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Begin with Part 1, where you will enter the Victim Information. Fill in your Alien Registration Number (if applicable), Family Name, Given Name, and any Other Names Used. Ensure all names are accurate.
Proceed to Part 2 for Agency Information. Enter the name of the certifying agency and official, including their title and address. This section is crucial for establishing the authority of the certifying body.
In Part 3, detail the Criminal Acts. Select all applicable offenses and provide dates of occurrence. Attach any relevant reports if necessary.
Complete Part 4 regarding Helpfulness of the Victim by answering questions about the victim's cooperation in the investigation.
If applicable, fill out Part 5 about Family Members involved in criminal activity.
Finally, sign and date Part 6 to certify that all information is true and complete before submitting your form.
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