Form I-360 04/12/18
Page 15 of 19
Petitioner's Declaration and 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
and all of my records that USCIS may need to determine my eligibility for the immigration benefit I seek.
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:
1) I provided or authorized all of the information contained in, and submitted with, my petition;
2) I reviewed and understood all of the information in, and submitted with, my petition; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that all of the information in my petition and any document submitted with it were provided or
authorized by me, that I reviewed and understand all of the information contained in, and submitted with, my petition, and that all of
this information is complete, true, and correct.
Date of Signature (mm/dd/yyyy)Petitioner's Signature6.
I further authorize release of information contained in this petition, 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.
NOTE TO ALL PETITIONERS: If you do not completely fill out this petition or fail to submit required documents listed in the
Instructions, USCIS may deny your petition.
Petitioner's Mobile Telephone Number (if any)4.
Petitioner's Email Address (if any)5.
Petitioner's Daytime Telephone Number3.
Petitioner's Contact Information
Part 11. Petitioner's Statement, Contact Information, Declaration, and Signature (Individual) (continued)
Part 12. Statement, Contact Information, Declaration, and Signature of the Petitioner or Authorized
NOTE: Read the Penalties section of the Form I-360 Instructions before completing this part.
IMPORTANT: Complete this section ONLY if you are filing Form I-360 to petition for another person or as an authorized signatory
of an organization. If you are an individual filing this petition for yourself, complete Part 11. Petitioner's Statement, Contact
Information, Declaration, and Signature (Individual).
I can read and understand English, and I have read and understand every question and instruction on this petition and
my answer to every question.
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1. Petitioner's Statement Regarding the Interpreter
Petitioner's or Authorized Signatory's Statement