U Visa – Sample Request for Law Enforcement Certification (I-918B)
Via Email
[email
address]
Dear [Law Enforcement Officer Name],
I am writing to request a U Visa Law Enforcement Certification on behalf of Ms. XXXXXX, who is
being represented by the Tahirih Justice Center. Attached, please find Herndon Police Department Public
Incident Report No. XXXX-XXXXX, a completed Form I-918 Supplement B, and a blank Form I-918B
containing only the victim’s biographical information. Please feel free to either sign the completed copy,
or to work from the copy containing only the biographical information.
For your convenience, the names of our client, the suspect, the incident number, and the date of the
incident are below:
Victim Name: XXXXXXX (DOB: mm/dd/yyyy)
Suspect Name: XXXXXXX
Case Number: XXXX-XXXXX
Date of Incident: mm/dd/yyyy
Ms. XXXXXX is a victim of a U visa qualifying crime. On April 18, 2011, Ms. XXXXXX was
physically assaulted by her ex-boyfriend, Mr. XXXXXX, who punched her face multiple times and pulled
her hair. Ms. XXXXXX reported the incident to the Herndon Police Department, but Mr. XXXXXX fled
the scene prior to their arrival.
Ms. XXXXXX remains willing and available should the Herndon Police Department require additional
assistance in their investigation of this case. Ms. XXXXXX continues to provide the Herndon Police
Department with any information she possesses regarding Mr. XXXXXX’s suspected whereabouts.
If you are able to sign this certification form, please mail the original to me at the address listed below ---
Ms. XXXXXX must submit an original I-918 Supplement B as part of her application to USCIS in
Vermont. USCIS will not accept Form I-918B if it is mailed in separately.
Thank you in advance for your assistance with this request. Please do not hesitate to contact me by
telephone at XXXX or email at XXX if I can provide you with any additional information.
Sincerely,
ATTORNEY NAME
