Form DS-4194 is used by the U. S. Department of State for documents submitted by U.S.
citizens and foreign nationals.The Authentications Office is
responsible for signing and issuing certificates under the Seal of the U. S.
Department of State for documents being submitted to foreign countries.
Complete one copy of this form for yourself or your company to be submitted with your
documents and payment. You must submit a new cover letter
for each request. Failure to do so will result in your case being rejected and
documents being returned.
Any false statement or concealment of a material fact may result in a delay or
SECTION 1: REQUESTOR'S CONTACT INFORMATION
Provide individual's full name or company's name (complete spelling).
Indicate e-mail address; telephone number(s) home,
work and/or cell.
If the document(s) were mailed or hand carried for a Federal Agency for Official
Government business please indicate agency name, bureau
and/or office acronyms. Provide formal mailing address(include street address,
city or town, zip code, province or country) .
SECTION 2: SUBMITTER'S CONTACT INFORMATION
If you are submitting/or retrieving a request on behalf of someone other
than yourself or a company, please provide specific and detailed information.
The full name of the individual's or company's name is required to properly
search the database.
If you are retrieving document(s) your name must appear in section 2 of the intake
form and State issued identification is required
Provide individual's full name or company's name (complete spelling). Indicate e-mail
address; telephone number(s) day time, evening or cell number
SECTION 3: METHOD OF RETURN (MAIL-IN)
Indicate delivery method (type of mail service used to return the
document). If this information is available, provide a tracking number and include
letters and numbers (i.e., DOS, USPS, FED/EX, UPS, DHL & Others).
Indicate the complete address that the document (s) will be returned to
for proper delivery.
It is imperative that the complete address is entered accurately!
(i.e., street address, city, state, ZIP code & country). REVIEW
Please note: All documents submitted will be returned
to one location
SECTION 4: DOCUMENT INFORMATION
Indicate the country (or countries) of use, the number of documents, and the document
type. (A maximum of 15 documents are allowed per
customer/company person for walk-in services).
SECTION 5: METHOD OF PAYMENT
Please note: The authentication
processing fee is $8.00 per document, not per page. This fee will be charged
regardless of whether you receive an
authentication certification or a correspondence letter. This change in policy
will take effect on April 1, 2012. Please pay the total amount shown in the
estimated cost field. (The exact amount is required.)
Allowable payment methods include U.S. Postal Money Orders, checks
(personal, corporate, certified, cashiers, travelers) all payable to "U.S.
Department of State."
Walk-in service only: In addition to the payment methods noted above; Credit
Cards and Debit/Check Cards (VISA, MasterCard, American Express,
Discover) are accepted.