Part 4. Applicant, Petitioner, or Respondent
Consent to Representation, Contact Information,
and Signature (continued)
2.b.

Part 6. Additional Information
Use the space provided below to provide additional information
pertaining to Part 3., Item Numbers 1.a. - 1.c.

I request that DHS send any secure identity document,
such as a Permanent Resident Card, Employment
Authorization Document, or Travel Document, that I
am approved to receive and authorized to possess, to
the business address of my attorney of record as listed
in this form. I consent to having my secure identity
document sent to my attorney of record and understand
that I may request, at any future date and through
written notice to DHS, that DHS send any secure
identity document to me directly.

DRAFT
NOT
FOR
PRODUCTION
02/27/2015

3.a. Signature of Applicant, Petitioner, or Respondent

3.b. Date of Signature (mm/dd/yyyy) ►

Part 5. Signature of Attorney

I have read and understand the regulations and conditions
contained in 8 CFR 103.2 and 292 governing appearances and
representation before the Department of Homeland Security.
I declare under penalty of perjury under the laws of the United
States that the information I have provided on this form is true
and correct.
1.a. Signature of Attorney

1.b. Date of Signature (mm/dd/yyyy) ►

Form G-28I 02/25/15 N

Page 3 of 3