Asylum Application I-589 Form

Asylum Application I-589 Form

Applicant Name:    Alien Registration Number (A-Number):

Country of Nationality:    Date of Birth:

Recitals

WHEREAS the Applicant is an individual who has filed an application for asylum and related relief in accordance with the immigration laws and regulations governing protection from persecution; and

WHEREAS the Applicant asserts that they have a well-founded fear of persecution in their country of nationality on account of race, religion, nationality, membership in a particular social group, or political opinion and seeks relief under applicable protections; and

WHEREAS the Applicant submits factual statements, supporting documentation, and certifications under penalty of perjury to demonstrate eligibility for asylum, withholding of removal, and protection under the Convention Against Torture where appropriate.

NOW THEREFORE, the Applicant submits this application and declares the following information to be true and complete:

1. Applicant Contact and Biographic Information

Other Names Used or Aliases:

Marital Status:    Number of Dependents:

2. Basis for Claim (Select all that apply and provide supporting facts)

Race    Religion    Nationality    Membership in a particular social group    Political opinion

3. Description of Persecution and Relevant Events

Most Recent Incident Date:

4. Relief Requested

Relief claimed: Asylum    Withholding of removal    Protection under the Convention Against Torture

5. Criminal History and Immigration Proceedings

Have you ever been arrested, charged, or convicted for any offense?   Yes   No

Have you previously applied for asylum or immigration relief in any country?   Yes   No

6. Declarations, Certifications, and Warnings

I certify under penalty of perjury under the laws of the United States that the statements made in this application and any accompanying evidence are true and correct to the best of my knowledge and belief. I understand that any willful misrepresentation or concealment of material facts may subject me to criminal penalties, civil penalties, or removal proceedings.

I authorize the release of information in this application, including supporting documentation, to governmental entities and their authorized representatives for the purpose of adjudicating this application and administering related immigration laws and benefits. I further consent to the sharing of relevant information with third parties where required by law or where disclosure is necessary to respond to inquiries regarding my eligibility for relief.

7. Notices and Representative Information

8. Governing Law; Miscellaneous Provisions

Governing Law: This application and any dispute arising under or in connection with it shall be governed by and construed in accordance with the immigration laws and regulations of the United States and applicable federal statutes and regulations.

Entire Agreement: This document, including any attachments and supporting statements, constitutes the entire written application for relief submitted by the Applicant. No oral statements or prior written materials shall modify the terms of this application unless made in writing and signed by the Applicant.

Severability: If any provision of this application is held to be invalid, illegal, or unenforceable, the remaining provisions will continue in full force and effect.

9. Acknowledgment of Penalties for False Statements

The Applicant acknowledges that knowingly and willfully making any materially false statement in this application or supporting materials may render the Applicant inadmissible, removable, or subject to criminal prosecution under applicable law. The Applicant further understands that omission of material facts may result in denial of the application and may affect future immigration benefits.

10. Interpreter / Preparer Declaration (if applicable)

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