Page 12,
Part 11. Applicant’s
Statement, Contact Information, Certification, and Signature
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[Page 12]
Part 11. Applicant's
Statement, Contact Information, Certification, and Signature
NOTE: Read the Penalties
section of the Form I-881 Instructions before completing this
section.
You must file Form I-881 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 12. 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 13., [fillable field], prepared this
application for me based only upon information I provided or
authorized.
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 will require
me to appear for an appointment to take my biometrics
(fingerprints, photograph, and/or signature) and, at that time, I
will be required to sign an oath reaffirming that:
1) I reviewed and provided or
authorized all of the information in my application;
2) I understood all of the
information contained in, and submitted with, my application; and
3) All of this information
was complete, true, and correct at the time of filing.
I certify, under penalty of perjury,
that I provided or authorized all of the information in my
application, I 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
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 12]
Part 11. 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
12.,
understood, all
of the responses
and information
contained in, and submitted with, my application, and that all of
the responses and the information
are
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.
Applicant’s
Signature
Date
of
Signature (mm/dd/yyyy)
[deleted]
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Page 12-13,
Part 12.
Interpreter’s Contact Information, Certification, and
Signature
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[Page 12]
Part 12. 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
[page 13]
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
11., 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 Certification, and has verified
the accuracy of every answer.
Interpreter's Signature
7.a. Interpreter's Signature
7.b. Date of Signature
(mm/dd/yyyy)
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[Page 12]
Part 12. Interpreter's Contact
Information, Certification, and Signature
[deleted]
Interpreter’s
Full
Name
1.
Interpreter’s
Family Name (Last Name)
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.
Interpreter’s
Signature
Date
of Signature (mm/dd/yyyy)
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Page 13-14,
Part 13. Contact
Information, Declaration, and Signature of the Person Preparing
this Application, if Other Than the Applicant
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[Page 13]
Part 13. 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)
[page 14]
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 need to submit a completed
Form G-28, Notice of Entry of Appearance as Attorney or Accredited
Representative, 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 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
8.b. Date of Signature
(mm/dd/yyyy)
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[Page 13]
Part 13. Contact Information,
Declaration, and Signature of the Person Preparing this
Application, if Other Than the Applicant
[deleted]
Preparer’s
Full
Name
1.
Preparer’s
Family Name (Last Name)
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 are 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.
Preparer’s
Signature
Date
of Signature (mm/dd/yyyy)
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