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 03/31/2018

Part 1. Information About Attorney
1.

USCIS ELIS Account Number (if any)
►

Name and Address of Attorney

1.a.

USCIS

1.b. List form numbers

2.a.

2.c. Middle Name

Name of Law Firm (if applicable)

Ste.

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
4.b. Apt.

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

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

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

5.

Telephone Number

6.

Fax Number

Information About Applicant, Petitioner, or
Respondent

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 03/04/15 N

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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: Provide the mailing address of the applicant,
petitioner, requestor, or respondent. Do not provide the
business mailing address of the attorney unless it serves as the
safe mailing address on the application, petition, or request
being filed with this Form G-28I.

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

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

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

Ste.

Flr.

11.c. City or Town
11.d. Province

Consent to Representation and Release of
Information

1.

11.e. Postal Code
11.f. Country

Select all applicable boxes.

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) at your U.S. mailing address
unless you ask us to send your secure identity 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 03/04/15 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.
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.

Part 3. Eligibility Information for Attorney
1.a.

I am associated with

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.

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

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 U.S. business address of my attorney of record as
listed in this form or to a designated military or
diplomatic address for pickup in a foreign country (if
permitted). 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.

Part 6. Additional Information
Use the space provided below to provide additional information
pertaining to Part 3., Item Numbers 1.a. - 1.d. or to provide
your U.S. business address for purposes of receiving secure
identity documents for your client (if your client has consented
to your receipt of such documents under Part 4.)

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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 03/04/15 N

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