H-1B Registration Form

H-1B REGISTRATION FORM

This H-1B Registration Form is made and entered into by and between Employer Name: , Employer EIN: , a business with principal place of business at (Employer), and Representative Name: , Representative Capacity: , with business address (Representative). Employer and Representative are collectively referred to as Parties.

RECITALS

WHEREAS, Employer desires to register a Beneficiary for potential selection under the H-1B electronic registration process for temporary employment in a specialty occupation; and

WHEREAS, Representative will prepare and submit the electronic registration on behalf of Employer, and Employer authorizes Representative to act as its agent solely for the limited purpose of registration submission; and

WHEREAS, the Parties agree to memorialize the information, representations, and certifications required for registration and to allocate responsibilities for accuracy, fees, and notices.

NOW, THEREFORE, in consideration of the mutual covenants herein, Employer and Representative agree as follows.

1. DEFINITIONS

For purposes of this Registration, the following terms shall have the meanings set forth below:

"Beneficiary" means the foreign national identified for registration: Beneficiary Name: .

"Registration Period" means the period during which electronic registrations are accepted, and "Petition" means any H nonimmigrant petition filed by Employer on behalf of Beneficiary.

2. BENEFICIARY INFORMATION

Beneficiary Date of Birth: ; Country of Citizenship: ; Country of Birth:

Passport Number: ; Current U.S. Immigration Status (if any):

Proposed Job Title: ; Occupational Classification / O*NET/SOC Title:

3. SUBMISSION, ACCURACY AND RESPONSIBILITY

Employer warrants and represents that all information provided in this Registration is true, correct and complete to the best of Employer's knowledge. Employer acknowledges that Employer is responsible for the accuracy of the data submitted and that Representative acts only as Employer's agent for submission purposes. Representative shall exercise commercially reasonable care in preparing and submitting the registration but shall not be liable for final determinations made by administrative authorities.

4. REPRESENTATIONS, ATTESTATIONS AND CERTIFICATIONS

By executing this Form, Employer certifies, under penalty of law, that: (a) Employer has a bona fide job opportunity for Beneficiary as described in Section 2; (b) the job qualifies as a specialty occupation requiring theoretical and practical application of a body of highly specialized knowledge; (c) the information provided is accurate and complete; and (d) Employer will maintain records and documentation supporting these statements for the period required by law and produce such documentation in response to lawful requests.

Attestation: I certify that the foregoing statements are true and that I am authorized to execute this Registration on behalf of Employer.

5. FEES AND PAYMENT

Employer shall be responsible for payment of any fees required for registration and any related petition. Representative may collect reasonable fees for services performed; the amount and timing of any Representative fees are set forth below.

6. RECORDKEEPING AND COMPLIANCE

Employer shall retain records substantiating the factual assertions made in this Registration and any subsequent petition for the period required by applicable law and shall promptly provide copies to Representative upon reasonable request. Employer remains responsible for compliance with immigration-related obligations, including maintenance of any required public access or personnel files.

7. NOTICES

All notices under this Registration shall be in writing and delivered to the addresses below by hand, certified mail, or other recorded delivery service.

8. AMENDMENT, WAIVER AND COUNTERPARTS

This Registration may be amended only by a written instrument executed by both Parties. No waiver of any provision shall be effective unless in writing and signed by the waiving Party. This Registration may be executed in counterparts, each of which shall constitute an original, and all counterparts together shall constitute one instrument.

9. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Registration shall be governed by and construed in accordance with the substantive laws of the state of: , without regard to its conflicts of law principles. This Registration constitutes the entire agreement between the Parties regarding the subject matter herein and supersedes all prior agreements and understandings. If any provision is held invalid or unenforceable, such provision shall be reformed only to the extent necessary to make it enforceable and the remaining provisions shall remain in full force and effect.

10. MISCELLANEOUS

If Employer is required to designate a third-party signatory for electronic submissions, Representative is authorized to accept electronic signatures of Employer's authorized signatory for the limited purpose of submitting the registration. The Parties acknowledge that submission does not guarantee selection or approval by administrative authorities and that any filing decisions remain subject to applicable laws and agency procedures.

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