I-129 Petition for Nonimmigrant Worker

Petition for a Nonimmigrant Worker: H-1 Classifications

USCIS
Form I-129H-1

Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0009
Expires xx/xx/xxxx

► START HERE - Type or print in black ink.

Part 1. Petitioner Information
If you are an individual or sole proprietor filing this petition, you must complete Item Numbers 1. - 2. If you are a company or an
organization filing this petition, complete Item Number 3. All petitioners should fill out Item Numbers 4. - 11., as applicable.
1.

Legal Name of Petitioning Individual or Sole Proprietor
Family Name (Last Name)

Given Name (First Name)

2.

Date of Birth (mm/dd/yyyy)

3.

4.

USCIS Online Account Number (if any)
►

5.

Trade Name or “Doing Business As” Name (if applicable)

6.

Primary U.S. Office Address of Petitioner

Petitioning Company or Organization Name

(USPS ZIP Code Lookup)

Street Number and Name

City or Town

7.

Middle Name (if applicable)

Apt. Ste. Flr. Number

County

State

ZIP Code

Is your mailing address different from your Primary U.S. Office Address?

Yes

No

If you answered “Yes” to Item Number 7., provide your mailing address below.
8.

Mailing Address

(USPS ZIP Code Lookup)

In Care Of Name (if any)

Street Number and Name

City or Town

Province

9.

Apt. Ste. Flr. Number

County

Postal Code

State

ZIP Code

Country

Petitioner's Contact Information
U.S. Daytime Telephone Number

U.S. Mobile Telephone Number (if any)

Email Address (if any)

Form I-129 01/17/17

Page 1 of 15

Part 1. Petitioner Information (continued)
10.

Tax Payer Identification Numbers

Provide the following information, as applicable.
A.

C.

Employer Identification Number (EIN)
►

B.

Individual Taxpayer Identification Number (ITIN)
►

U.S. Social Security Number (SSN) (if applicable)
►

11.

E-Verify Information

A.

Are you a participate in the E-Verify program?

Yes

No

If you answered “Yes,” to Item A. in Item Number 11., provide the information requested in Items B. - C.
B.

Employer's Name as Listed in E-Verify

C.

Employer's E-Verify Company Identification Number or an E-Verify Client Company Identification Number
►

Part 2. Information About This Petition
1.

Requested Nonimmigrant Classification (Select only one box.)
A.

H-1B Specialty Occupation

B.

H-1B2 Exceptional services relating to a cooperative research and development project administered by the U.S.
Department of Defense (DOD)

C.

H-1B3 Fashion model of distinguished merit and ability

D.

H-1B3 Fashion model of distinguished merit and ability

E.

Free Trade, Singapore (H-1B1)

2.

If you selected Item A. or C. in Item Number 1., and are filing an H-1B cap petition (including a petition under the U.S.
advanced degree exemption), provide the H-1B Beneficiary Confirmation Number from the H-1B Registration Selection Notice
for the beneficiary named in this petition (if applicable).
►

3.

If you selected Item D. or E. in Item Number 1., is this a sixth or subsequent consecutive request for
Free Trade Chile, or Singapore (H-1B1)?

4.

Basis for Classification (Select only one box)

5.

Yes

A.

New employment.

B.

Continuation of previously approved employment without change with the same employer.

C.

Change in previously approved employment (provide an explanation in Part 11. Additional Information).

D.

New concurrent employment.

E.

Change of employer for a beneficiary already in the requested classification.

F.

Amended petition (provide an explanation in Part 11. Additional Information)

No

Provide the most recent petition/application receipt number for the applicant. If none exists, indicate "None."
►

Form I-129 01/17/17

Page 2 of 15

Part 2. Information About This Petition (continued)
6.

Requested Action (Select only one box)
A.

Notify the office in Part 4. so that the beneficiary can apply for and obtain a visa or be admitted, if eligible. (NOTE:
A petition is not required for H-1B1 Chile/Singapore beneficiaries unless they are seeking a change of status or
extension of stay.)

B.

Change the status and extend the stay of each beneficiary because the beneficiary is now in the United States in another
status (see the Instructions for limitations). This is available only when you select Item A. in Item Number 4., above,
New employment.

C.

Extend the stay of the beneficiary because the beneficiary now holds this status.

D.

Amend the stay of the beneficiary because the beneficiary now holds this status.

Part 3. Beneficiary Information
Provide the information requested about the beneficiary for whom you are filing.
1.

Beneficiary's Full Name
Family Name (Last Name)

2.

Given Name (First Name)

Middle Name (if applicable)

Provide all other names the beneficiary has ever used, including aliases, maiden name, and nicknames. If you need extra space to
complete this section, use the space provided in Part 11. Additional Information.
Family Name (Last Name)

Given Name (First Name)

Middle Name

Other Information
3.

6.

Date of Birth (mm/dd/yyyy)

4.

Gender
Male

5.
Female

U.S. Social Security Number (if any)
►

Alien Registration Number (A-Number) (if any)
► A-

7.

Place of Birth
City or Town of Birth

Province of Birth

Country of Birth

8.

Country of Citizenship or Nationality

9.

Beneficiary's Foreign Address (if any)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

Postal Code

Form I-129 01/17/17

Province

Country

Page 3 of 15

Part 3. Beneficiary Information (continued)
10.

If the beneficiary is in the United States, complete the following:
Date of Last Arrival (mm/dd/yyyy) I-94 Arrival-Departure Record Number (if any) Passport or Travel Document Number
►
Date Passport or Travel Document
Issued (mm/dd/yyyy)

Date Passport or Travel Document Passport or Travel Document Country
Expires (mm/dd/yyyy)
of Issuance

Your Current Immigration Status or Category (for example, B-2
visitor, F-1 student, parolee, deferred action, or no status or category)

Student and Exchange Visitor Information System (SEVIS)
Number (if any)

11.

Date Status Expires or Duration of Status D/S (see Form
I-94 Arrival/Departure Document) mm/dd/yyyy

Employment Authorization Document (EAD)
Number (if any)

Does the beneficiary have a U.S. residential address?

Yes

No

If you answered “Yes,” to Item Number 11., you must provide the beneficiary's U.S. residential address information in Item
Number 12.
12.

Beneficiary's Current Residential U.S. Address (Do not list a P.O. Box unless the beneficiary resides in the Commonwealth of
the Northern Mariana Islands (CNMI).)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

County

State

ZIP Code

Part 4. Processing Information
1.

If the beneficiary named in Part 3. is requesting new employment, a continuation of previously approved employment without
change with the same employer, a change in previously approved employment with the same employer, a change of employer
for a beneficiary already in the requested classification, or is submitting an amended Form I-129H1 petition, indicate the U.S.
Consulate or US Customs and Border Protection (CBP) inspection facility you want notified if this petition is approved. Even if
you are not requesting consular notification in Part 2., Item Number 6., complete this section in the event the extension of stay
or change of status cannot be granted.
A. Type of Office (Select only one box)
U.S. Consulate

CBP Pre-flight inspection Facility

B. City Where Office is Located

2.

C. U.S. State or Foreign Country

Are you filing any other petitions with this one?
If yes, how many?

3.

U.S. Port of Entry

Form I-129 01/17/17

No

Yes

No

►

Are you filing any applications for replacement/initial Form I-94, Arrival-Departure Records, with this
petition? (If the beneficiary was issued an electronic Form I-94 by CBP when he/she was admitted to
the United States at an airport or seaport, he/she may be able to obtain the Form I-94 from the CBP
website at www.cbp.gov/i94 instead of filing an application for a replacement/initial Form I-94.)
If yes, how many?

Yes

►

Page 4 of 15

Part 4. Processing Information (continued)
4.

Are you filing any applications for dependents with this petitions?
If yes, how many?

Yes

No

►
Yes

No

5.

Is the beneficiary in this petition in removal proceedings?

6.

Have you ever filed an immigrant petition for this beneficiary?
Yes
No
If you answered “Yes” to Item Number 6., identify the classification requested and the receipt number for each petition in Part
11. Additional Information.

7.

Yes
No
Have you ever filed a nonimmigrant petition for this beneficiary?
If you answered “Yes” to Item Number 7., identify the classification requested and the receipt number for each petition in Part
11. Additional Information.

8.

Has the beneficiary in this petition ever been granted the classification you are now requesting?
If you answered “Yes” to Item Number 8., provide an explanation in Part 11. Additional Information.

Yes

No

9.

Has the beneficiary in this petition ever been denied the classification you are now requesting?
If you answered “Yes” to Item Number 9., provide an explanation in Part 11. Additional Information.

Yes

No

10.

Has the beneficiary in this petition ever been a J-1 exchange visitor or J-2 dependent of a J-1 exchange
visitor?

Yes

No

11.

If you selected "Yes" in Item Number 10., provide the dates the beneficiary maintained status as a J-1 exchange visitor or J-2
dependent. Also, provide evidence of this status by attaching a copy of either a DS-2019, Certificate of Eligibility for Exchange
Visitor (J-1) Status, a Form IAP-66, or a copy of the passport that includes the J visa stamp. Additionally, if applicable, provide
evidence that the beneficiary fulfilled the two-year foreign residence requirement or had such residence requirement waived.

Part 5. Basic Information About the Proposed Employment and Employer
1.

Job Title

2.

Labor Condition Application ETA Case Number 3. SOC Code

5.

Addresses where the beneficiaries will work if different from the address in Part 1. If you need to provide more than two
additional addresses, use Part 11. Additional Information.

4. NAICS Code

Address 1
Street Number and Name

City or Town

Apt. Ste. Flr. Number

County

State

Is this a third-party location?

ZIP Code

Yes

No

Address 2
Street Number and Name

City or Town

Form I-129 01/17/17

Apt. Ste. Flr. Number

County

State

ZIP Code

Page 5 of 15

Part 5. Basic Information About the Proposed Employment and Employer (continued)
Is this a third-party location?

Yes

No

6.

Did you include an itinerary with the petition?

Yes

No

7.

What level of education is required for the position?

9.

How many years of experience, if any, are required in order to qualify for the position?

10.

What special skills, if any, are required in order to qualify for the position?

11.

Will the beneficiary work exclusively in the CNMI?

Yes

No

12.

Is this a full-time position?

Yes

No

13.

If you answered "No" to Item 12., how many hours per week for the position?

14.

Wages (in U.S. dollars): $

15.

Other Compensation (Explain)

16.

Dates of intended employment
From (mm/dd/yyyy)

8.

What fields of study would qualify someone for this position?

►

►

per (Specify hour, week, month, or year)

To (mm/dd/yyyy)

17.

Type of Business

18. Year Established

19.

Current Number of Employees in the United States

22.

List the beneficiary's prior periods of stay in H or L classification in the United States. Be sure to only list those periods in
which the beneficiary was actually in the United States in an H or L classification. Do not include periods in which the
beneficiary was in a dependent status, for example, H-4 or L-2 status. If you need extra space to complete this section, use the
space provided in Part 11. Additional Information or attach an additional sheet of paper.

20. Gross Annual Income

21. Net Annual Income

NOTE: Submit photocopies of Forms I-94, I-797, and/or other U.S. Citizenship and Immigration Services USCIS issued
documents noting these periods of stay in the H or L classification.
Subject's Name

Form I-129 01/17/17

Period of Stay
From (mm/dd/yyyy)
To (mm/dd/yyyy)

Page 6 of 15

Part 5. Basic Information About the Proposed Employment and Employer (continued)
23.

Is this petition requesting: (Select all that apply)
A.

Recapture time

B.

3-year Per-Country Limitations Exemption

C.

1-year Lengthy Adjudication Delay Exemption

D.

A time limit exemption because the beneficiary did not reside continually in the United States and the beneficiary's
employment was intermittent, seasonal, or for an aggregate of six months or less per year.

24.

Are you filing this petition on behalf of a beneficiary who is eligible for the Guam-CNMI cap
exemption under Public 115-218?

Yes

No

25.

Are you requesting a change of employer for a beneficiary who was previously approved for H-1B
nonimmigrant status based on the Guam-CNMI cap exemption?

Yes

No

26.

Does any beneficiary in this petition have ownership interest in the petitioning organization?
If you answered "Yes" to Item Number 26., provide an explanation in Part 11. Additional Information

Yes

No

27.

Describe the proposed duties for the beneficiary's proffered position. If you need extra space to complete this section, use the
space provided in Part 11. Additional Information or attach an additional sheet of paper.

28.

Describe the beneficiary's present occupation and summary of prior work experience. If you need extra space to complete this
section, use the space provided in Part 11. Additional Information or attach an additional sheet of paper.

Statement for H-1B Specialty Occupations and H-1B1 Chile and Singapore, or H-1B3 Fashion Models
By filing this petition, I agree to, and will abide by, the terms of the labor condition application (LCA) for the duration of the
beneficiary's authorized period of stay for H-1B, H-1B1, or H-1B3 employment. I certify that I will maintain a valid employeremployee relationship with the beneficiary at all times. If the beneficiary is assigned to a position in a new location, I will obtain and
post an LCA for that site prior to reassignment and file a new or amended H-1B petition, if required.
I further understand that I cannot charge the beneficiary the ACWIA fee, and that any other required reimbursement will be
considered an offset against wages and benefits paid relative to the LCA.
29.

Signature of Petitioner

Name of Petitioner

Date (mm/dd/yyyy)

Statement for H-1B Speciaty Occupations and U.S. Department of Defense Projects
As an authorized official of the employer, I certify that the employer will be liable for the reasonable costs of return transportation of
the beneficiary abroad if the beneficiary is dismissed from employment by the employer before the end of the period of authorized
stay.
30.

Signature of Authorized Official Employer

Form I-129 01/17/17

Name of Authorized Official of Employer

Date (mm/dd/yyyy)

Page 7 of 15

Part 5. Basic Information About the Proposed Employment and Employer (continued)
Statement for H-1B U.S. Department of Defense Projects Only
As an authorized official of the employer, I certify that the beneficiary will be working on a cooperative research and development
project or a co-production project under a reciprocal government-to-government agreement administered by the U.S. Department of
Defense.
31.

Signature of Petitioner

Name of Petitioner

Date (mm/dd/yyyy)

Part 6. H-1B and H-1B1 Data Collection and Filing Fee Exemption Information
Section 1. General Information
Employer Information (Select all items that apply)
Yes

No

Has the petitioner ever been found to be a willful violator?

Yes

No

3.

Is the beneficiary an H-1B nonimmigrant exempt from the Department of Labor attestation
requirements?

Yes

No

4.

If you answered "Yes" to Item Number 3., indicate why the H-1B nonimmigrant is exempt.

Yes

No

1.

Is the petitioner an H-1B dependent employer?

2.

A.

The beneficiary's annual rate of pay is equal to at least $60,000?

Yes

No

B.

The beneficiary has a master's degree or higher degree in a specialty related to the employment?

Yes

No

5.

Rate of Pay Per Year

6.

Does the petitioner employ 50 or more individuals in the United States?

Yes

No

7.

If you answered "Yes" to Item Number 6., are more than 50 percent of those employees in H-1B, L-1A, or
L-1B nonimmigrant status?

Yes

No

8.

Beneficiary's Highest Level of Education (Select only one box)

9.

A.

NO DIPLOMA

F.

Bachelor's degree (for example, BA, AB, BS)

B.

HIGH SCHOOL GRADUATE DIPLOMA or
the equivalent (for example: GED)

G.

Master's degree (for example, MA, MS, MEng, MEd,
MSW, MBA)

C.

Some college credit, but less than 1 year

H.

Professional degree (for example: MD, DDS, DVM, LLB,
JD)

D.

One or more years of college, no degree

I.

Doctorate degree (for example: PhD, EdD)

E.

Associate's degree (for example, AA, AS)

Major/Primary Field of Study

Form I-129 01/17/17

Page 8 of 15

Part 6. H-1B and H-1B1 Data Collection and Filing Fee Exemption Information (continued)
Section 2. Fee Exemption and/or Determination
In order for USCIS to determine if you must pay the additional $1,500 or $750 American Competitiveness and Workforce
Improvement Act (ACWIA) fee, answer all of the following questions.
10.

Is the employer a U.S. institution of higher education as defined in section 101(a) of the Higher Education
Act of 1965, 20 U.S.C. 1001(a)?

Yes

No

11.

Is the employer a nonprofit organization or entity related to or affiliated with a U.S. institution of higher
education, as defined in 8 CFR 214.2(h)(19)(iii)(B)?

Yes

No

12.

Is the employer a nonprofit research organization or a governmental research organization, as defined in
8 CFR 214.2(h)(19)(iii)(C)?

Yes

No

13.

Is this the second or subsequent request for an extension of stay that this petitioner has filed for this
beneficiary?

Yes

No

14.

Is this an amended petition (filed by the same employer or a successor-in-interest) that does not contain any
request for extensions of stay?

Yes

No

15.

Are you filing this petition to correct a USCIS error?

Yes

No

16.

Is the employer a primary or secondary education institution?

Yes

No

17.

Is the employer a nonprofit entity that engages in an established curriculum-related clinical training of
students registered at such an institution?

Yes

No

If you answered "Yes" to Item Numbers 10. - 17. above, you are not required to submit the ACWIA fee for your Form I-129H1B
petition. If you answered "No" to all of of Item Number 10. - 17., answer Item Number 18. below.
18.

Does the employer currently employ a total of 25 or fewer full-time equivalent employees in the United
States, including all affiliates or subsidiaries of this company/organization?

Yes

No

If you answered "Yes" to Item Number 17., you are required to pay an additional ACWIA fee of $750. If you answered "No" to
Item Number 17., then you are required to pay an additional ACWIA fee of $1,500.
NOTE: A petitioner seeking initial approval of H-1B nonimmigrant status for a beneficiary, or seeking approval to employ an H-1B
nonimmigrant currently working for another employer, must submit an additional $500 Fraud Prevention and Detection fee. For
petitions filed on or after December 18, 2015, an additional fee of $4,000 must be submitted if you answered "Yes" to Part 6., Item
Numbers 6. and 7. This $4,000 fee was mandated by the provisions of Public Law 114-113.
The Fraud Prevention and Detection Fee and Public Law 114-113 fee do not apply to H-1B1 petitions. These fees, when applicable,
may not be waived. You must include payment of the fees when you submit this petition.
Failure to submit the fees when required will result in rejection or denial of your submission. Each of these fees should be paid by
separate checks or money orders.

Section 3. Numerical Limitation Information
19.

20.

Specify the type of H-1B petition you are filing. (Select only one box)
A.

Cap H-1B Bachelor's Degree

C.

Cap H-1B1 Chile/Singapore

B.

Cap H-1B U.S. Master's Degree or Higher

D.

Cap Exempt

If you selected Item B. in Item Number 19., Cap H-1B U.S. Master's Degree or Higher, provide the following information
regarding the master's or higher degree the beneficiary has earned from a U.S. institution of higher education as defined in
section 101(a) of the Higher Education Act of 1965, 20 U.S.C. 1001(a).
A. Name of the United States Institution of Higher Education

Form I-129 01/17/17

B.

Date Degree Awarded (dd/mm/yyyy

Page 9 of 15

Part 6. H-1B and H-1B1 Data Collection and Filing Fee Exemption Information (continued)
C. Type of United States Degree

D. Address of the United States Institution of Higher Education
Street Number and Name

City or Town

21.

Apt. Ste. Flr. Number

State

ZIP Code

Has your company or any related entity filed another petition for this beneficiary under the current fiscal
year numerical limitations?

Yes

No

If you answered "Yes" to Item Number 21., please explain the legitimate business need for both filings in Part 11. Additional
Information.
22.

If you selected Item D. in Item Number 19., Cap Exempt, you must specify the reasons this petition is exempt from the
numerical limitation for H-1B classification:
A.

The petitioner is an institution of higher education as defined in section 101(a) of the Higher Education Act, of 1965,
20 U.S.C. 1001(a).

B.

The petitioner is a nonprofit entity related to or affiliated with an institution of higher education as defined in
8 CFR 214.2(h)(8)(ii)(F)(2).

C.

The petitioner is a nonprofit research organization or a governmental research organization as defined in
8 CFR 214.2(h)(8)(ii)(F)(3).

D.

The beneficiary will be employed at a qualifying cap exempt institution, organization or entity pursuant to
8 CFR 214.2(h)(8)(ii)(F)(4).

E.

The beneficiary is currently employed at a cap-exempt institution, entity, or organization and you seek to concurrently
employ the H-1B beneficiary.

F.

The beneficiary of this petition is a J-1 nonimmigrant physician who has received a waiver based the Immigration and
Nationality Act (INA) section 214(l).

G.

The beneficiary of this petition has been counted against the cap and (1) is applying to amend a previous petition
without a request for extension of stay, (2) is applying for the remaining portion of the six year period of admission, or
(3) is seeking an extension beyond the 6-year limitation based upon the lengthy adjudication delay exemption at
8 CFR 214.2(h)(13)(iii)(D) or the per-country limitation exemption at 8 CFR 214.2(h)(13)(iii)(E).

H.

The petitioner is an employer subject to the Guam-CNMI cap exemption pursuant to Public Law 115-218.

Section 4. Off-Site Assignment of H-1B Beneficiaries
23.

The beneficiary of this petition will be assigned to work at an off-site location for all or part of the period
for which H-1B classification sought.
If answered "No" to Item Number 23., do not complete Item Numbers 24. - 26.

Yes

No

24.

Placement of the beneficiary off-site during the period of employment will comply with the statutory
and regulatory requirements of the H-1B nonimmigrant classification.

Yes

No

25.

The beneficiary will be paid the higher of the prevailing or actual wage at any and all off-site locations.

Yes

No

Form I-129 01/17/17

Page 10 of 15

Part 6. H-1B and H-1B1 Data Collection and Filing Fee Exemption Information (continued)
26.

If this off-site location belongs to a third party, list all vendors/parties that are involved between you (petitioner) and the ultimate
end client, if applicable, as known at the time of filing.
Petitioner

Vendor (if applicable)

Vendor (if applicable)

Vendor (if applicable)

End-client

Part 7. Certification Regarding the Release of Controlled Technology or Technical Data to Foreign
Persons in the United States
1.

Select Item Number 1. or Item Number 2., as appropriate. Select only one option.

With respect to the technology or technical data the petitioner will release or otherwise provide access to the beneficiary, the petitioner
certifies that it has reviewed the Export Administration Regulations (EAR) and the International Traffic in Arms Regulations (ITAR)
and has determined that:
A.

A license is not required from either the U.S. Department of Commerce or the U.S. Department of State to release such
technology or technical data to the foreign person; or

B.

A license is required from the U.S. Department of Commerce and/or the U.S. Department of State to release such
technology or technical data to the beneficiary and the petitioner will prevent access to the controlled technology or
technical data by the beneficiary until and unless the petitioner has received the required license or other authorization
to release it to the beneficiary.

Part 8. Statement, Contact Information, Certification, and Signature of Petitioner or Authorized
Signatory
NOTE: Read the Penalties section of the Form I-129H1 Instructions before completing this section.

Petitioner's or Authorized Signatory's Statement
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1.

Petioner's or Authorized Signatory's Statement Regarding the Interpreter
A.

I can read and understand English, and I have read and understand every question and instruction on this petition and
my answer to every question.

B.

The interpreter named in Part 9. read to me every question and instruction on this petition and my answer to
every question in
, a language in which I am fluent, and I
understood all of the information as interpreted.

2.

Petitioner's or Authorized Signatory's Statement Regarding the Preparer
At my request, the preparer named in Part 10.,

,

prepared this petition for me based only upon information I provided or authorized.

Form I-129 01/17/17

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Part 8. Statement, Contact Information, Certification, and Signature of Petitioner or Authorized
Signatory (continued)
Petitioner's or Authorized Signatory's Certification
Copies of any documents submitted are exact photocopies of unaltered, original documents, and I understand that, as the petitioner or
authorized signatory, I may be required to submit original documents to USCIS at a later date.
I authorize the release of any information contained in this petition, in supporting documents, and in the petitioning organization's
USCIS records, to USCIS or other entities and persons where necessary to determine eligibility for the immigration benefit sought or
where authorized by law. I recognize the authority of USCIS to conduct audits of this petition using publicly available open source
information. I also recognize that any supporting evidence submitted in support of this petition may be verified by USCIS through
any means determined appropriate by USCIS, including but not limited to, on-site compliance reviews.
If filing this petition on behalf of an organization, I certify that I am authorized to do so by the organization.
I certify, under penalty of perjury, that I provided or authorized all the information in my petition, I understand all of the information
contained in, and submitted with, my petition, and that all of this information is complete, true, and correct.

Petitioner's or Authorized Signatory's Signature
3.

Petitioner or Authorized Signatory Signature

Date of Signature (mm/dd/yyyy)

If Part 8. is being completed by an Authorized Signatory, provide the following information.

Authorized Signatory's Contact Information
4.

Authorized Signatory's Family Name (Last Name)

Authorized Signatory's Given Name (First Name)

5.

Authorized Signatory's Title

6.

Authorized Signatory's Daytime Telephone Number

7.

Authorized Signatory's Mobile Telephone Number (if any)

8.

Authorized Signatory's Email Address (if any)

NOTE TO ALL PETITIONERS AND AUTHORIZED SIGNATORIES: If you do not completely fill out this petition or fail to
submit required documents listed in the Instructions, USCIS may deny your petition.

Part 9. Interpreter's Contact Information, Certification, and Signature
Provide the following information about the interpreter.

Interpreter's Full Name
1.

Interpreter's Family Name (Last Name)

2.

Interpreter's Business or Organization Name (if any)

Form I-129 01/17/17

Interpreter's Given Name (First Name)

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Part 9. Interpreter's Contact Information, Certification, and Signature (continued)
Interpreter's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

ZIP Code

Country

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

6.

Interpreter's Email Address (if any)

5.

Interpreter's Mobile Telephone Number (if any)

Interpreter's Certification
I certify, under penalty of perjury, that:
, which is the same language specified in Part 8.,
I am fluent in English and
Item B., in Item Number 1.; and I have read to this petitioner or the authorized signatory in the identified language every question
and instruction on this petition and his or her answer to every question. The petitioner or authorized signatory informed me that he or
she understands every instruction, question, and answer on the petition, including the Petitioner's or Authorized Signatory's
Certification, and has verified the accuracy of every answer.

Interpreter's Signature
7.

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other
Than the Petitioner or Authorized Signatory
Provide the following information about the preparer.

Preparer's Full Name
1.

Preparer's Family Name (Last Name)

2.

Preparer's Business or Organization Name (if any) (If applicable , provide the name of your accredited organization recognized
by the Executive Office of Immigration Review (EOIR).)

Form I-129 01/17/17

Preparer's Given Name (First Name)

Page 13 of 15

Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other
Than the Petitioner or Authorized Signatory (continued)
Preparer's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

ZIP Code

Country

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

6.

Preparer's Email Address (if any)

5.

Preparer's Mobile Telephone Number (if any)

Preparer's Statement
7.

A.

I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and with the
petioner's or authorized signatory's consent.

B.

I am an attorney or accredited representative and my representation of the petitioner in this case
extends
does not extend beyond the preparation of this petition.
NOTE: If you are an attorney or accredited representative, you may need to submit a completed Form G-28, Notice of
Entry of Appearance as Attorney or Accredited Representative, or Form G-28I, Notice of Entry of Appearance as
Attorney In Matters Outside the Geographical Confines of the United States, with this petition.

Preparer's Certification
By my signature, I certify, under penalty of perjury, that I prepared this petition at the request of the petitioner or authorized signatory.
The petitioner or authorized signatory has reviewed this completed petition including the Petitioner's or Authorized Signatory's
Certification, and informed me that all of the information in the petition and in the supporting documents, is complete, true, and
correct.

Preparer's Signature
8.

Preparer's Signature

Form I-129 01/17/17

Date of Signature (mm/dd/yyyy)

Page 14 of 15

Part 11. Additional Information About Your I-129H1B Petition for Nonimmigrant Worker
If you need extra space to provide any additional information within this petition, use the space below. If you need more space than
what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Type or
print the individual petitioner or company name at the top of each sheet; indicate the Page Number, Part Number, and Item
Number to which your answer refers; and sign and date each sheet.
1.

Individual Petitioner or Company Name (same as in Part 1.)
Family Name Name (Last Name)

2.

A. Page Number

Given Name (First Name)

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

B. Part Number

C. Item Number

Middle Name

D.

3.

A. Page Number

D.

4.

A. Page Number

D.

5.

A. Page Number

D.

6.

A. Page Number

D.

Form I-129 01/17/17

Page 15 of 15