Part 3. Beneficiary Information
(Information about the beneficiary/beneficiaries you are filing for. Complete the
blocks below. Use the Attachment-1 sheet to name each beneficiary included in this petition.) (continued)
Alien Registration Number (A-Number)
Country of Birth
►
A-
Province of Birth
Country of Citizenship or Nationality
5. If the beneficiary is in the United States, complete the following:
Date of Last Arrival (mm/dd/yyyy)
I-94 Arrival-Departure Record Number
Passport or Travel Document Number
►
Date Passport or Travel Document
Date Passport or Travel Document
Passport or Travel Document Country
Issued (mm/dd/yyyy)
Expires (mm/dd/yyyy)
of Issuance
Current Nonimmigrant Status
Date Status Expires or D/S
(mm/dd/yyyy)
Student and Exchange Visitor Information System (SEVIS)
Employment Authorization Document (EAD)
Number (if any)
Number (if any)
6. Current Residential U.S. Address (if applicable) (do not list a P.O. Box)
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
Part 4. Processing Information
1.
If a beneficiary or beneficiaries named in Part 3. is/are outside the United States, or a requested extension of stay or change of
status cannot be granted, state the U.S. Consulate or inspection facility you want notified if this petition is approved.
a. Type of Office (select only one box):
Consulate
Pre-flight inspection
Port of Entry
b. Office Address (City)
c. U.S. State or Foreign Country
d. Beneficiary's Foreign Address
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
State
Province
Postal Code
Country
2. Does each person in this petition have a valid passport?
Yes
No. If no, go to Part 9. and type or print your
explanation.
Form I-129 08/13/15 Y
Page 3 of 36