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 05/31/2021

Part 1. Information About Attorney
1.

Name of Attorney
2.

Family Name (Last Name)

►

DRAFT

USCIS Online Account Number (if any)

Given Name (First Name)

Middle Name

Address of Attorney
3.

Apt Ste. Flr. Number

Street Number and Name

Province

City or Town

NOT FOR
PRODUCTION

Postal Code

Country

Contact Information of Attorney
4.

Daytime Telephone Number

5.

Mobile Telephone Number (if any)

6.

Email Address (if any)

7.

Fax Number (if any)

Part 2. Eligibility Information for Attorney
Select all applicable items.
1.

A.

I am an attorney licensed to practice law in, and in good standing of, a court of general jurisdiction in the following
country where I reside and I am regularly engaged in such practice. If you need extra space to complete this section,
use the space provided in Part 6. Additional Information.
Jurisdiction

2.

License Number (if applicable)

09/21/2021

B.

am not
am
I (select only one box)
subject to any order suspending, enjoining, restraining, disbarring, or otherwise restricting me in the practice of law. If
you are subject to any orders, use the space provided in Part 6. Additional Information to provide an explanation.

C.

Name of Law Firm or Organization (if applicable)

I am associated with

,

the attorney of record who previously filed Form G-28I in this case, and my appearance as an attorney for a limited
purpose is at their request.

Form G-28I 05/23/18

Page 1 of 4

Part 3. Notice of Appearance as Attorney Admitted to Practice Outside the United States
If you need extra space to complete this section, use the space provided in Part 6. Additional Information.
This appearance relates to immigration matters before (select only one box):
1.

A.
B.

2.

3.

U.S. Citizenship and Immigration Services (USCIS)

DRAFT

List the form numbers or specific matter in which appearance is entered.

A.

U.S. Immigration and Customs Enforcement (ICE)

B.

List the specific matter in which appearance is entered.

A.
B.

U.S. Customs and Border Protection (CBP)
List the specific matter in which appearance is entered.

►

4.

Receipt Number (if any)

5.

I enter my appearance as an attorney at the request of the (select only one box):

NOT FOR
PRODUCTION
Applicant

Petitioner

Beneficiary/Derivative

Respondent

Information About Client (Applicant, Petitioner, Beneficiary or Derivative, Respondent, or Authorized
Signatory for an Entity)
6.

Family Name (Last Name)

Given Name (First Name)

7.

Name of Entity (if applicable)

8.

Title of Authorized Signatory for Entity (if applicable)

9.

Client's USCIS Online Account Number (if any)

10.

Client's Alien Registration Number (A-Number) (if any)

►

Middle Name

► A-

Client's Contact Information
11.

Daytime Telephone Number

13.

Email Address (if any)

12.

Mobile Telephone Number (if any)

09/21/2021

Mailing Address of Client

NOTE: Provide the client's mailing address. Do not provide the business mailing address of the attorney unless it serves as the safe
mailing address on the application or petition being filed with this Form G-28I.
14.

Street Number and Name

Apt Ste. Flr. Number

City or Town

Postal Code

Form G-28I 05/23/18

Province

Country

Page 2 of 4

Part 4. Client's Consent to Representation and Signature
Consent to Representation and Release of Information
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 U.S. Department of Homeland Security (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.

DRAFT

Options Regarding Receipt of USCIS Notices

USCIS will send notices to both a represented party (the client) and their attorney either through mail or electronic delivery. If you
want to have notices sent to your attorney rather than to you, please select Item Number 1. below. You may change this election by
submitting a new Form G-28I to USCIS.
1.

I request that USCIS send original notices on an application or petition to the business address of my attorney as listed in
this form.

Signature of Client or Authorized Signatory for an Entity
2.

Signature of Client or Authorized Signatory for an Entity

Date of Signature (mm/dd/yyyy)

NOT FOR
PRODUCTION

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 DHS. 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.

Signature of Attorney

Date of Signature (mm/dd/yyyy)

09/21/2021
Form G-28I 05/23/18

Page 3 of 4

Part 6. Additional Information
If you need extra space to provide any additional information within this form, 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 form or attach a separate sheet of paper. Type or print
your 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.

Family Name (Last Name)

2.

A.

DRAFT
Given Name (First Name)

Page Number

B.

Part Number

C.

Item Number

Page Number

B.

Part Number

C.

Item Number

Page Number

B.

Part Number

C.

Item Number

Page Number

B.

Part Number

C.

Item Number

Middle Name

D.

3.

A.

D.

4.

A.

D.

5.

A.

NOT FOR
PRODUCTION

D.

6.

A.

09/21/2021
Page Number

B.

Part Number

C.

Item Number

D.

Form G-28I 05/23/18

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