Form G-1566 Certificate of Non-Existence

Request for a Certificate of Non-Existence

USCIS
Form G-1566

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

OMB No. 1615-xxxx
Expires xx/xx/20xx

► START HERE - Type or print in black ink. You may request information for one subject of record per form

Part 1. Certificate Request
1.

Certificate Type (select only one):
Certificate of Non-Existence of Naturalization
Certificate of Non-Existence of any U.S. Citizenship and Immigration Services (USCIS) records

DRAFT
Not for
Production
02/16/2022

Other (provide an explanation about the type of records about which you seek a Certificate of Non-Existence):

2.

Number of Certificates Requested: ►

Part 2. Information About Subject of Record

Provide the following information about the person for whom you are requesting a Certificate of Non-Existence.
1.

Name

Family Name (Last Name)

2.

Given Name (First Name)

Other Names Used (including maiden name, aliases, and nicknames). Providing other names or alternate spellings of the subject
of record's name may assist USCIS's search for relevant records.
Family Name (Last Name)

3.

Middle Name (if applicable)

Given Name (First Name)

Middle Name (if applicable)

Date of Birth (mm/dd/yyyy)

A. Is this an approximate date?

Yes

No

B. If applicable, provide any additional dates of birth the subject of record may have used. This information may assist our
search for relevant records.
Date 1 (mm/dd/yyyy)

Date 2 (mm/dd/yyyy)

4.

Country of Birth

5.

A. Date of Entry into the United States (mm/dd/yyyy)
B. Is this an approximate date?

Yes

No

6.

Provide any Alien Registration Numbers (A-Number) that may be associated with the subject of record. An A-Number may
also be called a USCIS Number.
► A-

7.

Provide any other identifying or reference numbers found on documents issued by USCIS or the former Immigration and
Naturalization Service (INS).

Form G-1566 xx/xx/xx

Page 1 of 4

Part 2. Information About Subject of Record (continued)
8.

Spouse's Name(s):
Family Name (Last Name)

9.

Given Name (First Name)

Middle Name (if applicable)

Given Name (First Name)

Middle Name (if applicable)

Children's Name(s):
Family Name (Last Name)

DRAFT
Not for
Production
02/16/2022

Part 3. Requestor Information
1.

Requestor's Full Name

Family Name (Last Name)

2.

Email Address:

3.

Mailing Address

Middle Name (if applicable)

Street Number and Name

Apt. Ste. Flr.

Number

City or Town

State

ZIP Code

Province

4.

Given Name (First Name)

Postal Code

Country

Is a self-addressed, prepaid return envelope submitted with your Form G-1566?
NOTE: USCIS will send Certificates to an international address only if a prepaid envelope with sufficient postage for
international shipping is submitted with Form G-1566.
Yes, a return envelope is included
No, a return envelope is not included

Part 4. Verification of Identity and Subject of Record Consent
If the Subject of Record named in Part 1. is alive, they must sign in either Item Number 1. or 2.
If you are both the Subject of Record and the requestor, you must sign in either Item Number 1. or 2.
If the Subject of Record was born less than 100 years ago and is deceased, you must attach an obituary, death certificate, or other
proof of death. The requestor named in Part 3. must provide a signature in Item Number 8.
If the Subject of Record listed in Part 2. was born 100 years ago or more and is deceased, proof of death is not required. The
requestor named in Part 3. must provide a signature in Item Number 8.
Form G-1566 xx/xx/xx

Page 2 of 4

Part 4. Verification of Identity and Subject of Consent (continued)
Declaration Under Penalty of Perjury
By my signature, I consent to USCIS providing a Certificate of Non-Existence or a response to the requestor named in Part 3. I
certify, swear, or affirm, under penalty of perjury under the laws of the United States of America, that the information in this request is
complete, true, and correct.
1.

Signature

Date of Signature (mm/dd/yyyy)

DRAFT
Not for
Production
02/16/2022

Notarized Affidavit of Identity

IMPORTANT: Do NOT sign and date below until the notary public provides instructions to you.

By my signature, I consent to USCIS providing a Certificate of Non-Existence or a response to the requestor named in Part 3.
2.

Signature

3.

Subscribed and sworn to before me on this day of

4.

Daytime Telephone Number

5.

Signature of Notary

Date of Signature (mm/dd/yyyy)

in the year

.

Daytime Telephone Number

6.

My Commission Expires on (mm/dd/yyyy)

Subject of Record Deceased
7.

Subject of Record is deceased

Signature of Requestor

By my signature, I certify that I understand all of the information contained in this request is complete, true, and correct.
8.

Signature

Form G-1566 xx/xx/xx

Date of Signature (mm/dd/yyyy)

Page 3 of 4

Part 5. Additional Information
If you need extra space to provide any additional information within this request, 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 request or attach a separate sheet of paper. Type or
print your 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.
1.

Family Name (Last Name)

2.

A-Number (if any)

3.

A.

A.

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

Page Number

B.

Part Number

C.

Item Number

DRAFT
Not for
Production
02/16/2022

D.

5.

A.

D.

6.

A.

Middle Name (if applicable)

► A-

Page Number

D.

4.

Given Name (First Name)

D.

7.

A.

D.

Form G-1566 xx/xx/xx

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