Immigration Non-U.S Citizen Application

IMMIGRATION NON-U.S. CITIZEN APPLICATION

Application Date:

WHEREAS — RECITALS

WHEREAS the Applicant named below is a non-U.S. citizen who seeks immigration assistance and/or to request an immigration benefit from an administrative authority and desires to submit required information and authorizations in support of that request; and

WHEREAS the Applicant acknowledges that information provided in this Application will be relied upon to determine eligibility, to prepare filings, and to authorize verification of records and background information;

WHEREAS the Applicant acknowledges that fees and terms for services or processing are set forth in this Application and that submission of this form constitutes consent to the terms and declarations herein.

APPLICANT INFORMATION

IMMIGRATION BENEFIT REQUESTED

Select the primary immigration benefit or service requested (check all that apply):

Adjustment of Status

Nonimmigrant Visa Extension / Change of Status

Employment Authorization Document (work permit)

Consular Processing / Visa Application

Family-Based Petition

Other (describe below)

SCOPE OF SERVICES

Describe the specific assistance or representation the Applicant requests. This Application does not itself create an attorney-client relationship or guarantee filing; a separate engagement agreement may be required.

PAYMENT TERMS

The Applicant agrees to pay fees and costs associated with the requested services as set forth below. Fees for governmental filing and third-party costs are separate and payable when due.

Applicant acknowledges that fees paid for work already performed are non-refundable unless otherwise agreed in writing. The Applicant is responsible for governmental filing fees, translation fees, courier charges, and other third-party costs incurred on the Applicant's behalf.

TERM AND TERMINATION

This Application and any agreed representation shall commence on Start Date and continue until the completion of the described services or until terminated as provided below.

Either party may terminate written representation upon written notice subject to payment of fees for work performed and costs incurred through the date of termination.

CONFIDENTIALITY

All non-public information provided by the Applicant in connection with this Application shall be treated as confidential and used only for preparation, filing, and processing of the requested immigration benefit, subject to required disclosures to governmental agencies, legal duties to disclose, and any written consent provided by the Applicant. Confidential information may be shared with third-party service providers to the extent necessary to perform requested services.

CERTIFICATIONS, AUTHORIZATIONS, AND DECLARATIONS

By signing this Application, the Applicant certifies under penalty of perjury that all statements made in this Application and in supporting documents are true, complete, and correct to the best of the Applicant's knowledge and belief. The Applicant authorizes the retrieval and verification of records, including but not limited to immigration records, employment records, educational records, and criminal history checks, as necessary for the processing of the requested benefit.

I certify that the information provided is true and complete.

I authorize verification and release of information as necessary for processing.

I understand that knowingly making a false statement may subject me to penalties under applicable law.

SUPPORTING DOCUMENTS (CHECKLIST)

Passport biographic page

Current visa and entry stamp pages

I-94 Arrival/Departure record (if applicable)

Birth certificate (with translation if not in English)

Marriage certificate (if applicable)

Police certificates / court records (if applicable)

GOVERNING LAW

This Application, and any agreement arising from it, shall be governed by and construed in accordance with the substantive laws of the applicable jurisdiction as determined by the location of services or by agreement in a subsequent engagement document. The Applicant acknowledges that certain matters may be governed by federal immigration law and by the rules and procedures of the relevant immigration authority.

ENTIRE AGREEMENT

This Application constitutes the entire written record of the Applicant's requests and certifications set forth herein. Any additional terms, fee arrangements, or representation agreements shall be documented in a separate written engagement agreement signed by the Applicant and the representative or entity providing services.

ADDITIONAL INFORMATION

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