Form I-192 - Application For Advance Permission To Enter As A Nonimmigrant Page 5
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8Part 4. Applicant's Statement, Contact Information, Certification, and Signature
NOTE: Read the information on penalties in the Penalties section of the Form I-192 Instructions before completing this part.
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1.
Applicant's Statement Regarding the Interpreter
A.
I can read and understand English, and have read and understand every question and instruction on this application and
my answer to every question.
B.
The interpreter named in Part 5. read to me every question and instruction on this application, and my answer to
every question in
, a language in which I
am fluent, and I understood everything.
2.
Applicant's Statement Regarding the Preparer
At my request, the preparer named in Part 6.,
,
prepared this application for me based only upon information I provided or authorized.
Applicant's Contact Information
3.
Applicant's Daytime Telephone Number
4. Applicant's Mobile Telephone Number (if any)
5.
Applicant's Email Address (if any)
Applicant’s Certification
Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may
require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of
my records that USCIS may need to determine my eligibility for the immigration benefit I seek.
I further authorize release of information contained in this application, in supporting documents, and in my USCIS records to other
entities and persons where necessary for the administration and enforcement of U.S. immigration laws.
I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or
signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that:
1) I reviewed and provided or authorized all of the information in my application;
2) I understood all of the information contained in, and submitted with, my application; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the
information contained in, and submitted with, my application, and that all of this information is complete, true, and correct.
Applicant's Signature
6.
Applicant's Signature
Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the
Instructions, USCIS may deny your application.
Form I-192 12/23/16 N
Page 5 of 8
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