NVC Case No: MNL123467890
CIS Case No: WAC1234567890
Petitioner's Name: JOHN DOE
Petitioner's Date of Birth: January 1, 1970
Beneficiary's Name: JANE DANE
Beneficiary's Date of Birth: August 1, 1985

Re: Declaration of Choice of Address and Agent for Immigrant Visa applicant

To whom it may concern:

My name is Beneficiary my visa case number is # Case Number.

Per the DS-3032 (Choice of Address and Agent for Immigrant Visa Applicants), I would like to appoint my husband, Name of Petitioner  as my agent of choice to receive all future correspondence from the U.S. Department of State.His  contact information is provided below:
Name: Name of Petitioner
Address of Petitioner
All mail from the U.S. Department of State concerning my immigrant visa should be sent to the address above.
Please let me know if you need additional information. Thank you for your help.

Sincerely yours,
Name of Beneficiary
Contact No.