Part 10: Applicant's Info
Applicant’s Contact Information
Provide your daytime telephone number, mobile telephone number (if any), and email address (if any).
Please provide a daytime telephone number.
Please enter a valid email address.
Applicant’s Signature
I certify, under penalty of perjury, that I provided or authorized all of the responses and
information contained in and submitted with my application, I read and understand or,
if interpreted to me in a language in which I am fluent by the interpreter listed in
Part 12,
…
I certify, under penalty of perjury, that I provided or authorized all of the responses and
information contained in and submitted with my application, I read and understand or, if
interpreted to me in a language in which I am fluent by the interpreter listed in
Part 11, understood, all of the responses and information contained in,
and submitted with, my application, and that all of the responses and the information are
complete, true, and correct. Furthermore, I authorize the release of any information from
any and all of my records that USCIS may need to determine my eligibility for an
immigration request and to other entities and persons where necessary for the
administration and enforcement of U.S. immigration law.
Read more
Sign Below
NOTE: Use your finger or mouse to draw your signature.
Don’t want to sign now? No worries — leave it blank and sign the PDF on paper or digitally later.
Don’t want to sign now? No worries — leave it blank and sign the PDF on paper or digitally later.