Page 7-8, Part 7.
Applicant’s Statement, Contact Information, Declaration,
Certification, and Signature
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[Page 7]
Part 7. Applicant's Statement,
Contact Information, Declaration, Certification, and Signature
Read the Penalties section of
the Form I-601 Instructions before completing this part. You must
file Form I-601 while in the United States.
Applicant's Statement
NOTE: Select the box for
either Item Number 1.a. or 1.b. If applicable,
select the box for Item Number 2.
1.a. I can read and
understand English, and I have read and understand every question
and instruction on this application and my answer to every
question.
1.b. The interpreter named
in Part 8. read to me every question and instruction on
this application and my answer to every question, in [fillable
field], a language in which I am fluent, and I understood
everything.
2. At my request, the
preparer named in Part 9., [fillable field], prepared this
application for me based only upon information I provided or
authorized.
[Page 8]
Applicant's Contact
Information
[new]
3. Applicant's Daytime
Telephone Number
4. Applicant's Mobile
Telephone Number (if any)
5. Applicant's Email Address
(if any)
Applicant's Certification
Copies of any documents I have
submitted are exact photocopies of unaltered, original documents,
and I understand that USCIS may require that I submit original
documents to USCIS at a later date. Furthermore, I authorize the
release of any information from any and all of my records that
USCIS may need to determine my eligibility for the immigration
benefit that I seek.
I furthermore authorize release of
information contained in this application, in supporting
documents, and in my USCIS records to other entities and persons
where necessary for the administration and enforcement of U.S.
immigration law.
I understand that USCIS may require
me to appear for an appointment to take my biometrics
(fingerprints, photograph, and/or signature) and, at that time, if
I am required to provide biometrics, I will be required to sign an
oath reaffirming that:
1) I reviewed and
understood all of the information contained in, and submitted
with, my application; and
2) All of this information
was complete, true, and correct at the time of filing.
I certify, under penalty of perjury,
that all of the information in my application and any document
submitted with it were provided or authorized by me, that I
reviewed and understand all of the information contained in, and
submitted with, my application and that all of this information is
complete, true, and correct.
Applicant's Signature
6.a. Applicant's Signature
(sign in ink)
6.b. Date of Signature
(mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If
you do not completely fill out this application or fail to submit
required documents listed in the Instructions, USCIS may deny your
application.
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[Page 7]
Part
7. Applicant's Contact Information,
Certification, and Signature
[deleted]
Applicant’s
Contact
Information
Provide your
daytime telephone number, mobile telephone number (if any), and
email address (if any).
1.
Applicant’s
Daytime Telephone
Number
2.
Applicant’s
Mobile Telephone Number
(if any)
3.
Applicant’s
Email Address (if any)
Applicant’s
Certification
and
Signature
[deleted]
I
certify, under penalty of perjury, that
I provided or authorized all of the responses and information
contained in and submitted with my application, I read and
understand or, if interpreted to me in a language in which I am
fluent by the interpreter listed in Part
8.,
understood, all of the responses and information contained in, and
submitted with, my application, and that all of the responses and
the information
is complete, true, and correct.
Furthermore, I authorize the release of any information from any
and all of my records that USCIS may need to determine my
eligibility for an immigration request and to other entities and
persons where necessary for the administration and enforcement of
U.S. immigration law.
[deleted]
4.a.
Applicant’s
Signature
4.b.
Date of Signature (mm/dd/yyyy)
[deleted]
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Page 8-9, Part 8.
Interpreter’s Contact Information, Certification, and
Signature
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[Page 8]
Part 8. Interpreter's Contact
Information, Certification, and Signature
Provide the following information
about the interpreter.
Interpreter's Full Name
1.a. Interpreter's Family
Name (Last Name)
1.b. Interpreter's Given
Name (First Name)
2. Interpreter's Business or
Organization Name (if any)
Interpreter's Mailing Address
3.a. Street Number and Name
3.b. Apt./Ste./Flr.
3.c. City or Town
3.d. State
3.e. ZIP Code
3.f. Province
3.g. Postal Code
3.h. Country
Interpreter's Contact
Information
4. Interpreter's Daytime
Telephone Number
5. Interpreter's Mobile
Telephone Number (if any)
6. Interpreter's Email
Address (if any)
Interpreter's Certification
I certify, under penalty of perjury,
that:
I am fluent in English and [fillable
field], which is the same language specified in Part 7.,
Item Number 1.b., and I have read to this applicant in the
identified language every question and instruction on this
application and his or her answer to every question. The
applicant informed me that he or she understands every
instruction, question, and answer on the application, including
the Applicant's Declaration and Certification, and has
verified the accuracy of every answer.
[Page 9]
Interpreter's Signature
7.a. Interpreter's Signature
(sign in ink)
7.b. Date of Signature
(mm/dd/yyyy)
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[Page 8]
Part 8. Interpreter's Contact
Information, Certification, and Signature
[deleted]
Interpreter’s
Full Name
1.a.
Interpreter’s Family Name (Last Name)
1.b.
Interpreter’s Given Name (First Name)
2.
Interpreter’s Business or Organization
Name
[deleted]
Interpreter’s
Contact
Information
3.
Interpreter’s
Daytime Telephone Number
4.
Interpreter’s
Mobile Telephone Number (if any)
5.
Interpreter’s
Email Address (if any)
Interpreter’s
Certification and
Signature
I
certify, under penalty of perjury, that
I
am fluent in
English and [Fillable language field], and
I have interpreted every question on the application and
Instructions and interpreted the applicant’s answers to the
questions in that language, and the applicant
informed me that
they understood every
instruction, question, and answer on the application.
[deleted]
6.a.
Interpreter’s Signature
6.b.
Date of Signature (mm/dd/yyyy)
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Page 9, Part 9. Contact
Information, Declaration, and Signature of the Person Preparing
this Application, if Other Than the Applicant
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[Page 9]
Part 9. Contact Information,
Declaration, and Signature of the Person Preparing this
Application, if Other Than the Applicant
Provide the following information
about the preparer.
Preparer's Full Name
1.a. Preparer's Family Name
(Last Name)
1.b. Preparer's Given Name
(First Name)
2. Preparer's Business or
Organization Name (if any)
Preparer's Mailing Address
3.a. Street Number and Name
3.b. Apt./Ste./Flr.
3.c. City or Town
3.d. State
3.e. ZIP Code
3.f. Province
3.g. Postal Code
3.h. Country
Preparer's Contact Information
4. Preparer's Daytime
Telephone Number
5. Preparer's Mobile
Telephone Number (if any)
6. Preparer's Email Address
(if any)
Preparer's Statement
7.a. I am not an attorney or
accredited representative but have prepared this application on
behalf of the applicant and with the applicant's consent.
7.b. I am an attorney or
accredited representative and my representation of the applicant
in this case extends/does not extend beyond the preparation of
this application.
NOTE: If you are an attorney
or accredited representative, you may be obliged to submit a
completed Form G-28, Notice of Entry of Appearance as Attorney or
Accredited Representative, or G-28I, Notice of Entry of Appearance
as Attorney in Matters Outside the Geographical Confines of the
United States, with this application.
Preparer's Certification
By my signature, I certify, under
penalty of perjury, that I prepared this application at the
request of the applicant. The applicant then reviewed this
completed application and informed me that he or she understands
all of the information contained in, and submitted with, his or
her application, including the Applicant's Declaration and
Certification, and that all of this information is complete,
true, and correct. I completed this application based only on
information that the applicant provided to me or authorized me to
obtain or use.
Preparer's Signature
8.a. Preparer's Signature
(sign in ink)
8.b. Date of Signature
(mm/dd/yyyy)
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[Page 9]
Part 9. Contact Information,
Declaration, and Signature of the Person Preparing this
Application, if Other Than the Applicant
[deleted]
Preparer’s
Full
Name
1.a.
Preparer’s Family Name (Last Name)
1.b.
Preparer’s Given Name (First Name)
2.
Preparer’s Business or Organization Name
[deleted]
Preparer’s
Contact
Information
3.
Preparer’s
Daytime Telephone Number
4.
Preparer’s
Mobile Telephone Number (if any)
5.
Preparer’s
Email Address (if any)
[deleted]
Preparer’s
Certification and
Signature
I
certify, under
penalty of perjury, that I prepared this application
for the applicant at their request and with express consent and
that all of the responses and information contained in and
submitted with the application is complete,
true, and correct
and reflects only information provided by the applicant. The
applicant reviewed the responses and information and
informed me that they understand the responses and information in
or submitted with the application.
[deleted]
6.a.
Preparer’s
Signature
6.b.
Date of Signature (mm/dd/yyyy)
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