Form I-131a - Application For Travel Document (Carrier Documentation) Page 3
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5Interpreter's Mailing Address
Part 4. Applicant's Statement, Contact
Information, Certification, and Signature
3.a.
Street Number
(continued)
and Name
3.b.
Flr.
Apt.
Ste.
I understand that USCIS may require me to appear for an
appointment to take my biometrics (fingerprints, photograph,
3.c. City or Town
and/or signature) and, at that time, if I am required to provide
biometrics, I will be required to sign an oath reaffirming that:
3.d. State
3.e. ZIP Code
1)
I reviewed and understood all of the information
contained in, and submitted with, my application; and
3.f.
Province
2)
All of this information was complete, true, and correct
3.g.
Postal Code
at the time of filing.
I certify, under penalty of perjury, that all of the information in
3.h. Country
my application and any document submitted with it were
provided or authorized by me, that I reviewed and understand
all of the information contained in, and submitted with, my
Interpreter's Contact Information
application and that all of this information is complete, true, and
correct.
4.
Interpreter's Daytime Telephone Number
Applicant's Signature
5.
Interpreter's Mobile Telephone Number (if any)
6.a.
Applicant's Signature
6.
Interpreter's Email Address (if any)
6.b.
Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill
Interpreter's Certification
out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your application.
I certify, under penalty of perjury, that:
I am fluent in English and
,
Part 5. Interpreter's Contact Information,
which is the same language specified in Part 4., Item
Certification, and Signature
Number 1.b., and I have read to this applicant in the identified
language every question and instruction on this application and
Provide the following information about the interpreter.
his or her answer to every question. The applicant informed me
that he or she understands every instruction, question, and
Interpreter's Full Name
answer on the application, including the Applicant's
Certification, and has verified the accuracy of every answer.
1.a.
Interpreter's Family Name (Last Name)
Interpreter's Signature
1.b.
Interpreter's Given Name (First Name)
7.a.
Interpreter's Signature
2.
Interpreter's Business or Organization Name (if any)
7.b.
Date of Signature (mm/dd/yyyy)
Form I-131A 12/23/16 N
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