Dhs Form G-28 - Notice Of Entry Of Appearance As Attorney Or Accredited Representative
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4Notice of Entry of Appearance
DHS
as Attorney or Accredited Representative
Form G-28
OMB No. 1615-0105
Department of Homeland Security
Expires 03/31/2018
Part 1. Information About Attorney or
Part 2. Notice of Appearance as Attorney or
Accredited Representative
Accredited Representative
1.
USCIS ELIS Account Number (if any)
This appearance relates to immigration matters before
►
(Select only one box):
1.a.
USCIS
Name and Address of Attorney or Accredited
1.b.
List the form numbers
Representative
2.a. Family Name
(Last Name)
2.a.
ICE
2.b. Given Name
(First Name)
2.b.
List the specific matter in which appearance is entered
2.c. Middle Name
3.a.
Street Number
3.a.
CBP
and Name
3.b.
List the specific matter in which appearance is entered
3.b. Apt.
Ste.
Flr.
3.c. City or Town
I enter my appearance as attorney or accredited representative at
the request of:
3.d. State
3.e. ZIP Code
4.
Select only one box:
3.f.
Province
Applicant
Petitioner
Requestor
3.g. Postal Code
Respondent (ICE, CBP)
3.h. Country
Information About Applicant, Petitioner,
Requestor, or Respondent
4.
Daytime Telephone Number
5.a. Family Name
(Last Name)
5.b. Given Name
5.
Fax Number
(First Name)
5.c. Middle Name
6.
E-Mail Address (if any)
6.
Name of Company or Organization (if applicable)
7.
Mobile Telephone Number (if any)
Form G-28 05/05/16 Y
Page 1 of 4
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