Form I-566 - Interagency Record Of Request - A, G Or Nato Dependent Employment Authorization Or Change/adjustment To/from A, G Or Nato Status Page 6

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For Official Use Only
8.
Name of Diplomatic Mission, International Organization,
Part 8. Certification by Diplomatic Mission,
NATO/HQ SACT, or NATO Member State
International Organization, NATO/HQ SACT,
or NATO Member State
NOTE: Certifying officer or official must have this
Address of Diplomatic Mission, International Organization,
information and page to complete process.
NATO/HQ SACT, or NATO Member State
9.a.
In Care Of Name
1.
I certify that the information provided on the first
page of this Form I-566 is true and correct to the best
of my knowledge and according to our official
9.b.
Street Number
records.
and Name
2.
I further certify that the requestor's eligibility for
9.c.
Apt.
Ste.
Flr.
employment authorization was verified under the
provisions of:
9.d.
City or Town
2.a.
A bilateral agreement with
9.e.
State
9.f.
ZIP Code
2.b.
A de facto agreement with
9.g.
Province
9.h.
Postal Code
2.c. Select all that apply
9.i.
Country
Without a numerical limit
Based on principal alien's G-4 status
With a numerical limit and this requestor is within
the limit
3.
I further certify that the requestor for status as a
principal alien is being offered the position below
and DOS was notified.
Position
DOS Notification Date (mm/dd/yyyy)
4.a. Certifying Officer or Official's Last Name
4.b.
Certifying Officer or Official's First Name
Official Seal
5.
Certifying Officer or Official's Duty/Title
6.a.
Certifying Officer or Official's Signature
6.b. Date of Signature (mm/dd/yyyy)
7.
Telephone Number (including area code)
Form I-566 12/07/16 N
Page 6 of 7

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