Form I-690 - Application For Waiver Of Grounds Of Inadmissibility Page 7
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8Part 5. Contact Information, Statement, Certification, and Signature of the Person Preparing this
Application, If Other Than the Applicant (continued)
Preparer's Mailing Address
3.
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
Province
Postal Code
Country
Preparer's Contact Information
4.
Preparer's Daytime Telephone Number
5.
Preparer's Fax Number (if any)
6.
Preparer's Email Address (if any)
Preparer's Statement
7.A.
I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the
applicant's consent.
7.B.
I am an attorney or accredited representative and my representation of the applicant in this case (choose one)
extends
does not extend beyond the preparation of this application.
NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this application,
you must submit a completed Form G-28, Notice of Attorney or Accredited Representative, with this petition.
Preparer's Certification
By my signature, I certify, swear, or affirm, under penalty of perjury, that I prepared this application on behalf of, at the request of,
and with the express consent of the applicant. I completed this application based only on responses the applicant provided to me.
After completing the application, I reviewed it and all of the applicant's responses with the applicant, who agreed with every answer
on the application. If the applicant supplied additional information concerning a question on the application, I recorded it on the
application. I have also read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant and
the applicant has informed me that he or she understands the ASC Acknowledgement.
Preparer's Signature
Preparer's Signature
8.
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, your application may be denied.
NOTE: We recommend that you print a copy of your completed application for your records. If you are required to appear for a
biometric services appointment at a USCIS ASC, you should bring a copy of your completed application with you.
Form I-690 12/23/16 N
Page 7 of 8
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