Fillable Form G-884: Request for the Return of Original (Visa Pro)

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Form G-884: Request for the Return of Original (Visa Pro)

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The Form G-884: Request for the Return of Original (Visa Pro) form is 6 pages long and contains:

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  • 18 check-boxes
  • 121 other fields

Country of origin: US
File type: PDF

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Form G-884 10/21/19 Page 1 of 6
Request for the Return of Original Documents
Department of Homeland Security
U.S. Citizenship and Immigration Services
►
For
USCIS
Use
Only
Remarks
Date
File No
START HERE - Type or print in black ink.
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c.
Middle Name
Your Full Name
Part 1. Information About You (Person requesting
the return of original documents)
IMPORTANT NOTE: You do not need to file this request if
you submitted original documents because U.S. Citizenship and
Immigration Services (USCIS) requested originals. We will
automatically return original documents that we requested once
we no longer need them. Please refer to the instructions for the
form you filed to determine whether non-requested original
documents are available for return or destroyed after electronic
processing.
Mailing Address
2.e. City or Town
2.a. In Care Of Name
2.f. State 2.g. ZIP Code
Street Number
and Name
2.b.
2.c.
Ste. Flr.Apt.
Other Information
►
A-
Alien Registration Number (A-Number) (if any)3.
City/Town/Village of Birth5.
6. Country of Birth
Date of Birth (mm/dd/yyyy)7.
Provide specific information about the desired documents
or records (for example, marriage license, birth certificate,
or death certificate).
8.
9. Receipt Number (if any)
►
Part 2. Data for Identification of Personal
Record
Subject's Full Name
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c.
Middle Name
2.d. Number
USCIS Online Account Number (if any)4.
►
(USPS ZIP Code Lookup)
USCIS
Form G-884
OMB No. 1615-0100
Expires 10/31/2021
Form G-884 10/21/19 Page 2 of 6
Part 2. Data for Identification of Personal
Record (continued)
Other Names Used (if any)
Provide all other names the subject has ever used, including
aliases, maiden name, and nicknames. If you need extra space
to complete this section, use the space provided in Part 6.
Additional Information.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c.
Middle Name
3.a. Family Name
(Last Name)
3.b. Given Name
(First Name)
3.c.
Middle Name
Birth Information
Date of Birth (mm/dd/yyyy)4.
5.a. City or Town
5.b. State or Province
5.c. Country
Entry Into the United States
Date of Entry (mm/dd/yyyy)6.
Port-of-Entry
7.
Type of Entry (for example, visitor, student, etc.)8.
A-Number (if any)
►
A-
9.
U.S. Citizenship Information
10.a. Family Name
(Last Name)
10.b. Given Name
(First Name)
10.c.
Middle Name
Certificate of Naturalization Number11.
Certificate of Naturalization Date (mm/dd/yyyy)12.
Name on Certificate of Citizenship
13.a. Family Name
(Last Name)
13.b. Given Name
(First Name)
13.c.
Middle Name
Certificate of Citizenship Number14.
Certificate of Citizenship Date (mm/dd/yyyy)15.
Naturalization Court/USCIS Office and Location
Naturalization Court/USCIS Office and Location16.a.
16.b. City or Town
16.c. State
Verification of Requestor's Identity17.
Legal Photocopies
In Person With Identification
Place of Birth
Name on Certificate of Naturalization
Form G-884 10/21/19 Page 3 of 6
Part 3. Interpreter's Contact Information,
Certification, and Signature
Provide the following information about the interpreter.
Interpreter's Full Name
1.a. Interpreter's Family Name (Last Name)
1.b. Interpreter's Given Name (First Name)
Interpreter's Business or Organization Name (if any)2.
Interpreter's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
Street Number
and Name
3.a.
3.b. Ste. Flr.
Apt.
3.h.
3.f. Province
Country
3.g. Postal Code
Interpreter's Daytime Telephone Number
6.
4.
Interpreter's Email Address (if any)
Interpreter's Contact Information
Interpreter's Mobile Telephone Number (if any) 5.
Interpreter's Signature
Interpreter's Signature7.a.
7.b. Date of Signature (mm/dd/yyyy)
Part 4. Contact Information, Declaration, and
Signature of the Person Preparing this Request,
if Other Than the Requestor
Provide the following information about the preparer.
Preparer's Full Name
1.a. Preparer's Family Name (Last Name)
Preparer's Given Name (First Name)1.b.
Preparer's Business or Organization Name (if any)2.
Preparer's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
Street Number
and Name
3.a.
3.b.
Ste. Flr.Apt.
3.h.
3.f. Province
Country
3.g. Postal Code
Interpreter's Certification
I certify, under penalty or perjury, that:
is the same language specified in Part 5., Item Number 1.b.,
and I have read every question and instruction on this request
and his or her answer to every question to this requestor in the
identified language. The requestor informed me that he or she
understands every instruction, question, and answer on the
request, including the Requestor's Declaration and
Certification, and has verified the accuracy of every answer.
I am fluent in English and , which
Preparer's Contact Information
Preparer's Daytime Telephone Number
6.
4.
Preparer's Email Address (if any)
Preparer's Mobile Telephone Number (if any)5.
Form G-884 10/21/19 Page 4 of 6
Part 4. Contact Information, Declaration, and
Signature of the Person Preparing this Request,
if Other Than the Requestor (continued)
Preparer's Statement
preparation of this request.
I am not an attorney or accredited representative but
have prepared this request on behalf of the requestor
and with the requestor's consent.
NOTE: If you are an attorney or accredited representative, you
may need to submit a completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited Representative,
with this
request.
7.a.
7.b.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
prepared this form at the request of the requestor. The requestor
then reviewed this completed form and informed me that he or
she understands all of the information contained in, and
submitted with, his or her request, including the Requestor's
Declaration and Certification, and that all of this information
is complete, true, and correct. I completed this form based only
on information that the requestor provided to me or authorized
me to obtain or use.
Preparer's Signature
Preparer's Signature 8.a.
8.b. Date of Signature (mm/dd/yyyy)
Part 5. Requestor's Declaration, Certification,
Signature, and Affidavit of Identity
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
I can read and understand English, and have read and
understand every question and instruction on this
request and my answer to every question.
1.a.
1.b.
The interpreter named in Part 3. read to me every
question and instruction on this request and my
answer to every question in
a language in which I am fluent, and I understood
everything.
,
,
2. At my request, the preparer named in Part 4.,
prepared this request for me based only upon
information I provided or authorized.
Requestor's Contact Information
Requestor's Email Address (if any)
4.
Requestor's Daytime Telephone Number3.
Requestor's Mobile Telephone Number (if any)
5.
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
verify my identity and my authority to obtain the desired
documents or records. I authorize the release of any
information from my records that USCIS needs in order to
respond to my request.
Requestor's Declaration and Certification
I certify, under penalty of perjury, that I reviewed and
understand all of the information contained in, and submitted
with, my request and that all of this information is complete,
true, and correct
I swear that I am the person named in Part 1. of this request. I
understand that if I falsify or conceal a material fact or submit a
false document with this request that USCIS will deny it, deny
any other immigration benefit, and that I may face severe
penalties provided by law and may be subject to criminal
prosecution, fine, or imprisonment (18 U.S.C. 1101).
Do not sign Part 5. until you are before the
Certifying Official.
I am an attorney or accredited representative and my
representation of the requestor in this case
extends does not extend beyond the
Form G-884 10/21/19 Page 5 of 6
Part 5. Requestor's Declaration, Certification,
Signature, and Affidavit of Identity (continued)
6.a. Family Name
(Last Name)
6.b. Given Name
(First Name)
6.c. Middle Name
7.a.
7.b. Date of Signature (mm/dd/yyyy)
Signature (Your signature must be notarized. Do not
sign until you are before the Certifying Official.)
I do hereby certify that the requestor named in Part 1. of this
request personally appeared before me and executed the
Affidavit of Identity.
8.a. Family Name
(Last Name)
8.b. Given Name
(First Name)
8.c. Middle Name
9. Title of USCIS Official
10.a. Signature of USCIS Official (Sign in ink.)
10.b. Date of Signature (mm/dd/yyyy)
Certifying Official
I do hereby certify that the requestor named in Part 1. of this
request personally appeared before me and executed the
Affidavit of Identity.
11.a.
Family Name
(Last Name)
11.b.
Given Name
(First Name)
11.c. Middle Name
12.a. Signature of Certifying Official (sign in ink)
12.b. Date of Signature (mm/dd/yyyy)
13. In and for the:
Given under my hand and official seal
Requestor's Printed Full Name
Printed Name of USCIS Official
Printed Name of Certifying Official
Form G-884 10/21/19 Page 6 of 6
Part 6. Additional Information
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 form or attach a separate sheet of
paper. Type or print your name 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.
1.a Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c.
Middle Name
►
A-
A-Number (if any)2.
Page Number Part Number Item Number5.a.
Page Number
5.b.
Part Number
5.c.
Item Number
5.d.
Part NumberPage Number
Item Number
6.d.
6.c.6.b.6.a.
7.c.7.b.7.a.
7.d.
3.a. Page Number
3.b. Part Number 3.c. Item Number
3.d.
Page Number
Part Number Item Number4.c.4.b.
4.d.
4.a.
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Form G-884: Request for the Return of Original (Visa Pro)

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Completed 29 July 2020

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