Form I-129S Nonimmigrant Petition Based on Blanket L Petition

USCIS
Form I-129S

Nonimmigrant Petition Based on Blanket L Petition
Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0010
Expires 09/30/2023

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For Government Use Only

Received

Relocated Sent

Resubmitted

Action Block

Fee Receipt

Relocated Received

Validity Dates

Beneficiary Interviewed on:

From:

Approved as:

To:

Denial Reason

Manager/Executive
Specialized Knowledge
Professional

Approval Date:

To be completed by an
attorney or BIAaccredited
representative (if any).

Select this box if
Form G-28 or Form
G-28I is attached.

Attorney State Bar Number
(if applicable)

Attorney or Accredited Representative
USCIS Online Account Number (if any)

► START HERE - Type or print in black ink.

Part 1. Information About The Employer
(Petitioner)
1.

Petitioner's Physical Address

4.a. Street Number
and Name

Name of the Petitioning Organization

4.b.

Apt.

Ste.

Flr.

4.c. City or Town

Petitioner's Mailing Address

4.d. State

2.a. In Care Of Name (if any)

4.e. ZIP Code

Petitioner's Contact Information
2.b. Street Number
and Name
2.c.

Apt.

Ste.

5.

Daytime Telephone Number

6.

Fax Number

7.

Email Address (if any)

8.

Website Address (if any)

Flr.

2.d. City or Town
2.e. State
3.

2.f.

ZIP Code

Is this mailing address the same as the physical location
of the sponsoring company or organization?
Yes

No

If you answered "No" to Item Number 3., provide the
sponsoring company's or organization's physical address
in Item Numbers 4.a. - 4.e.

Petitioner's Employees in the United States
9.

Does the petitioner employ 50 or more individuals in the
United States?
Yes
No
If you answered "Yes" to Item Number 9., complete
Item Number 10.

10.

Are more than 50 percent of the petitioner's employees in
H-1B, L-1A, or L-1B nonimmigrant status?
Yes

Form I-129S Edition 09/03/21

No
Page 1 of 7

Part 2. Information About the Proposed Position
and Prior Employment Periods in the United
States

Part 3. Information About the Beneficiary
Provide the following information about the beneficiary.

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1.

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

The beneficiary will work as a:
1.a.

Manager or Executive (L-1A)

1.b.

Specialized Knowledge Professional (L-1B)

2.

USCIS Online Account Number (if any)
►

3.

U.S. Social Security Number (if any)

Dates of Proposed Employment

Provide the beneficiary's dates of proposed employment.
2.a. Start Date (mm/dd/yyyy)
2.b. End Date (mm/dd/yyyy)

Prior Periods of Stay in the United States
3.

Was the beneficiary of this petition in the United States
during the last seven years?
Yes
No

If you answered “Yes” to Item Number 3., provide the dates of
the beneficiary's prior periods of stay for the last seven years in
a work-authorized capacity and indicate the beneficiary's
immigration status and visa category (for example, H-1B, O-1)
during the period of stay. If you need extra space to complete
this section, use the space provided in Part 10. Additional
Information.
Period of Stay 1

4.a. From (mm/dd/yyyy)

►

Beneficiary's Full Name

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

4.c. Middle Name

Other Names Used (if any)

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 10.
Additional Information.
5.a. Family Name
(Last Name)
5.b. Given Name
(First Name)

5.c. Middle Name

4.b. To (mm/dd/yyyy)

Beneficiary's Foreign Mailing Address

5.

6.a. In Care Of Name (if any)

Nonimmigrant Status During Period of Stay

Period of Stay 2

6.b. Street Number and Name or PO Box

6.a. From (mm/dd/yyyy)
6.c.

Apt.

Ste.

Flr.

6.b. To (mm/dd/yyyy)
7.

Nonimmigrant Status During Period of Stay

6.d. City or Town
6.e. Province
6.f.

Postal Code

6.g. Country

7.

Is this mailing address also where the beneficiary
physically resides?
Yes

No

If you answered "No" to Item Number 7., provide the
beneficiary's physical address in Item Numbers 8.a. - 8.f.
Form I-129S Edition 09/03/21

Page 2 of 7

Part 3. Information About the Beneficiary
(continued)

8.a. Street Number
and Name
Apt.

Ste.

Flr.

8.c. City or Town
8.d. Province

Provide the wages per year the beneficiary will receive and the
number of hours the beneficiary will work per week for the
proposed employment. Also describe any other compensation
the beneficiary will receive, including dollar value (if
applicable).

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Beneficiary's Foreign Physical Address

8.b.

Wages and Hours of Proposed Employment

4.

Beneficiary's Wages Per Year $

5.

Beneficiary's Hours Per Week

6.

Other Compensation

8.e. Postal Code
8.f.

Country

Proposed Job Title and Duties

Other Information About the Beneficiary
9.

Date of Birth (mm/dd/yyyy)

10.

Gender

11.

City or Town of Birth

12.

Province or State of Birth

13.

Country of Birth

14.

Country of Citizenship or Nationality

Male

Female

Provide the job title and duties the beneficiary will perform.
Also indicate the percentage of time the beneficiary will spend
performing the duties on a daily basis. If you need extra space
to complete this section, use the space provided in Part 10.
Additional Information.
7.

Job Title

8.

Duties Performed on a Daily Basis

Primary Worksite
If you need extra space to complete this section, use the space
provided in Part 10. Additional Information.
9.

Part 4. Information About Proposed United
States Employment
1.

Provide the receipt number for the Blanket L petition
upon which this petition is based.
►

2.

Are you filing Form I-129, Petition for a Nonimmigrant
Worker, with this petition?
Yes
No

Proposed Employment Address for the Beneficiary
3.a. Street Number
and Name
3.b.

Apt.

Ste.

Flr.

If you are seeking L-1B specialized knowledge
professional status for the beneficiary, will the beneficiary
work primarily offsite (at a worksite of a company or
organization other than the petitioner or its affiliate,
branch, subsidiary, or parent company)?
Yes

No

If you answered "Yes" to Item Number 9., describe how
and who will control and supervise the beneficiary's work
and why the placement is not labor for hire in Item
Numbers 10.a. - 11.
10.a. Supervisor's Name

10.b. Nature of Supervision and Control of the Beneficiary's
Work

3.c. City or Town
3.d. State

3.e. ZIP Code

Form I-129S Edition 09/03/21

Page 3 of 7

Part 4. Information About Proposed United
States Employment (continued)
11.

Other Information About the Beneficiary's Foreign
Employment

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Describe the reasons why the placement of the beneficiary
at this worksite is not an arrangement to provide labor for
hire. Also include a description of how the beneficiary's
duties at this worksite relate to your need for the
specialized knowledge he or she possesses.

Provide the beneficiary's job titles, dates of foreign
employment, and the duties of the jobs the beneficiary
performed during the required one continuous year out of three
years. Also provide the yearly wage the beneficiary received
and the number of hours the beneficiary worked per week.
Job 1
4.

Job Title

5.a. Start Date (mm/dd/yyyy)

Part 5. Information About Foreign Employment
Provide information for each qualifying foreign employer for
whom the beneficiary worked during the required one
continuous year out of three years. If you need extra space to
complete this section, use the space provided in Part 10.
Additional Information.

5.b. End Date (mm/dd/yyyy)
6.

Job Duties

7.

Wages Earned Per Year

8.

Hours Worked Per Week

Qualifying Foreign Position

Indicate the type of qualifying position the beneficiary was
employed in while working for the qualifying foreign employer.
1.a.

Manager

1.b.

Executive

Job 2

1.c.

Specialized Knowledge Professional

9.

Job Title

Qualifying Foreign Employer Name and Address

10.a. Start Date (mm/dd/yyyy)

Provide the name and address for the qualifying foreign
employer for whom the beneficiary worked.

10.b. End Date (mm/dd/yyyy)

2.

11.

Job Duties

12.

Wages Earned Per Year

13.

Hours Worked Per Week

Foreign Employer Name

$

Mailing Address
3.a. Street Number
and Name
3.b.

Apt.

Ste.

Flr.

$

3.c. City or Town
3.d. Province
3.e. Postal Code
3.f.

Country

Form I-129S Edition 09/03/21

Page 4 of 7

Part 6. Certification Regarding the Release of
Controlled Technology or Technical Data to
Foreign Persons in the United States

Petitioner's or Authorized Signatory's Certification
and Signature

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Select Item Number 1. or 2., as appropriate.

If filing this petition on behalf of an organization, I certify that I
am authorized to do so by the organization:

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:
1.

2.

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

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 7. Contact Information, Certification, and
Signature of the Petitioner or Authorized
Signatory
Petitioner's or Authorized Signatory's Contact
Information
1.

1)

I reviewed and provided or authorized all of the
responses and information in my petition;

2)

I understood all of the responses and information
contained in, and submitted with, my petition; and

3)

All of the responses and information were
complete, true, and correct at the time of filing.

Furthermore, I authorize the release of any information from
any and all of my records as authorized signatory and the
petitioner's records that USCIS may need to determine the
petitioner's eligibility for an immigration request and to other
entities and persons where necessary for the administration and
enforcement of U.S. immigration law.
6.

Petitioner's or Authorized Signatory's Signature

Date of Signature (mm/dd/yyyy)

Part 8. Interpreter's Contact Information,
Certification, and Signature
Interpreter's Full Name

1.

Petitioner's or Authorized Signatory's Family Name
(Last Name)

Interpreter's Family Name (Last Name)

Interpreter's Given Name (First Name)

2.

Interpreter's Business or Organization Name

Petitioner's or Authorized Signatory's Given Name
(First Name)

Interpreter's Contact Information
2.

Petitioner's or Authorized Signatory's Title

3.

Petitioner's or Authorized Signatory's Daytime Telephone
Number

4.

Petitioner's or Authorized Signatory's Mobile Telephone
Number (if any)

5.

Petitioner's or Authorized Signatory's Email Address
(if any)

Form I-129S Edition 09/03/21

3.

Interpreter's Daytime Telephone Number

4.

Interpreter's Mobile Telephone Number (if any)

5.

Interpreter's Email Address (if any)

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Part 8. Interpreter's Contact Information,
Certification, and Signature (continued)

Preparer's Certification and Signature

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Interpreter's Certification and Signature

I certify, under penalty of perjury, that I am fluent in English
and

,

and I have interpreted every question on the petition and
Instructions and interpreted the petitioner's or authorized
signatory's answers to the questions in that language, and the
petitioner or authorized signatory informed me that they
understood every instruction, question, and answer on the
petition.
6.

I certify, under penalty of perjury, that I prepared this petition
for the petitioner at their request and with express consent and
that all of the responses and information contained in and
submitted with the petition are complete, true, and correct and
reflects only information provided by the petitioner. The
petitioner reviewed the responses and information and informed
me that they understand the responses and information in or
submitted with the petition.
6.

Preparer's Signature

Date of Signature (mm/dd/yyyy)

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

Part 9. Contact Information, Declaration, and
Signature of the Person Preparing this Petition,
if Other Than the Petitioner or Authorized
Signatory
Preparer's Full Name
1.

Preparer's Family Name (Last Name)

Preparer's Given Name (First Name)

2.

Preparer's Business or Organization Name

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)

Form I-129S Edition 09/03/21

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5.a. Page Number

Part 10. Additional Information
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 beneficiary's name and A-Number
(if any) 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.

5.b. Part Number

5.c. Item Number

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5.d.

1.a. Beneficiary's Family Name (Last Name)

1.b. Beneficiary's Given Name (First Name)

1.c. Beneficiary's Middle Name

6.a. Page Number

2.

Beneficiary's A-Number (if any)
► A-

3.a. Page Number

3.d.

3.b. Part Number

6.b. Part Number

6.c. Item Number

7.b. Part Number

7.c. Item Number

6.d.

3.c. Item Number

7.a. Page Number

7.d.
4.a. Page Number

4.b. Part Number

4.c. Item Number

4.d.

Form I-129S Edition 09/03/21

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