Form I-690 - Application For Waiver Of Grounds Of Inadmissibility Page 5
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8Part 3. Applicant's Statement, Contact Information, Acknowledgement of Appointment at USCIS
Application Support Center, Certification, and Signature (continued)
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)
Acknowledgement of Appointment at USCIS Application Support Center
I,
,
understand that the purpose of a USCIS ASC appointment is for me to provide my fingerprints, photograph, and/or signature and to
re-affirm that all of the information in my application is complete, true, and correct and was provided by me. I understand that I will sign
my name to the following declaration which USCIS will display to me at the time I provide my fingerprints, photograph, and/or signature
during my ASC appointment:
By signing here, I declare under penalty of perjury that I have reviewed and understand my application, petition, or request, as
identified by the receipt number displayed on the screen above, and all supporting documents, applications, petitions, or
requests filed with my application, petition, or request that I (or my attorney or accredited representative) filed with USCIS, and
that all of the information in these materials is complete, true, and correct.
I also understand that when I sign my name, provide my fingerprints, and am photographed at the USCIS ASC, I will be re-affirming
that I willingly submit this application; I have reviewed the contents of this application; all of the information in my application and all
supporting documents submitted with my application were provided by me and are complete, true, and correct; and if I was assisted in
completing this application, the person assisting me also reviewed this Acknowledgement of Appointment at USCIS Application
Support Center.
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
and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek.
I furthermore 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 certify, under penalty of perjury, that the information in my application and any document submitted with my application were
provided by me and are complete, true, and correct.
Applicant's Signature
6.
Applicant's Signature
Date of Signature
(mm/dd/yyyy)
Part 4. Interpreter's Contact Information, Certification, and Signature
Provide the following information concerning the interpreter.
Interpreter's Full Name
1.
Interpreter's Family Name (Last Name)
Interpreter's Given Name (First Name)
2.
Interpreter's Business or Organization Name (if any)
Form I-690 12/23/16 N
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