I-134A Application Form I-134A, Declaration of Financial Support Back Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.I am filing this form on behalf of *Myself as the beneficiary.Another individual who is the beneficiary.Beneficiary's Current Legal Name (Do not provide a nickname.) *FirstMiddleLastOther Names UsedFirstMiddleLastLayoutDate of BirthGenderMaleFemaleAlien Registration NumberPlace of Birth LayoutCity or TownState or ProvinceCountryCountry of Citizenship or Nationality *Marital StatusSingleMarriedDivorcedWidowedLegally SeparatedMarriage AnnulledOther>> Beneficiary's Mailing Address In Care Of Name (if any)LayoutStreet Number and NameNumberLayoutCity or TownStateZip CodeProvincePostal CodeCountryAre the beneficiary's mailing address and physical address the same?YesNoLayout (copy)Street Number and NameNumberLayout (copy)City or TownStateZip CodeProvincePostal CodeCountry>> Beneficiary's Anticipated Period of Stay in the United States LayoutFrom (dd/mm/yyyy)To (dd/mm/yyyy)End DateNo End Date>> Beneficiary's Financial Information Provide information about the beneficiary's income and assets. If you need additional space to complete any Item Number in this section LayoutIndividual's Full Name Date of BirthRelationship to the BeneficiaryIncome contribution to the beneficiary annuallyDoes any of the beneficiary's total income (including income from dependents and other individuals who contribute to the beneficiary's income, excluding any individuals named ) come from an illegal activity or source (such as proceeds from illegal gambling or illegal drug sales)?YesNo>> Beneficiary's Assets LayoutFull Name of Asset Holder Type of Asset Select AssetChecking - Bank AccountSavings - Bank AccountAnnuitiesStocks, Bonds, Certificates of DepositRetirement or Educational AccountReal Estate HoldingsPersonal Property (net value)Total Amount (Cash Value) (U.S. dollars)>> Information About the Individual Agreeing to Financially Support the Beneficiary Named Current Legal NameFirstMiddleLastOther Names UsedFirstMiddleLastCurrent Mailing Address In Care Of Name (if any)LayoutStreet Number and NameNumberLayoutCity or TownStateZip CodeProvincePostal CodeCountryLayoutDate of BirthPlace of BirthState or ProvinceCountryLayoutAlien Registration Number (A-Number) (if any)USCIS Online Account Number (if any)What is your current immigration status?U.S. CitizenU.S. NationalLawful Permanent ResidentNonimmigrantLayoutBeneficiary's Daytime Telephone NumberBeneficiary's Mobile Number (if any)Beneficiary's Email Address (if any)Evidence Layout Work Letter Upload your file here Bank Letter Upload your file here Income Tax Upload your file here Assets Upload your file here Immigration Status (Green Card, Citizenship, Work Authorization Card) Upload your file here Passport Front Page Upload your file here Beneficiary Assets If Any Upload your file hereEmailPhone Number Of BeneficiaryOther DocumentsSubmit
