Form I-363 02/02/15 Y
1. Beneficiary's Family Name (Capital Letters) First Name Middle Name 2. Alien Registration Number
A -
Type or print in black ink. - See instructions on reverse side.
4. Employer or School (Name and Address 5. Country of Citizenship
6. Date of Birth (mm/dd/yyyy) 7. Place of Birth (City or Town) (Province or State) (Country) 8. Applicant's Phone Number
(Include Area Code)
3. Mailing Address in U.S.
C/O:
(Number, Street, Apt.) (City) (State) (Zip Code)
15. Sponsor's Employer Sponsor's Phone Number
(Include Area Code)
16. Does the beneficiary live with the sponsor? 17. If not, with whom does the beneficiary live?
9. Initially Admitted to U.S. at (City and State)
10. Beneficiary's Relationship to Sponsor
11. Destination in U.S. at Time of Initial Admission 12. Beneficiary's file is at USCIS office in (City and State)
18. How is the beneficiary supported? (Sponsor? Other Sources?) How long has the beneficiary been supported by the sponsor?
13. Sponsor's Family Name (Capital Letters) First Name Middle Name
14. Sponsor's Present Address
19. Is the beneficiary in the legal custody of the sponsor? (Explain)
20. Has the sponsor stopped all support?
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.
Since when? (mm/dd/yyyy)
23. Signature and Date of Person Preparing Form, If Other Than Applicant 24. Signature of Applicant and Date
21. Has the sponsor give any reason for
withdrawal of support?
If "Yes," describe the circumstances under which the
sponsor ceased his or her support.
22. Relationship of Applicant
Self
Individual Having Legal Custody of the Beneficiary
Representative of the Agency Having Legal Custody of the Beneficiary
Guardian Ad Litem
ACTION BLOCK (For use by USCIS officer) This applicant was interviewed by me
Remarks:
on
(Date)
at
(Place)
in person
by phone
Recommendation Forwarded to U.S. Attorney
Date:
Investigation Completed on
Investigation Not Necessary
(Signature and Title)
Enforcement Recommended
No Action Recommended
(Regional Counsel and Region)
Received Trans In Ret'd Trans Out Completed
Yes
No
Yes
No
Yes
No
Yes
No
U.S. Citizen
Lawful Permanent Resident
(Date)
Department of Homeland Security
U.S. Citizenship and Immigration Services
Form I-363, Request to Enforce Affidavit of
Financial Support and Intent to Petition
for Custody for Pub. L. 97-359 Amerasian
OMB No. 1615-0022;Exp. 02/28/2017
Do Not Write Below This Line.
