Fillable Form I-942 - Request For Reduced Fee (Page 4 of 9) in pdf

Form I-942 - Request For Reduced Fee Page 4

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Part 4. Requestor's Statement, Contact Information, Certification, and Signature (continued)

I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or

signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that:

1) I reviewed and provided or authorized all of the information in my request;

2) I understood all of the information contained in, and submitted with, my request; and

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 request, I understand all of the

information contained in, and submitted with, my request, and that all of this information is complete, true, and correct.

Requestor's Signature

Date of Signature (mm/dd/yyyy)

Family Members' Signatures

NOTE: Each family member must type or print their full name and sign in the spaces below. You can find additional family

members' signature spaces in Item Numbers 7. - 10. below. All family members identified in Part 2., Item Number 1. must sign

and date Form I-942.

I certify that the information provided by the requestor in Part 4. applies to me.

Family Member 1

Family Member's Name

Family Member's Signature

Date of Signature (mm/dd/yyyy)

Family Member 2

Family Member's Name

Family Member's Signature

Date of Signature (mm/dd/yyyy)

Family Member 3

Family Member's Name

Family Member's Signature

Date of Signature (mm/dd/yyyy)

10.

Family Member 4

Family Member's Name

Family Member's Signature

Date of Signature (mm/dd/yyyy)

NOTE TO ALL REQUESTORS: If you do not completely fill out this request or fail to submit required documents listed in the

Instructions, USCIS may deny your request.

Form I-942 12/23/16

Page 4 of 9

Form I-942 - Request For Reduced Fee Page 4

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