Form I-730 - Refugee/asylee Relative Petition - Department Of Homeland Security Page 5

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Part 6. Beneficiary's Statement, Contact Information, Declaration, Certification, and Signature if in the
United States
NOTE: Read the information on penalties in the Penalties section of the Form I-730 Instructions before completing this part.
NOTE: If the beneficiary is not currently in the United States, or is not 14 years of age or older, this section should be left
blank.
Beneficiary's Statement
NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2.
I can read and understand English, and I have read and I understand every question and instruction on this petition and my
1.a.
answer to every question.
The interpreter named in Part 7. read to me every question and instruction on this petition and my answer to every question
1.b.
in
,
a language in which I am fluent, and I understood everything.
2.
At my request, the preparer named in Part 8.,
,
prepared this
petition for me based only upon information I and the petitioner provided or authorized.
Beneficiary's Contact Information
3.
Beneficiary's Daytime Telephone Number
4.
Beneficiary's Mobile Telephone Number (if any)
5.
Beneficiary's Email Address (if any)
Beneficiary's Declaration and 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 of
my records that USCIS may need to determine my eligibility for the immigration benefit I seek.
I further authorize release of information contained in this petition, 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 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 provided or authorized all of the information contained in, and submitted with, my petition;
2) I reviewed and understood all of the information in, and submitted with, my petition; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that all of the information in my petition and any document submitted with it were provided or
authorized by me, that I reviewed and understand all of the information contained in, and submitted with, my petition, and that all of
this information is complete, true, and correct.
Beneficiary's Signature
6.a.
Beneficiary's Signature
6.b.
Date of Signature (mm/dd/yyyy)
NOTE: This petition must be completely filled out and all required evidence submitted or USCIS may deny this petition.
Form I-730 (05/30/17) N Page 5

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