Part 4: Information About Beneficiary

Provide the beneficiary's identity, address, and contact information.

Identification Numbers

Enter a valid A-Number, up to 9 digits, or leave it blank.
Enter a valid USCIS Online Account Number, up to 12 digits, or leave it blank.
Enter a valid 9-digit Social Security number, or leave it blank.

Beneficiary's Full Name

Beneficiary family name is required.
Beneficiary given name is required.

Other Names Used (if any)

Provide all other names the beneficiary has ever used, including aliases, maiden name, and nicknames.

Other Information About Beneficiary

City, town, or village of birth is required.
Country of birth is required.
Enter a valid date of birth.
Select Unknown only if you do not know and the beneficiary also does not know.

Beneficiary's Physical Address

Physical street number and name is required for a U.S. physical address.
Unit number is required when Apt., Ste., or Flr. is selected.
Physical address city or town is required.
State is required for a U.S. physical address.
Enter a valid ZIP Code.
Physical address country is required.

Other Address and Contact Information

Provide the address in the United States where the beneficiary intends to live, if different from the physical address.

U.S. address street number and name is required, or mark it as same as physical address.
Unit number is required when Apt., Ste., or Flr. is selected.
U.S. address city or town is required.
State is required.
Enter a valid ZIP Code.

Provide the beneficiary's address outside the United States, if different from the physical address.

Outside-U.S. street number and name is required, or mark it as same as physical address.
Unit number is required when Apt., Ste., or Flr. is selected.
Outside-U.S. city or town is required.
Outside-U.S. country is required.
Enter a valid daytime telephone number, or leave it blank.
Enter a valid mobile telephone number, or leave it blank.
Enter a valid email address, or leave it blank.

Beneficiary's Marital Information

Enter the number of times the beneficiary has been married.
Enter a valid current marriage date.

Place of Beneficiary's Current Marriage

City or town of current marriage is required.
State is required for a U.S. marriage location.
Country of current marriage is required.

Names of Beneficiary's Spouses (if any)

Provide information on the beneficiary's current spouse first if currently married, and then all prior spouses.

Spouse 1
Spouse 1 family name is required.
Spouse 1 given name is required.
Enter the date this marriage ended.
Spouse 2
Spouse 2 family name is required when Spouse 2 is provided.
Spouse 2 given name is required when Spouse 2 is provided.
Enter the date this marriage ended.

Information About Beneficiary's Family

Provide information about the beneficiary's spouse and children.

Person 1
Person 1 family name is required.
Person 1 given name is required.
Person 1 relationship is required.
Enter Person 1 date of birth.
Person 1 country of birth is required.
Person 2
Person 2 family name is required.
Person 2 given name is required.
Person 2 relationship is required.
Enter Person 2 date of birth.
Person 2 country of birth is required.
Person 3
Person 3 family name is required.
Person 3 given name is required.
Person 3 relationship is required.
Enter Person 3 date of birth.
Person 3 country of birth is required.
Person 4
Person 4 family name is required.
Person 4 given name is required.
Person 4 relationship is required.
Enter Person 4 date of birth.
Person 4 country of birth is required.
Person 5
Person 5 family name is required.
Person 5 given name is required.
Person 5 relationship is required.
Enter Person 5 date of birth.
Person 5 country of birth is required.

Beneficiary's Entry Information

Class of admission is required when the beneficiary is currently in the United States.
Enter a valid I-94 number, up to 11 characters.
Enter a valid date of arrival.
If applicable, enter the expiration date. If the PDF must show duration of status, enter it manually later.
Enter a valid expiration date.
Passport or Travel Document
Enter a valid passport or travel document expiration date.

Beneficiary's Employment Information

Provide the beneficiary's current employment information, if applicable.

Enter the employer name, or mark the beneficiary as unemployed.
Employer street number and name is required.
Unit number is required when Apt., Ste., or Flr. is selected.
Employer city or town is required.
State is required for a U.S. employer address.
Enter a valid ZIP Code.
Employer country is required.
Enter a valid employment start date.

Additional Information About Beneficiary

Proceedings city or town is required.
Proceedings state is required.
Enter a valid proceedings date.

Name and Foreign Address in Native Written Language

Native-language family name is required.
Native-language given name is required.
Native-language street number and name is required.
Unit number is required when Apt., Ste., or Flr. is selected.
Native-language city or town is required.
Native-language country is required.

Last Address Where You Physically Lived Together

If filing for your spouse, provide the last address where you physically lived together.

Last shared street number and name is required when filing for a spouse.
Unit number is required when Apt., Ste., or Flr. is selected.
Last shared city or town is required.
State is required for a U.S. last shared address.
Enter a valid ZIP Code.
Last shared country is required.
Enter a valid date from.
Enter a valid date to.

Beneficiary's Processing Location

The beneficiary is in the United States and will apply for adjustment of status at the USCIS office in:

USCIS office city or town is required.
USCIS office state is required.

The beneficiary will apply for an immigrant visa abroad at the U.S. Embassy or U.S. Consulate in:

Embassy or consulate city or town is required.
Embassy or consulate country is required.
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