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Immigrant Visa Address & Agent Form

This document provides instructions for immigrant visa applicants to choose an address for receiving mail about their application. Applicants can either appoint an agent to receive mail, provide their own address, indicate they have already immigrated to the US, or state they no longer wish to apply for a visa. The applicant must sign and date the document to confirm their choice.

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620 views1 page

Immigrant Visa Address & Agent Form

This document provides instructions for immigrant visa applicants to choose an address for receiving mail about their application. Applicants can either appoint an agent to receive mail, provide their own address, indicate they have already immigrated to the US, or state they no longer wish to apply for a visa. The applicant must sign and date the document to confirm their choice.

Uploaded by

nujahm1639
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
  • Choice of Address and Agent Form: This form is used by immigration visa applicants to choose an address or agent for correspondence with the U.S. Department of State.

OMB No.

1405-0126
Make sure the address is complete and correct. We will use this address for future mailings. EXPIRATION DATE: 12/31/2006
ESTIMATED BURDEN: 30 minutes*

Place Case Barcode Strip Here Before Mailing to the National Visa Center

U.S. Department of State


CHOICE OF ADDRESS AND AGENT
For Immigrant Visa Applicants

Print or type your full name


Check one box only to the left of the statement that is your choice.

I appoint:
as my agent or attorney to receive mail about my application. Mail from the U. S. Department of State concerning
my immigrant visa application should be sent to:

Name of the person who will act as your agent or attorney for receipt of mail

Street address (where my agent or attorney will receive mail about my application)

City State/Province Postal Code Country

I do not appoint an agent or an attorney to receive mail about my application. Mail from the U.S. Department of
State concerning my immigrant visa application should be sent to me at:

Street address (include "in care of" if needed)

City State/Province Postal Code Country

I have already legally immigrated to the U. S. and do not need to apply for an immigrant visa.

I no longer wish to apply for an immigrant visa.

As proof of your choice, sign and date this document:

Signature of Applicant Date of Signature

PAPERWORK REDUCTION ACT

*Public reporting burden for this collection of information is estimated to average 30 minutes per response. Persons are not required to
provide this information in the absence of a valid OMB approval number. Send comments on the accuracy of this estimate of the burden and
recommendations for reducing it to: U.S. Department of State (A/RPS/DIR) Washington, DC 20520-1849.

DS-3032
12-2003

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