Form I-910 - Application For Civil Surgeon Designation Page 5
Download a blank fillable Form I-910 - Application For Civil Surgeon Designation in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form I-910 - Application For Civil Surgeon Designation with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7Preparer's Mailing Address
Part 7. Applicant's Statement, Contact
Information, Certification, and Signature
3.a.
Street Number
(continued)
and Name
3.b.
Apt.
Ste.
Flr.
Copies of any documents I have submitted are exact
photocopies of unaltered, original documents, and I understand
3.c. City or Town
that USCIS may require that I submit original documents to
USCIS at a later date. Furthermore, I authorize the release of
3.d. State
3.e. ZIP Code
any information from any of my records that USCIS may need
to determine my eligibility for the designation that I seek.
3.f.
Province
I authorize the release of any information from my records
which USCIS deems necessary in order to determine my
3.g. Postal Code
eligibility for designation as a civil surgeon.
3.h.
Country
I further 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.
Preparer's Contact Information
I certify, under penalty of perjury, that I provided or authorized
4.
Preparer's Daytime Telephone Number
all of the information in my application, I understand all of the
information contained in, and submitted with, my application,
and that all of this information is complete, true, and correct.
5.
Preparer's Fax Number
Applicant's Signature
6.
Preparer's Email Address (if any)
5.a.
Applicant's Signature
7.
Select this box if the preparer may act as a secondary
5.b.
Date of Signature (mm/dd/yyyy)
point of contact for you. USCIS will contact this
preparer if you cannot be reached using the
NOTE TO ALL APPLICANTS: If you do not completely fill
information in Part 2.
out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your application.
Preparer's Statement
I am not an attorney or accredited representative but
8.a.
Part 8. Contact Information, Declaration, and
have prepared this application on behalf of the
Signature of the Person Preparing this
applicant and with the applicant's consent.
Application, if Other Than the Applicant
I am an attorney or accredited representative and my
8.b.
representation of the applicant in this case
Attorney or Representative Only: May USCIS contact you
extends
does not extend beyond the
by fax or email if we need to issue a Request for Evidence
preparation of this application.
(RFE)?
Yes
No
NOTE: If you are an attorney or accredited
representative, you may be obliged to submit a
Provide the following information about the preparer.
completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited
Preparer's Full Name
Representative, with this application.
1.a. Preparer's Family Name (Last Name)
1.b.
Preparer's Given Name (First Name)
2.
Preparer's Business or Organization Name (if any)
Form I-910 12/23/16 N
Page 5 of 7
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal