PART A: EMPLOYEE INFORMATION

Please fill all the information requested and send this via email:
Any information that is not filled will delay in the process

1. First Name : Kirubanandam

2. Last Name : Swayamprakasam
3. Middle Name :
4. Maiden Name :
5. Date of Birth : 09-Aug-1977
6. Country of Birth : India
7. City of Birth : Thanjavur
8. Nationality : Indian
9. Marital Status : Single
10. Email : kripa777@yahoo.com
11. SSN # : 611-51-4107
12. Current US Residence Address : 536 Glennburry Way, San Jose,
California, USA-95136
13. Home Phone Number : 408-228-3126
14. Office Phone Number : 408-528-2852
15. Mobile Phone Number : 480-747-0543
16. Fax Number :
17. Foreign Contact Address :
18. Foreign Contact Phone :
19. Foreign Contact Name :
20. I – 94# :
(The one on the Passport at the time of Entry)
21. I-94 Expiration Date : 7-Jan-2007
22. US Arriving State : California
23. US Arrival Date (Latest) :
24. US Arrival City(Airport) : Los Angeles
25. Passport # : A3294641
26. Passport Issue Date : 21-Jul-1997
27. Passport Expiration Date : 20-Jul-2007
28. Passport Issuing Country : India
29. Education Acquired : B.E (Electronics and Communication
Engg0
30. Previous H1B visas with US employers with Duration:
Exact approval dates that are present on the H1B
(Not Duration With Employers)
From : To:
31. Previous H1-B visa Receipt Number:
32. Exact dates of entry and exists from US Should be very specific:
ENTRY EXIT
01-May-2005 05-Apr-2006
 PART B: REQUIRED DOCUMENTS:

PROVIDE THREE (3) COPIES

DO NOT STAPLE
ALL COPIES SHOULD BE ON 8 ½ INCHES X 11 INCHES PAPER (OTHER
SIZES WILL NOT BE ACCEPTED BY USCIS)

EACH SET SHOULD CONSIST OF THE FOLLOWING DOCUMENTS

1. Copy of recent 3 Salary Slips/Stubs

2. Copy of ALL Approved H-1B’s (if applicable)
3. Copy of Experience Letters
4. Current Resume
5. Copy of College Educational Degree Certificate(s)
6. Copy of College Mark Sheets
7. Copy of Higher Secondary/High School Mark Sheets:
(more documents provided the better)
8. Copy of U.S. Educational Evaluation (if available)
9. Copy of Passport (PROVIDE EVERY PAGE INCLUDING EMPTY PAGES)
10. Copy of I-94 (One attached to the Passport)

MAIL THREE (3) COPIES OF THE AFOREMENTIONED APPLICABLE

DOCUMENTS TO:

SOFTWARE GALAXY SYSTEMS, LLC

4390 U.S. ROUTE 1 NORTH
SUITE # 210
PRINCETON, NEW JERSEY 08540