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pdfImmigrant Petition for the Gold Card Program
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-140G
OMB No. 1615-xxxx
Expires xx/xx/xxxx
To be completed by an Attorney or Accredited 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)
NOTE: If you do not completely fill out this form or fail to submit required documents listed in the Instructions, your petition may be
rejected or denied.
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Part 1. Petition Type
The requested classification for this petition is (select only one box):
1.
2.
203(b)(1)(A) Alien of Extraordinary Ability;
203(b)(2)(B) Alien of Exceptional Ability who is seeking a National Interest Waiver (NIW).
NOTE: Please refer to the U.S. Department of State's Visa Bulletin to see the availability of immigrant visas for each classification.
3.
Total number of aliens who are requesting a Gold Card based on this petition:
Part 2. Information About the Petitioner
This petition is being filed by (select only one box):
1.
2.
An individual filing on his or her own behalf (self-petitioner). The required gift to the United States is $1 million per
person, including any accompanying spouse or children listed on this petition.
A corporation or similar entity filing on behalf of an individual. The required gift to the United States is $2 million for the
principal beneficiary, and $1 million per person for any accompanying spouse or children listed on this petition.
The gift amount is separate from the required fee.
If you selected Item Number 1. for self-petitioner, only answer Item Number 3. of Part 2. If you selected Item Number 2. for a
corporation or similar entity, only answer Item Numbers 4. - 13. of Part 2.
Individual Self-Petitioner
3.
Individual Self-Petitioner's Full Legal Name
Family Name (Last Name)
Given Name (First Name)
Middle Name (if applicable)
Corporation or Similar Entity Information
4.
Corporation or Similar Entity Name
Form I-140G Edition xx/xx/xx
Page 1 of 24
Part 2. Information About the Petitioner (continued)
5.
Corporate or Similar Entity Mailing Address
In Care Of Name
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
ZIP Code
(USCIS ZIP Code Lookup)
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Province
Postal Code
Country
Other Information for Corporate or Similar Entity
6.
Type of Business
7.
Date Established (mm/dd/yyyy)
9.
Gross Annual Income $
11.
IRS Employer Identification Number (EIN) (if any)
►
12.
U.S. Social Security Number (if any)
►
8.
10.
13.
Current Number of Employees
Net Annual Income $
USCIS Online Account Number (if any)
►
Part 3. Information About the Principal Beneficiary Who is Requesting a Gold Card
The petitioner must fill out this section for the principal beneficiary of this petition requesting a Gold Card.
If you are the Individual Self-Petitioner, skip Item Number 1.
1.
Full Legal Name
Family Name (Last Name)
2.
Given Name (First Name)
Middle Name (if any)
Given Name (First Name)
Middle Name (if any)
Other Names Used
Family Name (Last Name)
Form I-140G Edition xx/xx/xx
Page 2 of 24
Part 3. Information About the Principal Beneficiary Who is Requesting a Gold Card (continued)
Other Information
3.
Principal Beneficiary's Receipt Number
5.
Sex
6.
City/Town/Village of Birth
8.
Country of Birth
Male
4.
Date of Birth (mm/dd/yyyy)
7.
State or Province of Birth
Female
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9.a. Country/Countries of Citizenship or Nationality
9.b. All Prior Countries of Citizenship or Nationality (if any)
9.c. Relinquished Countries of Citizenship or Nationality (if any)
10.
12.
Alien Registration Number (A-Number) (if any)
► A-
11.
U.S. Social Security Number (if any)
►
Mailing Address
In Care Of Name
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
Postal Code
ZIP Code
Country
Last Arrival in the United States
If this person is in the United States, provide the following information.
13.
Place and Date of Last Arrival into the United States
City or Town
14.a. Form I-94 Arrival/Departure Record Number
State
Date of Last Arrival (mm/dd/yyyy)
►
14.b. Expiration Date of Authorized Stay Shown on Form I-94 (mm/dd/yyyy)
or Type or Print "D/S" for Duration of Status
14.c. Immigration Status on Form I-94 (for example, class of admission, or
paroled, if paroled)
15.
Passport/Travel Document/National ID Number Used at Last Arrival
Form I-140G Edition xx/xx/xx
Page 3 of 24
Part 3. Information About Each Individual Who is Requesting a Gold Card (continued)
16.
Country that Issued this Passport/Travel Document/National ID
17.
Expiration Date of this Passport/Travel Document/National ID (mm/dd/yyyy)
Employment History
If applicable, provide the last 20 years of your employment history. Also provide any government or military positions held at any
time (for example, even if older than 20 years). List present employment first. If you need extra space to complete this section, use the
space provided in Part 11. Additional Information.
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18.
Has this person ever been employed?
19.
Employer 1
Yes
No
Employer Name
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
Postal Code
ZIP Code
Country
Job Title
From (mm/dd/yyyy)
20.
To (mm/dd/yyyy)
Employer 2
Employer Name
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
Postal Code
ZIP Code
Country
Job Title
From (mm/dd/yyyy)
Form I-140G Edition xx/xx/xx
To (mm/dd/yyyy)
Page 4 of 24
Part 3. Information About Each Individual Who is Requesting a Gold Card (continued)
21.
Employer 3
Employer Name
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
ZIP Code
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Province
Postal Code
Country
Job Title
From (mm/dd/yyyy)
To (mm/dd/yyyy)
Education History
If applicable, provide your education history post high school or secondary education to present. Include schools, area of concentration, and
dates attended (whether a degree was obtained or not); also include instructions or training academies, including military academies or
government sponsored training. List most recent education first. If you need extra space to complete this section, use the space provided in
Part 11. Additional Information.
22.
Education 1
Name of Institution
Type of Institution (University, Academy, Military Branch, etc.)
From (mm/dd/yyyy)
To (mm/dd/yyyy)
Degree or Certification obtained or worked toward, if no degree obtained
Field or subject studied or majored
List of honors or awards
Form I-140G Edition xx/xx/xx
Page 5 of 24
Part 3. Information About Each Individual Who is Requesting a Gold Card (continued)
23.
Education 2
Name of Institution
Type of Institution (University, Academy, Military Branch, etc.)
From (mm/dd/yyyy)
To (mm/dd/yyyy)
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Degree or Certification obtained or worked toward, if no degree obtained
Field or subject studied or majored
List of honors or awards
24.
Education 3
Name of Institution
Type of Institution (University, Academy, Military Branch, etc.)
From (mm/dd/yyyy)
To (mm/dd/yyyy)
Degree or Certification obtained or worked toward, if no degree obtained
Field or subject studied or majored
List of honors or awards
Information About Marital History
25.
What is this person's current marital status?
Single (Never Married)
Married
Divorced
Widowed
Separated
Marriage Annulled
If this person is single and have never married, go to Part 4.
26.
How many times has this person been married?
27.
Date of Current Marriage (if currently married) (mm/dd/yyyy)
Form I-140G Edition xx/xx/xx
Page 6 of 24
Part 3. Information About Each Individual Who is Requesting a Gold Card (continued)
28.
29.
Current Spouse (if current spouse is not requesting a Gold Card)
Family Name (Last Name)
Given Name (First Name)
Date of Birth (mm/dd/yyyy)
Country of Birth
Former Spouse 1
Family Name (Last Name)
Given Name (First Name)
Middle Name (if applicable)
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Date of Birth (mm/dd/yyyy)
30.
Middle Name (if applicable)
Country of Birth
Date Marriage Ended (mm/dd/yyyy)
Family Name (Last Name)
Given Name (First Name)
Middle Name (if applicable)
Date of Birth (mm/dd/yyyy)
Country of Birth
Date Marriage Ended (mm/dd/yyyy)
Former Spouse 2
Part 4. Source of Funds - Individual Self-Petitioner
Only complete this Part if you are a self-petitioner. If the petitioner is a corporation or other entity, skip to Part 7.
The funds described in this section must be sufficient to cover the significant financial gift being made on behalf of the principal
beneficiary and any spouse and/or children requesting participation in the Gold Card program. The funds must also cover the required
filing fees for the principal and any spouse/children.
Net Worth
1.
Your Current Net Worth at the time of transfer, less any unsellable assets (such as, for
example, due to equity in assets for which you are not the sole owner).
2.
Please identify the sources of your funds. (Select all that apply.)
A.
Income
B.
Sale of Property
C.
Ownership in a Business
D.
Gift (including capital obtained through inheritance)
E.
Other (Explain):
$
You must provide an explanation on the addendum pages to Form I-140G and submit supporting documentary evidence.
Form I-140G Edition xx/xx/xx
Page 7 of 24
Part 4. Source of Funds - Individual Self-Petitioner (continued)
3.
Identify the types of evidence submitted to demonstrate the lawfulness of the funds. (Select all that apply) Provide the page or
exhibit number for each piece of evidence.
If funds are accumulated by income
A.
Complete Bank records demonstrating the accumulation and path of funds, at a minimum covering the past five (5) years
NOTE: If using crypto funds, those must be traceable through blockchain with wallet identification with a known
wallet exchange through regulated financial institutions. Provide your wallet identification. USCIS may request
additional evidence.
B.
C.
D.
Income certificates issued by your employer and those for your spouse (if applicable)
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Personal income tax returns for you and your spouse (if applicable) for the period when the funds were accumulated,
which must cover a minimum of the past seven (7) years
Sale of Securities (if applicable)
If funds were obtained from the sale or mortgage of property
A.
B.
C.
D.
E.
Appraisal or property value of a property sold to obtain the funds
Evidence of ownership of a property sold to obtain the funds
Mortgage, purchase, or sale contract of a property sold to obtain the funds
Sales tax or transfer tax payment receipts for a property sold to obtain the funds
Evidence of how funds were initially acquired and used to purchase any property sold to obtain the funds
If funds are derived from your ownership in a business
A.
B.
C.
D.
E.
Company bank statements
Financial audit reports
Foreign business registration records
Relevant corporate tax returns for the past seven (7) years
Evidence of how you accumulated funds used to purchase any business ownership
Other income, if applicable
A.
B.
C.
Inheritance
Legal proceedings
Insurance proceeds
If any part of the funds are derived from a gift, please provide the following information for each individual who gifted
the funds:
A.
Biographical information contained in Part 3.
B.
Source of funds information contained in Part 4.
C.
Attestation in Part 5.
D.
An explanation on the relationship between the gifter and the beneficiary
E.
Was the money provided in exchange for a note, bond, convertible debt, obligation, or any other
debt arrangement between the beneficiary and yourself? If yes, please explain the arrangement.
Form I-140G Edition xx/xx/xx
Yes
No
Page 8 of 24
Part 4. Source of Funds - Individual Self-Petitioner (continued)
4.
Provide a listing of all your and your spouse (if applicable) financial accounts, including cryptocurrency accounts.
Account Owner(s) Name(s) & Nationality
Name of Bank & Country
Account #
Payment/Path of Funds
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Please identify the path of funds:
5.
Path of funds
A.
B.
Credit Card. A payment receipt from Pay.gov/Treasury system, which includes credit card holder name, issuer, credit
card number.
Bank Transfer. Trace the complete path of the funds from your account to the Department of Commerce through
financial institutions regulated by government entities. The following information and supporting evidence is needed
for each bank that the money is transferred through.
Date of Transfer
in
(mm/dd/yyyy)
6.
Sender Name
Routing
Number
Name of Bank &
Country
Account #
Amount(s)
SWIFT/BIC Code
(Bank Identifier
code) or IBAN
(International Bank
Account Number)
Did you use a migration agent, promoter, marketer, concierge or similar entity in arranging your petition and/or
funds transfer?
Yes
No
If yes, identify that entity/individual
Part 5. Attestation - Individual Self-Petitioner
For Item Numbers 1. - 14., you should answer “Yes” to any question that applies, even if the records were sealed or otherwise
cleared, or if anyone, including a judge, law enforcement officer, or attorney, told you that you no longer have a record. You should
also answer “Yes” to the following questions whether it occurred here in the United States or anywhere else in the world. If you
answer “Yes” to Item Numbers 1. - 14., use the space provided in Part 11. Additional Information to provide an explanation and
include all relevant documentation that includes why you were arrested, cited, detained, or charged; and the outcome or disposition
(for example no charges filed, charges dismissed, jail, probation, community service).
1.
Have the assets, associated directly or indirectly with any of your Gold Card funds, been subject to a
foreign or domestic freeze order or injunction from a court or regulatory agency in the past 10 years for an
offense involving financial fraud or deceit?
Yes
No
2.
Have you, any of the entities you have legal ownership in, or the sources (direct or indirect) of your Gold
Card funds ever committed, been charged with, arrested for, or convicted of a criminal or civil offense?
Yes
No
3.
Are you, any of the entities you have legal ownership in, or the sources of your Gold Card funds engaged
in, ever been engaged in, or sought to engage in any illicit trafficking in any controlled substance or in any
listed chemical (as defined in section 102 of the Controlled Substances Act)?
Yes
No
Form I-140G Edition xx/xx/xx
Page 9 of 24
Part 5. Attestation - Individual Self-Petitioner (continued)
4.
Have you, any of the entities you have legal ownership in, entities you are employed by, or the sources of
your Gold Card funds engaged in, ever been engaged in, or sought to engage in any activity relating to
espionage, sabotage, or theft of intellectual property?
Yes
No
5.
Are you, any of the entities you have legal ownership in, or the sources of your Gold Card funds engaged
in, ever been engaged in, or sought to engage in any activity related to money laundering (as described in
section 1956 or 1957 of title 18, United States Code)?
Yes
No
6.
Are you, any of the entities you have legal ownership in, or the sources of your Gold Card funds engaged
in, ever been engaged in, or sought to engage in any terrorist activity (as defined in INA section 212(a)(3)
(B))? If a company, has your company, or any of its principals ever financed or otherwise supported any
terrorist activity (as defined in INA section 212(a)(3)(B)?
Yes
No
7.
Are you, any of the entities you have legal ownership in, or the sources of your Gold Card funds engaged
in, ever been engaged in, or sought to engage in any activity constituting or facilitating human trafficking
or a human rights offense?
Yes
No
8.
Are you engaged in, or have you ever been engaged in, or do you seek to engage in any activity described
in INA section 212(a)(3)(E) (such as participating in Nazi persecutions or genocide)? Has any entity you
have legal ownership in, or the sources of your Gold Card funds, financed or otherwise supported any
person or organization that has participated or is participating in genocide?
Yes
No
9.
Have you ever been a member of, or in any way affiliated with, the Communist Party or any totalitarian
party (in the United States or abroad) as described in INA section 212(a)(3)(D)?
Yes
No
10.
Are you, any of the entities you have legal ownership in, or the sources of your Gold Card funds engaged
in, ever been engaged in, or sought to engage in a violation of any statute, regulation, or executive order
regarding foreign financial transactions or foreign asset control?
Yes
No
11.
Have you, any of the entities you have legal ownership in, or the sources of your Gold Card funds been
included, during the preceding 10 years, on any U.S., foreign country, or international sanctions or
watchlist? (Examples include, but are not limited to: OFAC's Specialty Designated Nationals List, the
UNSC Consolidated List, the European Union Consolidated Financial Sanctions List, or the UK HM
Treasury Sanctions List).
Yes
No
12.
Are you now, or have you ever been, an agent, official, or other similar entity or representative of a foreign
government entity?
Yes
No
13.
Have your funds derived from an agency, official, or other similar entity (or representative of) a foreign
government entity?
Yes
No
14.
Are any entities you have legal ownership in, or the sources of your Gold Card funds subject to, the direct
or indirect involvement of an agency, official, or other similar entity (or representative of) a foreign
government entity?
Yes
No
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Part 6. Statement, Declaration, Certification, and Signature of the Principal Beneficiary
Principal Beneficiary's Statement
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 petition and my
answer to every question.
1.b.
The interpreter named in Part 9. has read to me every question and instruction on this petition and my answer to every
question in
,
a language in which I am fluent. I understood all of this information as interpreted.
2.
At my request, the preparer named in Part 10.,
prepared this petition for me based only upon information I provided or authorized.
Form I-140G Edition xx/xx/xx
,
Page 10 of 24
Part 6. Statement, Declaration, Certification, and Signature of the Principal Beneficiary (continued)
Principal Beneficiary's Declaration and Certification
Copies of any documents submitted are exact photocopies of unaltered, original documents, and I understand that, as the petitioner, I
may be required to submit original documents to USCIS at a later date.
I authorize the release of any information from my records to USCIS or other entities and persons where necessary to determine
eligibility for the immigration benefit sought or where authorized by law. I recognize the authority of USCIS to conduct audits of this
petition using publicly available open-source information. I also recognize that any supporting evidence submitted in support of this
petition may be verified by USCIS through any means determined appropriate by USCIS, including but not limited to, on-site
compliance reviews.
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I certify, under penalty of perjury, that I have reviewed this petition, I understand all of the information contained in, and submitted
with, my petition, and all of this information is complete, true, and correct.
Principal Beneficiary's Signature
8.
Principal Beneficiary's Signature
Date of Signature (mm/dd/yyyy)
Part 7. Source of Funds - Corporation or Similar Entity Petitioner
The funds described in this section must be sufficient to cover the significant financial gift being made on behalf of the principal
beneficiary and any spouse and/or children requesting participation in the Gold Card program. The funds must also cover the required
filing fees for the principal and any spouse/children.
1.
Company name (Legal & Doing Business As (DBA))
2.
Are you seeking to rely on the Gold Card funds used for a prior Form I-140G on behalf of another alien(s)?
Yes
No
If yes, provide the receipt number of the prior Form I-140G, and the Alien Number of each alien beneficiary of that petition and
proceed to Part 8.
3.
Location where company is incorporated
State
5.
Country
Company Ownership. Identify each of the owners, board of directors or equivalent, and beneficial owners of the company. For
each, provide the following information, as applicable.
Name
EIN
SSN
Date of Birth
(mm/dd/yyyy)
U.S. Immigration Status
NOTE: Submit a comprehensive organization chart for your Company Organization.
6.
Company's Net Worth at the time of the transfer funds
Form I-140G Edition xx/xx/xx
Page 11 of 24
Part 7. Source of Funds - Corporation or Similar Entity Petitioner (continued)
7.
Provide one or more of the following (Select all that apply):
3 years of Company Federal Tax Returns including all forms and schedules
3 years of Company Annual Reports
3 years of Audited Financial Statements
8.
Is the company organized in the United States?
Yes
9.
Provide your EIN (if a U.S. Company) or Tax Identification Number (TIN)
►
10.
Is the company a parent, branch, subsidiary, or affiliate of a foreign entity?
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Yes
No
No
If yes, identify the foreign entity.
11.
Is the company state-owned?
Yes
No
If so, which State?
Payment/Path of Funds
Please identify the path funds:
12.a. Credit Card
A payment receipt from Pay.gov/Treasury system, which includes credit card holder name, issuer, credit card number.
12.b. Bank Transfer
Trace the complete path of the funds from your account to the Department of Commerce through financial institutions
regulated by government entities. The following information and supporting evidence is needed for each bank that the
money is transferred through.
Date of Transfer
in
(mm/dd/yyyy)
13.
Sender Name
Routing
Number
Name of Bank &
Country
Account #
Amount(s)
SWIFT/BIC Code
(Bank Identifier
code) or IBAN
(International Bank
Account Number)
Did you use a migration agent, promoter, marketer, concierge, or similar entity in arranging your petition or
funds transfer?
Yes
No
Yes
No
Yes
No
If yes, identify that entity/individual.
14.
What is your relationship to the beneficiary?
15.
Was the money provided in exchange for a note, bond, convertible debt, obligation, or any other debt
arrangement between the beneficiary and yourself?
If yes, please explain the arrangement.
16.
Have your company assets been subject to a foreign or domestic freeze order or injunction from a court or
regulatory agency in the past 10 years for an offense involving financial fraud or deceit?
Form I-140G Edition xx/xx/xx
Page 12 of 24
Part 7. Source of Funds - Corporation or Similar Entity Petitioner (continued)
17.
Has your company or your company's principals ever committed, been charged with, arrested for, or
convicted of a criminal or civil offense?
Yes
No
18.
Is your company or your company's principals engaged in, ever been engaged in, or sought to engage in
any illicit trafficking in any controlled substance or in any listed chemical (as defined in section 102 of the
Controlled Substances Act)?
Yes
No
19.
Is your company or your company's principals engaged in, ever been engaged in, or sought to engage in
any activity relating to espionage, sabotage, or theft of intellectual property? Has your company or any of
its principals financed or otherwise supported or does it seek to finance or otherwise support any activity
relating to espionage, sabotage, or theft of intellectual property?
Yes
No
20.
Is your company or your company's principals engaged in, ever been engaged in, or sought to engage in
any activity related to money laundering (as described in section 1956 or 1957 of title 18, United States
Code)?
Yes
No
21.
Has your company or your company's principals engaged in, ever been engaged in, or sought to engage in
any terrorist activity (as defined in INA section 212(a)(3)(B))? Has your company or any of its principals
ever financed or otherwise supported any terrorist activity (as defined in INA section 212(a)(3)(B)?
Yes
No
22.
Has your company or your company's principals engaged in, ever been engaged in, or sought to engage in
any activity constituting or facilitating human trafficking or a human rights offense?
Yes
No
23.
Has your company or your company's principals engaged in, ever been engaged in, or sought to engage in
any activity described in INA section 212(a)(3)(E) (such as participating in Nazi persecutions or genocide)?
Has your company or any of its principals financed or otherwise supported any person or organization that
has participated or is participating in genocide?
Yes
No
24.
Has your company or your company's principals engaged in, ever been engaged in, or sought to engage in a
violation of any statute, regulation, or executive order regarding foreign financial transactions or foreign
asset control?
Yes
No
25.
Is your company or any of its principals now, or during the preceding 10 years has your company or any of
its principals been, included on any U.S., foreign country, or international sanctions or watchlist?
(Examples include, but are not limited to: OFAC's Specialty Designated Nationals List, the UNSC
Consolidated List, the European Union Consolidated Financial Sanctions List, or the UK HM Treasury
Sanctions List).
Yes
No
26.
Has your company or your company principals ever called for sectarian violence?
Yes
No
27.
Is your company or company principals now, or have they ever been, an agency, official, or other similar
entity (or representative of) a foreign government entity?
Yes
No
28.
Have your company's funds derived from an agency, official, or other similar entity (or representative of) a
foreign government entity?
Yes
No
29.
Is your company's ownership subject to the direct or indirect involvement of an agency, official, or other
similar entity or representative of a foreign government entity?
Yes
No
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Form I-140G Edition xx/xx/xx
Page 13 of 24
Part 8. Statement, Contact Information, Declaration, Certification, and Signature of the Authorized
Signatory of the Corporation or Similar Entity
Statement of the Authorized Signatory
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 petition and my
answer to every question.
1.b.
The interpreter named in Part 9. has read to me every question and instruction on this petition and my answer to every
question in
, a language in which I am fluent. I understood all of this
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information as interpreted.
2.
At my request, the preparer named in Part 10.,
, prepared this petition for
me based only upon information I provided or authorized.
Authorized Signatory's Contact Information
3.
Authorized Signatory's Full Legal Name
Family Name (Last Name)
4.
Authorized Signatory's Title
5.
Authorized Signatory's Daytime Telephone Number
7.
Authorized Signatory's Email Address (if any)
Given Name (First Name)
6.
Middle Name (if applicable)
Authorized Signatory's Mobile Telephone Number (if any)
Authorized Signatory's Declaration and Certification
Copies of any documents submitted are exact photocopies of unaltered, original documents, and I understand that, as the petitioner, I
may be required to submit original documents to USCIS at a later date.
I authorize the release of any information from the petitioner's records, to USCIS or other entities and persons where necessary to
determine eligibility for the immigration benefit sought or where authorized by law. I recognize the authority of USCIS to conduct
audits of this petition using publicly available open-source information. I also recognize that any supporting evidence submitted in
support of this petition may be verified by USCIS through any means determined appropriate by USCIS, including but not limited to,
on-site compliance reviews.
If filing this petition on behalf of an organization, I certify that I am authorized to do so by the organization.
I certify, under penalty of perjury, that I have reviewed this petition, I understand all of the information contained in, and submitted
with, my petition, and all of this information is complete, true, and correct.
Authorized Signatory's Signature
8.
Petitioner's or Authorized Signatory's Signature
Form I-140G Edition xx/xx/xx
Date of Signature (mm/dd/yyyy)
Page 14 of 24
Part 9. Interpreter's Contact Information, Certification, and Signature
Provide the following information about the interpreter.
Interpreter's Full Name
1.
Interpreter's Family Name (Last Name)
2.
Interpreter's Business or Organization Name (if any)
Interpreter's Given Name (First Name)
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Interpreter's Contact Information
4.
Interpreter's Daytime Telephone Number
6.
Interpreter's Email Address (if any)
5.
Interpreter's Mobile Telephone Number (if any)
Interpreter's Certification
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 he or she understood every instruction,
question, and answer on the petition.
Interpreter's Signature
7.
Interpreter's Signature
Date of Signature (mm/dd/yyyy)
Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other
Than the Petitioner
Provide the following information about the preparer.
Preparer's Full Name
1.
Preparer's Family Name (Last Name)
2.
Preparer's Business or Organization Name (if any)
Preparer's Given Name (First Name)
Preparer's Contact Information
4.
Preparer's Daytime Telephone Number
6.
Preparer's Email Address (if any)
Form I-140G Edition xx/xx/xx
5.
Preparer's Mobile Telephone Number (if any)
Page 15 of 24
Part 10. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other
Than the Petitioner (continued)
Preparer's Certification
I certify, under penalty of perjury, that I prepared this petition for the petitioner or authorized signatory at his or her 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 or authorized signatory. The petitioner or authorized signatory
reviewed the responses and information and informed me that he or she understands the responses and information in or submitted
with the petition.
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Preparer's Signature
8.
Preparer's Signature
Form I-140G Edition xx/xx/xx
Date of Signature (mm/dd/yyyy)
Page 16 of 24
Part 11. 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 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.
Page Number
Part Number
Item Number
2.
Page Number
Part Number
Item Number
3.
Page Number
Part Number
Item Number
4.
Page Number
Part Number
Item Number
5.
Page Number
Part Number
Item Number
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Form I-140G Edition xx/xx/xx
Page 17 of 24
Supplement - Information About Each Beneficiary Who is Requesting a Gold Card
This section must be filled out to indicate any spouse and children of a principal beneficiary
of the primary Form I-140G petition, who are also requesting a Gold Card
Department of Homeland Security
U.S. Citizenship and Immigration Services
Part 1. Information About the Beneficiary
This person is the (choose one)
Spouse of the Principal Beneficiary
Child of the Principal Beneficiary
1.
Full Legal Name
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Family Name (Last Name)
2.
Given Name (First Name)
Middle Name (if applicable)
Given Name (First Name)
Middle Name (if applicable)
Other Names Used
Family Name (Last Name)
Other Information
3.
Principal Beneficiary's Receipt Number
4.
Beneficiary's Receipt Number
5.
Date of Birth (mm/dd/yyyy)
6.
Sex
7.
City/Town/Village of Birth
8.
State or Province of Birth
9.
Country of Birth
Male
Female
10.a. Country/Countries of Citizenship or Nationality
10.b. Additional Countries of Citizenship or Nationality (if any)
10.c. Relinquished Countries of Citizenship or Nationality (if any)
11.
Alien Registration Number (A-Number) (if any)
► A-
Form I-140G Edition xx/xx/xx
12.
U.S. Social Security Number (if any)
►
Page 18 of 24
Part 1. Information About the Beneficiary (continued)
13.
Mailing Address
In Care Of Name
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
ZIP Code
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Province
Postal Code
Country
Last Arrival in the United States
If this person is in the United States, provide the following information.
14.
Place and Date of Last Arrival into the United States
City or Town
State
15.a. Form I-94 Arrival/Departure Record Number
Date of Last Arrival (mm/dd/yyyy)
►
15.b. Expiration Date of Authorized Stay Shown on Form I-94 (mm/dd/yyyy)
or Type or Print "D/S" for Duration of Status
15.c. Immigration Status on Form I-94 (for example, class of admission, or
paroled, if paroled)
16.
Passport/Travel Document/National ID Number Used at Last Arrival
17.
Country that Issued this Passport/Travel Document/National ID
18.
Expiration Date of this Passport/Travel Document/National ID
(mm/dd/yyyy)
Employment History
If applicable, provide the last 20 years of this person's employment history. Also provide any government or military positions held at
any time (for example, even if older than 20 years). List present employment first. If you need extra space to complete this section, use
the space provided in Part 11. Additional Information.
19.
Has this person ever been employed?
20.
Employer 1
Yes
No
Employer Name
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
Form I-140G Edition xx/xx/xx
Postal Code
ZIP Code
Country
Page 19 of 24
Part 1. Information About the Beneficiary (continued)
Job Title
From (mm/dd/yyyy)
21.
To (mm/dd/yyyy)
Employer 2
Employer Name
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Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
Postal Code
ZIP Code
Country
Job Title
From (mm/dd/yyyy)
22.
To (mm/dd/yyyy)
Employer 3
Employer Name
Street Number and Name
Apt. Ste. Flr. Number
City or Town
State
Province
Postal Code
ZIP Code
Country
Job Title
From (mm/dd/yyyy)
Form I-140G Edition xx/xx/xx
To (mm/dd/yyyy)
Page 20 of 24
Part 1. Information About the Beneficiary (continued)
Education History
If applicable, provide this person's education history from post high school or secondary education to present. Include schools, area of
concentration, and dates attended (whether a degree was obtained or not); also include instructions or training academies, including military
academies or government sponsored training. List most recent education first. If you need extra space to complete this section, use the
space provided in Part 11. Additional Information.
23.
Education 1
Name of Institution
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Type of Institution (University, Academy, Military Branch, etc.)
From (mm/dd/yyyy)
To (mm/dd/yyyy)
Degree or Certification obtained or worked toward, if no degree obtained
Field or subject studied or majored
List of honors or awards
24.
Education 2
Name of Institution
Type of Institution (University, Academy, Military Branch, etc.)
From (mm/dd/yyyy)
To (mm/dd/yyyy)
Degree or Certification obtained or worked toward, if no degree obtained
Field or subject studied or majored
List of honors or awards
Form I-140G Edition xx/xx/xx
Page 21 of 24
Part 1. Information About the Beneficiary (continued)
25.
Education 3
Name of Institution
Type of Institution (University, Academy, Military Branch, etc.)
From (mm/dd/yyyy)
To (mm/dd/yyyy)
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Degree or Certification obtained or worked toward, if no degree obtained
Field or subject studied or majored
List of honors or awards
Information about Marital History
26.
What is this person's current marital status?
Single (Never Married)
Married
Divorced
Widowed
Separated
Marriage Annulled
If this person is single and have never married, go to Part 4.
27.
How many times has this person been married?
28.
Date of Current Marriage (if currently married) (mm/dd/yyyy)
29.
Current Spouse
30.
31.
Family Name (Last Name)
Given Name (First Name)
Date of Birth (mm/dd/yyyy)
Country of Birth
Middle Name (if applicable)
Former Spouse 1
Family Name (Last Name)
Given Name (First Name)
Middle Name (if applicable)
Date of Birth (mm/dd/yyyy)
Country of Birth
Date Marriage Ended (mm/dd/yyyy)
Family Name (Last Name)
Given Name (First Name)
Middle Name (if applicable)
Date of Birth (mm/dd/yyyy)
Country of Birth
Date Marriage Ended (mm/dd/yyyy)
Former Spouse 2
Form I-140G Edition xx/xx/xx
Page 22 of 24
Part 2. Beneficiary’s Statement, Declaration, Certification, and Signature
Beneficiary's Statement
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 petition and my
answer to every question.
1.b.
The interpreter named in Part 3. has read to me every question and instruction on this petition and my answer to every
question in
,
a language in which I am fluent. I understood all of this information as interpreted.
2.
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At my request, the preparer named in Part 4.,
prepared this petition for me based only upon information I provided or authorized.
,
Beneficiary's Declaration and Certification
Copies of any documents submitted are exact photocopies of unaltered, original documents, and I understand that, as the petitioner, I
may be required to submit original documents to USCIS at a later date.
I authorize the release of any information from my records to USCIS or other entities and persons where necessary to determine
eligibility for the immigration benefit sought or where authorized by law. I recognize the authority of USCIS to conduct audits of this
petition using publicly available open-source information. I also recognize that any supporting evidence submitted in support of this
petition may be verified by USCIS through any means determined appropriate by USCIS, including but not limited to, on-site
compliance reviews.
I certify, under penalty of perjury, that I have reviewed this petition, I understand all of the information contained in, and submitted
with, my petition, and all of this information is complete, true, and correct.
Beneficiary's Signature
3.
Petitioner's Signature
Date of Signature (mm/dd/yyyy)
Part 3. Interpreter’s Contact Information, Certification, and Signature
Provide the following information about the interpreter.
Interpreter's Full Name
1.
Interpreter's Family Name (Last Name)
2.
Interpreter's Business or Organization Name (if any)
Interpreter's Given Name (First Name)
Interpreter's Contact Information
4.
Interpreter's Daytime Telephone Number
6.
Interpreter's Email Address (if any)
Form I-140G Edition xx/xx/xx
5.
Interpreter's Mobile Telephone Number (if any)
Page 23 of 24
Part 3. Interpreter’s Contact Information, Certification, and Signature (continued)
Interpreter's Certification
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 answers to the questions in that language,
and the petitioner informed me that he or she understood every instruction, question, and answer on the petition.
Interpreter's Signature
7.
Interpreter's Signature
Date of Signature (mm/dd/yyyy)
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Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other
Than the Beneficiary
Provide the following information about the preparer.
Preparer's Full Name
1.
Preparer's Family Name (Last Name)
2.
Preparer's Business or Organization Name (if any)
Preparer's Given Name (First Name)
Preparer's Contact Information
3
Preparer's Daytime Telephone Number
5.
Preparer's Email Address (if any)
4.
Preparer's Mobile Telephone Number (if any)
Preparer's Certification
I certify, under penalty of perjury, that I prepared this petition for the petitioner at his or her 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 he or she
understands the responses and information in or submitted with the petition.
Preparer's Signature
6.
Preparer's Signature
Form I-140G Edition xx/xx/xx
Date of Signature (mm/dd/yyyy)
Page 24 of 24
| File Type | application/pdf |
| File Title | Form I-140G, Foreign Investment Visa Program |
| Subject | Foreign Investment Visa Program |
| Author | USCIS |
| File Modified | 2025-11-14 |
| File Created | 2025-11-14 |