Fillable Printable Form I-363
Fillable Printable Form I-363
Form I-363
Form I-363 03/01/17 N Page 1 of 7
Request to Enforce Affidavit of Financial Support and Intent
to Petition for Custody for Pub. L. 97-359 Amerasian
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-363
For USCIS Use Only
Action Block
Received
Trans In
Ret'd Trans Out
Completed
Remarks
Select this box if
Form G-28 is
attached.
Attorney State Bar Number
(if applicable)
Attorney or Accredited Representative
USCIS Online Account Number (if any)
Part 1. Information About You (Beneficiary)
START HERE - Type or print in black ink.►
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
A-
►
Alien Registration Number (A-Number) (if any)5.
Mailing Address
12.d.
12.e.
12.b.
12.c.
City or Town
State 12.f. ZIP Code
Street Number
and Name
Apt. Flr.Ste.
U.S. Social Security Number (if any)6.
►
USCIS Online Account Number (if any)7.
►
File Location
2. Date of Birth (mm/dd/yyyy)
3.b.
Province or State of Birth
Beneficiary's Relationship to Sponsor
10.
3.c.
Country of Birth
Initially Admitted to the United States
Destination in U.S. at Time of Initial Admission
9.
12.a. In Care of
Place of Birth
3.a.
City or Town of Birth
4. Country
of Citizenship or Nationality
Port-of-Entry
8.a.
8.b.
City or Town
State
Beneficiary's file is at the USCIS office in
11.a.
11.b.
City or Town
State
This applicant was interviewed by me
in person by phone
On (Date)
At (Location)
To be completed by an
Attorney or Accredited
Representative (if any).
Form I-363 03/01/17 N Page 2 of 7
Employer or School Address
15.c.
15.d.
15.a.
15.b.
City or Town
State 15.e. ZIP Code
Street Number
and Name
Apt. Flr.Ste.
Part 1. Information About You (Beneficiary)
(continued)
Part 2. Information About Sponsor
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
U.S. Social Security Number (if any)4.
►
USCIS Online Account Number (if any)5.
►
A-
►
A-Number (if any)3.
Employment Information
12. Name of Employer
13. Type of Business
Employment or School Information
13. Name of Employer or School
14. Type of Business
Sponsor's Mobile Telephone Number (if any)10.
Sponsor's Daytime Telephone Number9.
Sponsor's Contact Information
Sponsor's Email Address (if any)11.
2.
The Sponsor Is A:
U.S. Citizen Lawful Permanent Resident
Mailing Address
6.c.
6.d.
6.a.
6.b.
City or Town
State 6.e. ZIP Code
Street Number
and Name
Apt. Flr.Ste.
7. Are your mailing address and physical address the same?
Yes No
If you answered "No" to Item Number 7., provide your
physical address in Item Numbers 8.a. - 8.e.
Physical Address
8.b.
8.c.
8.a.
8.d.
City or Town
State 8.e. ZIP Code
Street Number
and Name
Apt. Flr.Ste.
Employer Address
14.c.
14.d.
14.a.
14.b.
14.g.
14.h.
14.f.
City or Town
State 14.e. ZIP Code
Postal Code
Province
Country
Street Number
and Name
Apt. Flr.Ste.
Form I-363 03/01/17 N Page 3 of 7
No
Part 3. Other Information
1. Does the beneficiary live with the sponsor?
Yes No
3. How is the beneficiary supported?
Sponsor Other Sources
If you answered "No" to Item Number 1., provide the
name of the person with whom the beneficiary lives in
Item Numbers 2.a. - 2.c.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name
4.
If the beneficiary is supported by the sponsor, how long
has the sponsor supported the beneficiary?
5.
Is the beneficiary in the legal custody of the sponsor?
(Explain)
Yes No
6. Has the sponsor stopped all support?
Yes
If you answered "Yes" to Item Number 6., provide the
date when the support stopped in Item Numbers 7.
7. Date Support Stopped (mm/dd/yyyy)
8. Has the sponsor given any reason for withdrawal of support?
Yes No
If you answered "Yes" to Item Number 8., describe the
circumstances under which the sponsor ceased his or her
support. If you need extra space to provide any additional
information, use the space provided below in Part 7.
Additional Information.
The interpreter named in Part 5. read to me every
question and instruction on this application and my
answer to every question in
1.b.
a language in which I am fluent, and I understood
everything.
,
2. At my request, the preparer named in Part 6.,
prepared this application for me based only upon
information I provided or authorized.
,
Part 4. Applicant's Statement, Contact
Information, Certification, and Signature
I can read and understand English, and I have read
and understand every question and instruction on this
application and my answer to every question.
1.a.
Note: Select the box for either Item Number 1.a. or 1.b.
If applicable, select the box for Item Number 2.
NOTE: Read the Penalties section of the Form I-363
Instructions before completing this part.
Applicant's Signature
Applicant's Mobile Telephone Number (if any)4.
Applicant's Daytime Telephone Number3.
Applicant's Contact Information
Applicant's Email Address (if any)5.
NOTE: Attach a copy of Form I-361, Affidavit of Financial
Support and Intent to Petition for Legal Custody for P.L. 97-359
Amerasian, if available.
9. Relationship of Applicant
Self
Representative of the Agency Having Legal Custody
of the Beneficiary
Individual Having Legal Custody of the Beneficiary
Guardian Ad Litem
Form I-363 03/01/17 N Page 4 of 7
Part 4. Applicant's Statement, Contact
Information, Certification, and Signature
(continued)
(mm/dd/yyyy)Date of Signature6.b.
Applicant's Signature (sign in ink)6.a.
Applicant's Signature
NOTE TO ALL APPLICANTS: If you do not completely fill
out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your request.
Interpreter's Mailing Address
Street Number
and Name
3.a.
3.b.
Apt.
Flr.Ste.
3.c. City or Town
3.g.
Postal Code
3.h. Country
3.d.
State
3.e.
ZIP Code
3.f.
Province
Interpreter's Daytime Telephone Number4.
Interpreter's Email Address (if any)6.
Interpreter's Contact Information
Interpreter's Mobile Telephone Number (if any)5.
I further authorize release of information contained in this
request, 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:
I reviewed and provided or authorized all of the
information in my request;
1.
I understood all of the information contained in, and
submitted with, my request; and
2.
All of this information was complete, true, and
correct at the time of filing
3.
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.
Interpreter's Business or Organization Name (if any)2.
Interpreter's Given Name (First Name)1.b.
Part 5. Interpreter's Contact Information,
Certification, and Signature
Interpreter's Family Name (Last Name)1.a.
Interpreter's Full Name
Provide the following information about the interpreter.
Applicant's 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 that I
seek.
Form I-363 03/01/17 N Page 5 of 7
Preparer's Statement
I am not an attorney or accredited representative
but have prepared this application on behalf of
the applicant and with the applicant's consent.
7.a.
I am an attorney or accredited representative and
my representation of the applicant in this case
7.b.
preparation of this application.
does not extend beyond the
NOTE: If you are an attorney or accredited
representative whose representation extends
beyond preparation of this application, you may
be obliged to submit a completed Form G-28,
Notice of Entry of Appearance as Attorney or
Accredited Representative, with this request.
extends
By my signature, I certify, under penalty of perjury, that I
prepared this application at the request of the applicant. The
applicant then reviewed this completed request and informed
me that he or she understands all of the information contained
in, and submitted with, his or her request, including the
Applicant's Certification, and that all of this information is
complete, true, and correct. I completed this request based only
on information that the applicant provided to me or authorized
me to obtain or use.
8.a.
Preparer's Signature (sign in ink)
8.b. Date of Signature (mm/dd/yyyy)
Preparer's Signature
Preparer's Certification
Part 6. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, if Other Than the Applicant
Preparer's Given Name (First Name)1.b.
2. Preparer's Business or Organization Name
Preparer's Full Name
Provide the following information about the preparer.
1.a. Preparer's Family Name (Last Name)
Preparer's Mailing Address
Street Number
and Name
3.a.
3.b.
Apt.
Flr.Ste.
3.c. City or Town
3.g.
Postal Code
3.h. Country
3.d.
State
3.e.
ZIP Code
3.f.
Province
Preparer's Contact Information
Preparer's Mobile Telephone Number (if any)5.
Preparer's Daytime Telephone Number4.
Preparer's Email Address (if any)6.
Part 5. Interpreter's Contact Information,
Certification, and Signature (continued)
Interpreter's Certification
I am fluent in English and
which is the same language specified in Part 4., Item Number
1.b., and I have read to this applicant in the identified language
every question and instruction on this request and his or her
answer to every question. The applicant informed me that he or
she understands every instruction, question, and answer on the
request, including the Applicant's Certification, and has
verified the accuracy of every answer.
I certify, under penalty of perjury, that:
,
Date of Signature (mm/dd/yyyy)7.b.
Interpreter's Signature (sign in ink)
7.a.
Interpreter's Signature
Form I-363 03/01/17 N Page 6 of 7
If you need extra space to provide any additional information
within this request, use the space below. If you need more
space than what is provided, you may make copies of this page
to complete and file with this request or attach a separate sheet
of paper. Type or print your name and A-Number (if any) at the
top of each sheet; indicate the Page Number, Part Number,
and Item Number to which your answer refers; and sign and
date each sheet.
A-Number (if any)
►
A-
3.a.
2.
Page Number 3.b. Part Number
3.c.
Item Number
3.d.
4.a.
Page Number
4.b. Part Number
4.c.
Item Number
4.d.
5.a.
Page Number
5.b. Part Number
5.c.
Item Number
5.d.
6.a.
Page Number 6.b. Part Number
6.c.
Item Number
6.d.
Part Number
7.a.
Page Number 7.b.
7.c.
Item Number
7.d.
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c.
Middle Name
Part 7. Additional Information
Form I-363 03/01/17 N Page 7 of 7
For USCIS Use Only
1.a.
If an investigation was conducted, provide the date it was completed (Date) (mm/dd/yyyy
2.
Signature of USCIS Officer (sign in ink)
Investigation Not Necessary
Enforcement Recommended
No Action Recommended
4.
Name of Regional Counsel
Date (mm/dd/yyyy
Recommendation Forwarded to U.S. Attorney
1.b.
1.c.
1.d.
Investigation Necessary
3. Title of USCIS Officer
5.
6.
