Immigration I-821 Renewal Form

IMMIGRATION I-821 RENEWAL FORM

This Immigration I-821 Renewal Form is submitted by Applicant Name: Alien Registration Number (A-Number): Date of Birth:

Country of Birth: Country of Citizenship:

RECITALS

WHEREAS, Applicant seeks renewal of immigration relief previously granted under the Temporary Immigration Program or similar authorized classification, and has submitted evidence supporting continued eligibility for renewal; and

WHEREAS, Applicant certifies that the facts stated in this Renewal Form are true and complete to the best of Applicant's knowledge, and understands that any material misrepresentation or omission may subject Applicant to penalties under immigration law, including denial of renewal, revocation of status, removal proceedings, and criminal prosecution where applicable; and

WHEREAS, Applicant intends that this Renewal Form serve as a formal request for continuation of relief for the Renewal Period described herein and to update the administrative record with current identifying and eligibility information.

NOW, THEREFORE, in consideration of the foregoing recitals and the mutual covenants contained herein, Applicant submits this Renewal Form under penalty of perjury and agrees to the terms, representations and certifications that follow.

1. DEFINITIONS

For the purposes of this Renewal Form, the following definitions apply: "Applicant" means the individual identified above who seeks renewal of immigration relief; "Renewal Period" means the period for which renewal of immigration relief is requested; "Representative" means any accredited individual or attorney acting on behalf of Applicant pursuant to a separate written authorization.

2. ELIGIBILITY AND DECLARATIONS

Applicant declares that Applicant currently meets, or seeks renewal based on previously established satisfaction of, all eligibility criteria applicable to the immigration classification under which renewal is sought. Applicant must answer the following questions truthfully:

Have you ever been convicted of a felony or any crime involving moral turpitude? Yes No

Are you currently subject to removal, deportation, or exclusion proceedings? Yes No

Have any material facts changed since your last approval or filing? Yes No

3. APPLICANT INFORMATION

4. SUPPORTING DOCUMENTS

Applicant must submit all documents that evidence continued eligibility. Use the field below to list each document submitted with the renewal application, together with a brief description and the document date.

5. FEES AND PAYMENT

Applicant acknowledges the fee requirements applicable to renewal filings. If a fee waiver or exemption is requested, explain the basis below and attach supporting documentation.

6. CERTIFICATIONS AND ACKNOWLEDGMENTS

By signing below, Applicant certifies, under penalty of perjury under the laws of the United States, that the information provided in this Renewal Form and in all attached documents is true, correct, and complete. Applicant further acknowledges that submission of false information or failure to disclose material facts may result in denial of renewal, revocation of previously granted relief, removal proceedings, fines, or imprisonment.

Applicant authorizes the review and retention of submitted documents for adjudicative and record-keeping purposes, and acknowledges responsibility to notify the adjudicating authority of any change in address or circumstances materially affecting eligibility during the pendency of this renewal.

7. NOTICES

Any notice required or permitted under this Renewal Form shall be effective upon receipt at the mailing address provided by Applicant or such other address as Applicant subsequently furnishes in writing. Notices related to adverse determinations shall be governed by applicable administrative rules and statutes.

8. AMENDMENTS, WAIVER, COUNTERPARTS

This Renewal Form may be amended only by a written instrument signed by Applicant and, where required, the authorized representative. No waiver of any provision of this Renewal Form shall be effective unless in writing and signed by the party waiving compliance. This Renewal Form may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

9. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Renewal Form shall be governed by and construed in accordance with the laws and statutes governing immigration and nationality as applicable. This Renewal Form, together with all attached exhibits and supporting documents, constitutes the entire record submitted by Applicant for renewal and supersedes all prior written or oral statements with respect to the matters addressed herein. If any provision of this Renewal Form is held to be invalid, illegal, or unenforceable, the remaining provisions shall remain in full force and effect.

10. ADDITIONAL INFORMATION

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