Immigration Form I-765 G-28

IMMIGRATION FORM I-765 / G-28 — AUTHORIZATION AND REPRESENTATION AGREEMENT

This Agreement is entered into on Date: by and between Client Name: (the "Client") and Representative Name: (the "Representative").

RECITALS

WHEREAS, the Client seeks employment authorization and intends to submit or has submitted an Application for Employment Authorization, commonly referred to as Form I-765, to the appropriate immigration authority; and

WHEREAS, the Client wishes to authorize the Representative to prepare, sign as authorized, submit, and receive correspondence related to Form I-765 and to enter an appearance on the Client's behalf by executing the Notice of Entry of Appearance as Attorney or Representative (Form G-28) where applicable; and

WHEREAS, the Representative is willing to provide immigration filing and representation services under the terms and conditions set forth in this Agreement.

NOW THEREFORE, in consideration of the mutual covenants and promises contained herein, the parties agree as follows:

1. SCOPE OF ENGAGEMENT

1.1 The Representative shall prepare, review, and file Form I-765 on behalf of the Client and shall complete and file Form G-28 to enter an appearance, if required. Services include drafting the application, assembling supporting documents, submitting the filing to the immigration agency, responding to routine requests for evidence, and communicating with the agency regarding the application status. The Representative will not guarantee any particular result or the timing of adjudication.

1.2 The Representative is authorized to: sign Form G-28 and any related filing documents as the Client's attorney or accredited representative; receive notices and correspondence relating to this matter; and to request and receive copies of the Client's file from the immigration agency to the extent permitted by law.

2. APPLICANT INFORMATION

3. ELIGIBILITY CATEGORY AND DOCUMENTS

The Client represents that the basis for requesting employment authorization is:

a) Refugee or asylee adjustment (a01)    b) Pending adjustment applicant (c08)

c) Pending asylum applicant (c09)    d) STEM OPT or other (c19)

4. FEES, PAYMENT AND REFUNDS

4.1 The Client agrees to pay Representative fees as set forth below. The Client acknowledges that filing fees or biometric fees imposed by the immigration agency are separate from the Representative's fees and are the sole responsibility of the Client unless otherwise agreed in writing.

5. AUTHORIZATION TO FILE G-28 AND RELEASE OF INFORMATION

5.1 The Client authorizes the Representative to execute and file Form G-28 or any other required authorization of representation, to receive copies of notices and decisions, and to communicate with the immigration agency on matters related to Form I-765.

5.2 The Client authorizes the Representative to obtain records and information from third parties as necessary to support the I-765 filing and to disclose information to such third parties as reasonably necessary. The Client understands that the Representative will maintain a record of the file and may retain copies as permitted by law.

Client authorizes Representative to sign and file Form G-28 on Client's behalf.

6. CLIENT REPRESENTATIONS; PENALTIES

The Client certifies that all information provided to the Representative for the preparation of Form I-765 and Form G-28 is complete, true, and correct to the best of the Client's knowledge. The Client acknowledges that knowingly submitting false or fraudulent information may result in denial of the application and civil or criminal penalties under applicable law.

7. NOTICES

Any notice required or permitted under this Agreement shall be given in writing and delivered by hand, certified mail, or other verifiable delivery method to the addresses set forth below. Notice is effective upon receipt.

8. AMENDMENTS, WAIVER, ENTIRE AGREEMENT

8.1 This Agreement constitutes the entire agreement between the parties regarding the subject matter herein and supersedes all prior agreements, understandings, and representations, whether written or oral.

8.2 Any amendment to this Agreement shall be in writing and signed by both parties. The failure of either party to insist upon strict performance of any provision of this Agreement shall not be construed as a waiver of any subsequent default of the same or similar nature.

9. GOVERNING LAW; SEVERABILITY

This Agreement shall be governed by and construed in accordance with the laws of the state of Jurisdiction State: excluding its conflicts of law rules. If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

10. COUNTERPARTS

This Agreement may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one agreement. Facsimile or electronic signatures shall be deemed original signatures for all purposes.

CERTIFICATION AND ACKNOWLEDGMENT

By signing below, the Client certifies under penalty of perjury that the statements contained in this Agreement and in the documents provided to the Representative for preparation of the Form I-765 and Form G-28 are true and correct to the best of the Client's knowledge. The Representative certifies that they are authorized to provide immigration representation as indicated and will comply with applicable rules of professional conduct.

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