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5. Part 5. Applicant’s Statement, Contact Information, Declaration, Certification, and Signature. Select the

appropriate box to indicate whether you read this application yourself or whether you had an interpreter assist you.

If someone assisted you in completing the application, select the box indicating that you used a preparer. Further,

you must sign and date your application and provide your daytime telephone number, mobile telephone number (if

any), and email address (if any). Every application MUST contain the signature of the applicant (or parent or legal

guardian, if applicable). A stamped or typewritten name in place of a signature is not acceptable.

6. Part 6. Interpreter’s Contact Information, Certification, and Signature. If you used anyone as an interpreter

to read the Instructions and questions on this application to you in a language in which you are fluent, the interpreter

must fill out this section, provide his or her name, the name and address of his or her business or organization (if any),

his or her daytime telephone number, his or her mobile telephone number (if any), and his or her email address (if

any). The interpreter must sign and date the application.

7. Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other

Than the Applicant. This section must contain the signature of the person who completed your application, if

other than you, the applicant. If the same individual acted as your interpreter and your preparer, that person should

complete both Part 6. and Part 7. If the person who completed this application is associated with a business or

organization, that person should complete the business or organization name and address information. Anyone who

helped you complete this application MUST sign and date the application. A stamped or typewritten name in place

of a signature is not acceptable. If the person who helped you prepare your application is an attorney or accredited

representative, he or she may be obliged to also submit a completed Form G-28, Notice of Entry of Appearance as

Attorney or Accredited Representative, or Form G-28I, Notice of Entry of Appearance as Attorney In Matters Outside

the Geographical Confines of the United States, along with your application.

We recommend that you print or save a copy of your completed application to review in the future and for

your records.

What Evidence Must You Submit

You must submit all evidence in these Instructions with your application. If you fail to submit required evidence, USCIS

may reject or deny your application for failure to submit requested evidence or supporting documents in accordance with

8 CFR 103.2(b)(1) and these Instructions.

You must submit the following documents with your application.

1. If you select Part 3., Item Number 1., you must submit evidence of U.S. citizenship or lawful permanent resident

status of your spouse or child:

A. If your spouse or child is a U.S. citizen by birth in the United States, submit a birth certificate for your spouse or

child. If a birth certificate is not available, you must submit a letter and supporting evidence from the appropriate

state agency stating a birth certificate is not available and explaining why a birth certificate is not available. Also

submit:

(1) A copy of the baptismal certificate showing that the baptism occurred within two months after birth, under the

seal of the religious organization, showing the place of birth; or

(2) If you cannot obtain the birth or baptismal certificate, affidavits of two U.S. citizens who have personal

knowledge of the birth of your spouse or child in the United States;

B. If your spouse or child was born outside the United States, became a U.S. citizen through a parent, and was not

issued a certificate of citizenship, you must submit evidence of the citizenship and marriage of the parent, as well

as termination of any prior marriages of the parent. Also, you must submit a birth certificate of the child and a

separate statement showing the dates, ports-of-entry, and means of all arrivals into and departures from the United

States by the spouse or child;

Form I-612 Instructions 04/24/17 N

Page 4 of 7

Instructions For Form I-612 - Application For Waiver Of The Foreign Residence Requirement (Under Section 212(E) Of The Immigration And Nationality Act, As Amended) Page 4

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