Form I-864 Affidavit of Support

Form I-864 Affidavit of Support
Basis for Filing
Principal Immigrant Full Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Country of Birth
A-Number
USCIS Online Account Number
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Immigration Case and Sponsored Immigrants
Immigration Case Visa Category
Consulate or USCIS Office
Total Immigrants Sponsored
Sponsored Immigrant Name
Relationship to Sponsor
A-Number
Sponsor Information and Domicile
Sponsor Full Name

First NameMiddle NameLast Name
Other Names Used
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
SSN
A-Number
USCIS Online Account Number
Date of Birth

MonthDayYear
Date
Country of Birth
Citizenship Status
Do you live in the U.S.?
If not, explain
Household Size and Employment
Yourself
Spouse
Dependent children
Other dependents
Immigrants sponsored now
Immigrants previously sponsored
Total Household Size
Employment Status
Employer Name
Employer Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Income, Tax Filing, and Household Member Income
Most recent year income
Second year income
Third year income
Filed taxes?
IRS transcripts

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Household member name

First NameMiddle NameLast Name
Household member income
Household member relationship
Assets, Acknowledgements, Supporting Documents, and Signature
Assets - Cash
Assets - Bank accounts
Assets - Property
Assets - Stocks
Total asset value
Income vs poverty guideline
Sponsor's Contract - Agreement acknowledgement
Sponsor's Contract - Legal obligations acknowledgement
Upload - Tax returns

Cancelof
Upload - W-2

Cancelof
Upload - Pay stubs

Cancelof
Upload - Bank statements

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Signature
Date

MonthDayYear
Date
Should be Empty:

Form I-864 Affidavit of Support

Immigration Case and Sponsored Immigrants

Sponsor Information and Domicile

Household Size and Employment

Income, Tax Filing, and Household Member Income

Assets, Acknowledgements, Supporting Documents, and Signature