USCIS Immigration Form

USCIS Immigration Form

This USCIS Immigration Form is executed by Petitioner Name: (Petitioner) and Beneficiary Name: on Effective Date: . This form collects biographical and immigration-related information, authorizations for verification, and certifications required for processing immigration benefit requests.

RECITALS

WHEREAS, Petitioner seeks to file or has filed an immigration benefit application on behalf of Beneficiary and requires submission of accurate biographical, identity and status information to the appropriate immigration authorities; and

WHEREAS, Beneficiary provides the information and authorizations set forth in this document to permit verification of identity, status, admissibility, and eligibility for the requested immigration benefit; and

WHEREAS, the parties acknowledge that submission of false or misleading information may subject the submitter to penalties under law, including denial of benefit and other penalties.

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

1. DEFINITIONS

For purposes of this form: "Applicant" means Beneficiary identified above; "Petitioner" means the person or entity filing on behalf of Applicant; "Immigration Authorities" means the federal agency responsible for adjudication of the immigration benefit. Terms not otherwise defined have the ordinary meaning used in immigration practice.

2. BIOGRAPHICAL INFORMATION

3. ADDRESS AND CONTACT INFORMATION

4. REPRESENTATIONS AND AUTHORIZATIONS

The Beneficiary represents and warrants that all information provided in this form and any supporting documentation submitted in connection with the immigration benefit request is true, correct, and complete to the best of Beneficiary's knowledge. Beneficiary authorizes Immigration Authorities and other relevant agencies to verify the information provided and to obtain relevant records, including but not limited to immigration, criminal justice, educational, and employment records.

By checking the box below, Beneficiary authorizes the representative to communicate with Immigration Authorities on Beneficiary's behalf and to receive copies of correspondence and notices related to the application.

5. DOCUMENTATION AND ADDITIONAL EVIDENCE

The parties shall attach copies of supporting identity, civil status, nationality, and eligibility documents. Originals may be required for inspection by Immigration Authorities. Failure to provide required documentation may result in denial of the requested benefit.

6. NOTICES

Any notices or communications required under this form shall be delivered in writing to the mailing address or email address provided above. Service of notice is effective upon receipt when sent by certified or registered mail, or upon transmission when sent by electronic mail with confirmation of delivery.

7. AMENDMENT, WAIVER AND COUNTERPARTS

This form may be amended only by a written instrument signed by both parties. No failure or delay by any party in exercising any right under this form operates as a waiver of that right. This form may be executed in counterparts, each of which constitutes an original and all of which together constitute one instrument.

8. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This form is governed by the laws of the United States as they pertain to federal immigration processes and, to the extent consistent therewith, by the laws of the state of the Petitioner's principal place of residence. This form constitutes the entire agreement between the parties with respect to the subject matter herein. If any provision of this form is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

9. CERTIFICATION AND PENALTY OF PERJURY

I certify under penalty of perjury under the laws of the United States that the information provided in this form and any accompanying statements are true, correct and complete to the best of my knowledge and belief. I understand that submission of false information may subject me to civil and criminal penalties and may result in denial of any immigration benefit requested.

If Representative is signing on behalf of a party, Representative certifies that they are authorized to sign and that the signature is made with the signer’s knowledge and consent.

10. SIGNATURES

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