Перевод свидетельства о рождении

Переклад свідоцтва про народження UA>EN. 
Для I-485 – Immediate Relative (Spouse) Family Based Adjustment of Status Application

It must be translated word for word and it should say at the end, 

I, <translator name>, certify that I am fluent in the English and <native language name> languages, that I am competent to perform the translation and that the above translation is the complete and accurate translation of the document entitled <document title>. 
Signature:                                                             Date:               Typed Name                         Address