I-130A

FORM I-130A — SUPPLEMENTAL INFORMATION FOR SPOUSE BENEFICIARY

This Form I-130A is submitted in connection with the petition filed by Petitioner Name: and provides supplemental biographic and background information for Beneficiary Name: .

RECITALS

WHEREAS, Petitioner has filed or will file Form I-130, Petition for Alien Relative, seeking classification of Beneficiary as the spouse of Petitioner; and

WHEREAS, federal immigration law and implementing regulations require the submission of supplemental identifying and background information for a spouse beneficiary; and

WHEREAS, the parties submit this Form I-130A to attest to the accuracy of the information provided below and to certify the Beneficiary's identity, residence, and other relevant background information.

NOW THEREFORE, the parties state and declare as follows:

1. BENEFICIARY IDENTIFYING INFORMATION

Date of birth:    Country of birth:

2. RESIDENCE HISTORY

3. EMPLOYMENT AND EDUCATION

Dates employed or enrolled:

4. MARITAL HISTORY

Has the Beneficiary had prior marriages?   Yes   No

5. CHILDREN

6. IMMIGRATION, CRIMINAL, AND SECURITY INFORMATION

Has the Beneficiary ever been arrested, charged, convicted, or pleaded guilty to any crime?   Yes   No

Has the Beneficiary ever been removed, deported, or ordered excluded from the United States?   Yes   No

7. CERTIFICATION BY BENEFICIARY

I certify, under penalty of perjury under the laws of the United States, that the information contained in this Form I-130A and any accompanying documents is complete, true, and correct to the best of my knowledge. I understand that knowingly providing materially false information may subject me to criminal and/or civil penalties, including removal proceedings and ineligibility for immigration benefits.

Beneficiary's contact telephone number:

Beneficiary's email address:

8. ADDITIONAL LEGAL PROVISIONS

Governing Law: This Form I-130A and any determinations made in reliance upon it shall be governed by applicable federal immigration laws and regulations, and by the laws of the United States to the extent authorized by federal statute.

Entire Agreement: This Form I-130A, together with the principal petition and any attachments, constitutes the entire written statement of the supplementary information provided by the Beneficiary and supersedes any prior statements, whether oral or written, regarding such supplemental information.

Severability: If any provision of this Form I-130A is held invalid or unenforceable, the remaining provisions shall remain in full force and effect and shall be construed so as to effectuate the original intent to the fullest extent permitted by law.

Amendments and Waiver: Any amendment or waiver of any provision of this Form I-130A must be in writing and signed by the party to be charged. No waiver by any party of a breach or default shall be deemed a waiver of any subsequent breach or default.

Notices: Any notices or correspondence required or permitted under this Form I-130A shall be in writing and delivered to the addresses provided in the principal petition or to such other address as a party may designate in writing.

9. DECLARATION AND SIGNATURES

The parties below declare under penalty of perjury that the foregoing is true and correct.

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