Form I-601a - Application For Provisional Unlawful Presence Waiver Page 7
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9Interpreter's Mailing Address
Part 6. Applicant's Statement, Contact
Information, Certification, and Signature
3.a.
Street Number
(continued)
and Name
3.b.
Apt.
Ste.
Flr.
I understand that USCIS will 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, I will be required to sign an
oath reaffirming that:
3.d. State
3.e. ZIP Code
1) I reviewed and provided or authorized all of the
information in my application;
3.f.
Province
2) I understood all of the information contained in, and
3.g. Postal Code
submitted with, my application; and
3.h.
Country
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
Interpreter's Contact Information
information contained in, and submitted with, my 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 7. Interpreter's Contact Information,
which is the same language specified in Part 6., Item Number
Certification, and Signature
1.b., and I have read to this applicant in the identified language
Provide the following information about the interpreter.
every question and instruction on this application and his or her
answer to every question. The applicant informed me that he or
she understands every instruction, question, and answer on the
Interpreter's Full Name
application, including the Applicant's Certification, and has
1.a.
Interpreter's Family Name (Last Name)
verified the accuracy of every answer.
Interpreter's Signature
1.b.
Interpreter's Given Name (First Name)
7.a.
Interpreter's Signature (sign in ink)
2.
Interpreter's Business or Organization Name (if any)
7.b.
Date of Signature (mm/dd/yyyy)
Form I-601A 12/23/16 N
Page 7 of 9
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