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CANDIDATE SUMMARY SHEET (CSS)PLEASE TYPE THE DETAILS ON THIS

ALL ENTRIES MUST BE FILLED IN THIS FORM INDICATE BLANK ENTRIES WITH NOT APPLICABLE(N/A)

PERSONAL INFORMATIONFirst Name (as it appears in passport)

Ashish

For COMPANY use ONLY

HR Manager :_________________________________

Employee ID#:________________________________

Complete Client Name__________________________

Street Address_________________________________

City/St/Zip____________________________________

Salary $______________________________per year

Has Labor been filed?____________________________

Has I-140 been filed?_____________________________

Has I-140 been approved?________________________

Has I-485 been filed? ____________________________

Priority Date: __________________________________

Middle Name

Last Name (as it appears in passport)Phogat

Date of Birth (MM/DD/YY)03/26/86

Social Security #:804 - 93 - 2660

State & Country of Birth

Haryana, India

Country of CitizenshipIndia

Marital Status:Single

US consulate where first visa was stamped :Mumbai

For LEGAL DEPT. use ONLY

Received on:____________________________________

LCA City/State:_________________________________

LCA PW :_________________valid till______________LCA#: _________________________________________

Signed I-539 included, if H4 is to be filed

Passport No. Date Issued(MM/DD/YY)

Date Expires on(MM/DD/YY)

G6088696

12/14/07 12/13/17

U.S Residential Address2, Grotto Court, Germantown, MD - 20874

Complete Foreign Address (in home country including zip code)101, Vikas Nagar, Rohtak - 124001

Email address and Phone number:Ashish.phogat@igate.com, 301-515-2073

CURRENT VISA STATUS INFORMATIONDate first entered the U.S (MM/DD/YY)

09/23/12

Date of most recent arrival in US

(MM/DD/YY) (from I-94 card issued atthe port of entry)09/23/12

Current immigration status (H-1B, H4, L1, L2,

F1, TN)H1BVisa status when first entered the U.S

Valid - H1B

I-94 # (from card issued at the Port-of-entry)38656742827

I-94 expires on (MM/DD/YY)12/31/12

Current H-1B approval notice # (10 digit numberstarting with EAC/WAC/SRC or LIN)EAC-12-031-52004

Revised: April 24, 2007Page 1

mailto:Ashish.phogat@igate.commailto:Ashish.phogat@igate.commailto:Ashish.phogat@igate.com

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CANDIDATE SUMMARY SHEET (CSS)PLEASE TYPE THE DETAILS ON THIS FORM

ALL ENTRIES MUST BE FILLED IN

CALCULATION OF DATES OF STAY IN THE U.S IN H OR L STATUS (to determine 6 H-1Byear limit please list exact dates spent IN the U.S and visa category)

From (MM/DD/YY) To (MM/DD/YY) Visa Category (H or L) Total no. of months

09/23/12 12/19/12 H 3 months

Have you ever received a visa stamp from a U.S. consulate? YESIf Yes, please complete the following and submit legible copies of the visa stamps.

Date of Issue Location of Consulate (City& Country)

Visa Type Expiration Date

04/17/12 MUMBAI, INDIA H1B 12/31/12

INFORMATION OF YOUR SPOUSE AND/OR CHILDREN, if applicable:Name of Dependent Relationshi

pIn the US oroutside the US?

If in the US,what is thevisa status?

Country of Birth I-94 expirationdate

If your spouse and/or children are in the U.S , please follow these instructions

1. Please go to the following link - -http://www.uscis.gov/files/form/i-539.pdf.

2. Please complete the form online and print. Please have your spouse sign Part 5 in blue inkon page 2 of the Form I-539 (The CIS only accepts original signature)

Please send the following documents and the signed I-539 alongwith your extension documentation:

Good photocopy of your spouse/childrens I-94 card.

Photocopy of the marriage certificate (if your spouse is still using her maiden name).

Photocopies of relevant pages of spouse's passport (introductory, validity of passport and the visa stamp pages).

Photocopy of the birth certificate (if you have any children).

Revised April 24, 2007

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http://www.uscis.gov/files/form/i-539.pdfhttp://www.uscis.gov/files/form/i-539.pdfhttp://www.uscis.gov/files/form/i-539.pdf