Form G-28I 05/23/18 Page 2 of 4
Part 3. Notice of Appearance as Attorney
Admitted to Practice Outside the United States
(continued)
3.a. U.S. Customs and Border Protection (CBP)
List the specific matter in which appearance is entered.3.b.
4. Receipt Number (if any)
►
I enter my appearance as an attorney at the request of the
(select only one box):
5.
Applicant Petitioner
Respondent (ICE, CBP)Beneficiary/Derivative
9. Client's Alien Registration Number (A-Number) (if any)
8. Client's USCIS Online Account Number (if any)
►
6.a. Family Name
(Last Name)
6.b. Given Name
(First Name)
6.c. Middle Name
Information About Client (Applicant, Petitioner,
Beneficiary or Derivative, Respondent, or
Authorized Signatory for an Entity)
7.a. Name of Entity (if applicable)
►
A-
Title of Authorized Signatory for Entity (if applicable)7.b.
10. Daytime Telephone Number
12. Email Address (if any)
Client's Contact Information
Mobile Telephone Number (if any)11.
13.f.
13.e. Postal Code
Country
NOTE: Provide the client's mailing address. Do not provide
the business mailing address of the attorney unless it serves as
the safe mailing address on the application or petition being
filed with this Form G-28I.
13.a.
13.c.
13.b.
Mailing Address of Client
City or Town
Street Number
and Name
Ste. Flr.Apt.
13.d. Province
Part 4. Client's Consent to Representation and
Signature
I request that USCIS send original notices on an
application or petition to the business address of my
attorney as listed in this form.
1.
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 U.S. Department of
Homeland Security (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.
Consent to Representation and Release of
Information
USCIS will send notices to both a represented party (the client)
and his, her, or its attorney or accredited representative either
through mail or electronic delivery. If you want to have notices
sent to your attorney rather than to you, please select Item
Number 1. below. You may change this election through
written notice to USCIS.
Options Regarding Receipt of USCIS Notices
Signature of Client or Authorized Signatory for an Entity2.a.
2.b. Date of Signature (mm/dd/yyyy)
Signature of Client or Authorized Signatory for an
Entity