Green Card Template

June 6, 2011

Date of issuing: –/–/—- [dd / mm / yyyy]

Surname of the Card Holder: __________________________________________

First Name of the Card Holder: ________________________________________

USCIS No. : ______________________________

Country of Birth: ___________________________

Date of Birth: –/–/—- [dd / mm / yyyy]

Port-of-entry or the office where the adjustment status was granted: ______________

Sex: Male/ Female

Date from when the card holder becomes a permanent resident: –/–/—- [dd / mm / yyyy]

Card Expiry Date: –/–/—- [dd / mm / yyyy]

________________________                                         _______________________

(Signature of the Card Holder)                                        (Signature of the Issuing Officer)

Download Green Card Template in Word Format

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