Fillable Printable Form G-28I
Fillable Printable Form G-28I
Form G-28I
Form G-28I 05/05/16 Y Page 1 of 3
Notice of Entry of Appearance as Attorney
In Matters Outside the Geographical Confines
of the United States
Department of Homeland Security
Part 1. Information About Attorney
5.
Mobile Telephone Number (if any)8.
Fax Number6.
7. E-Mail Address (if any)
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name
Telephone Number
4.a.
4.b.
4.c.
4.d.
4.e.
4.f.
DHS
Form G-28I
OMB No. 1615-0105
Expires 03/31/2018
1.
USCIS ELIS Account Number (if any)
►
2.a.
ICE
List the specific matter in which appearance is entered
2.b.
Name and Address of Attorney
Postal Code
Country
City or Town
Street Number
and Name
Apt. Flr.Ste.
Province
3. Name of Law Firm (if applicable)
I enter my appearance as attorney at the request of:
4.
3.a.
CBP
List the specific matter in which appearance is entered3.b.
Select only one box:
Applicant Petitioner Respondent (ICE, CBP)
5.a. Family Name
(Last Name)
5.b. Given Name
(First Name)
5.c. Middle Name
6. Name of Company or Organization (if applicable)
8.
Alien Registration Number (A-Number) or Receipt Number (if any)
9. Telephone Number
7. USCIS ELIS Account Number (if any)
►
Information About Applicant, Petitioner, or
Respondent
10. E-Mail Address (if any)
Part 2. Notice of Appearance as Attorney
Admitted to Practice Outside the United States
This appearance relates to immigration matters before
(Select only one box):
1.a.
USCIS
List form numbers
1.b.
Form G-28I 05/05/16 Y Page 2 of 3
Part 2. Notice of Appearance as Attorney
Admitted to Practice Outside the United States
(continued)
I have requested the representation of and consented to
being represented by the attorney named in Part 1. of this
form. According to the Privacy Act of 1974 and DHS
policy, I also consent to the disclosure to the named
attorney of any record pertaining to me that appears in
any system of records of USCIS, ICE, or CBP.
1.
I request that DHS send any notice (including Form
I-94) on an application, petition, or request that I
have filed with DHS to the business address of my
attorney of record as listed in this form. I understand
that I may change this election at any future date
through written notice to DHS.
2.a.
If you do not want to receive original notices or secure
identity documents directly, but would rather have such
notices and documents sent to your attorney of record,
please select all applicable boxes below:
Part 4. Applicant, Petitioner, or Respondent
Consent to Representation, Contact Information,
and Signature
Consent to Representation and Release of
Information
NOTE: Provide the mailing address of the applicant,
petitioner, requestor, or respondent. Do not provide the
business mailing address of the attorney unless it serves as the
safe mailing address on the application, petition, or request
being filed with this Form G-28I.
11.f.
11.a.
11.c.
11.b.
Mailing Address
11.d.
11.e. Postal Code
Country
City or Town
Street Number
and Name
Apt. Flr.Ste.
Province
1.d. I (choose one)
subject to any order of any court or administrative agency
disbarring, suspending, enjoining, restraining, or otherwise
restricting me in the practice of law. If you are subject to
any orders, explain in the space below. (If you need
additional space, use Part 6.)
am not am
Select all applicable boxes.
Part 3. Eligibility Information for Attorney
1.a. I am licensed and authorized to practice law in the
following countries. (If you need additional space,
use Part 6.)
1.c. I am in good standing in a court of general
jurisdiction in the following countries where I reside
and am engaged in the practice of law. (If you need
additional space, use Part 6.)
NOTE: If you select this item, also complete Item
Numbers 1.a. - 1.c.
Bar Number (if applicable)
Licensing Authority
1.b.
2.
I am associated with
the attorney of record who previously filed Form G-28I
in this case, and my appearance as an attorney is at his
or her request.
,
When you (the applicant, petitioner, requestor, or
respondent) are represented, DHS will send notices to
both you and your attorney either through mail or
electronic delivery.
DHS will also send the Form I-94, Arrival Departure
Record, to you unless you select Item Number 2.a. in
Part 4. All secure identity documents and Travel
Documents will be sent to you (the applicant, petitioner,
requestor, or respondent) at your U.S. mailing address
unless you ask us to send your secure identity documents
to your attorney of record.
Form G-28I 05/05/16 Y Page 3 of 3
Part 5. Signature of Attorney
I have read and understand the regulations and conditions
contained in 8 CFR 103.2 and 292 governing appearances and
representation before the Department of Homeland Security.
I declare under penalty of perjury under the laws of the United
States that the information I have provided on this form is true
and correct.
1.a. Signature of Attorney
1.b. Date of Signature (mm/dd/yyyy)
Part 6. Additional Information
Use the space provided below to provide additional information
pertaining to Part 3., Item Numbers 1.a. - 1.d. or to provide
your U.S. business address for purposes of receiving secure
identity documents for your client (if your client has consented
to your receipt of such documents under Part 4.)
I request that DHS send any secure identity document,
such as a Permanent Resident Card, Employment
Authorization Document, or Travel Document, that I
am approved to receive and authorized to possess, to
the U.S. business address of my attorney of record as
listed in this form or to a designated military or
diplomatic address for pickup in a foreign country (if
permitted). I consent to having my secure identity
document sent to my attorney of record and
understand that I may request, at any future date and
through written notice to DHS, that DHS send any
secure identity document to me directly.
2.b.
3.a. Signature of Applicant, Petitioner, or Respondent
3.b. Date of Signature (mm/dd/yyyy)
Part 4. Applicant, Petitioner, or Respondent
Consent to Representation, Contact Information,
and Signature (continued)
