H-1B Multiple Registration Disclosure Form
Please complete this form to disclose all H-1B registrations submitted or intended for the same beneficiary. Accurate disclosure is required to ensure compliance with H-1B program rules.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company/Organization Name
*
Your Role
*
Please Select
Beneficiary
Employer
Attorney/Representative
Other
Beneficiary's Full Name
*
List all companies/organizations that have submitted or intend to submit H-1B registrations for this beneficiary (separate by comma)
*
Have you or any employer/representative submitted more than one H-1B registration for the same beneficiary this cap season?
*
Yes
No
If Yes, please provide details of each submission (company name, date submitted, registration confirmation number if available)
Signature
*
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Disclosure
Submit Disclosure
Should be Empty: