Asylum Request Form

ASYLUM REQUEST FORM

RECITALS

WHEREAS, Applicant seeks international protection by filing an application for asylum on the grounds that Applicant faces past persecution or has a well-founded fear of future persecution in Applicant's country of origin; and

WHEREAS, Representative is qualified and agrees to provide legal services to prepare, present, and, where applicable, pursue appeals of the asylum claim according to the scope described below; and

WHEREAS, the parties intend these terms to define their legal relationship, fees, confidentiality obligations, and the duties of each party in connection with the asylum request.

APPLICANT INFORMATION

TRAVEL / LEGAL STATUS

Date of most recent arrival into the receiving country:

Current immigration status:

Currently detained? Yes Detention facility (if applicable):

GROUNDS FOR ASYLUM

Indicate asserted protected ground(s) (check all that apply):

Race    Religion    Nationality    Political opinion    Membership in a particular social group

SCOPE OF REPRESENTATION

Representative will provide legal services specifically limited to the asylum matter described in this form. Services include preparing and filing the asylum application, advising Applicant on evidentiary documentation, preparing declarations, representing Applicant at interviews and hearings before the relevant authorities, and pursuing administrative appeals or motions directly related to the asylum claim as agreed in writing. Representative does not undertake unrelated immigration matters unless expressly agreed in writing.

PAYMENT TERMS

Client agrees to pay Representative the fees described below for the services within the Scope of Representation.

Late payment shall accrue interest at the rate of on outstanding balances, and Representative may suspend work upon thirty (30) days' written notice for nonpayment unless otherwise prohibited by law.

TERM AND TERMINATION

This Agreement commences on the date signed below and continues until conclusion of the asylum matter described in the Scope of Representation, unless earlier terminated as set forth herein.

Either party may terminate this Agreement for any reason upon days' written notice to the other. Termination does not relieve Applicant of the obligation to pay for services performed and costs incurred through the effective date of termination.

Representative may withdraw if continued representation would violate law or professional obligations, subject to applicable rules protecting client interests and providing reasonable notice where practicable.

CONFIDENTIALITY

Representative shall maintain confidentiality of all communications and records as required by applicable law and professional rules, except to the extent disclosure is necessary to carry out the representation, is required by law, or is otherwise authorized by Applicant in writing. Applicant authorizes Representative to collect, use, and disclose information to third-party service providers, translators, or consultants when necessary to advance the asylum claim.

DOCUMENTS AND EVIDENCE

Documents submitted with this request (check all that apply):

Passport    National ID    Affidavits    Medical records    Police reports    Other:

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction where Representative is authorized to practice, except where applicable immigration law or treaty obligations otherwise control. Governing jurisdiction:

ENTIRE AGREEMENT

This document, together with any written addenda or fee schedules executed by the parties, constitutes the entire agreement between Applicant and Representative regarding the asylum matter and supersedes all prior understandings, communications, and agreements, whether written or oral.

ATTESTATION

Applicant certifies under penalty of perjury under the laws of the relevant jurisdiction that the information provided in this form and in supporting documents is true and correct to the best of Applicant's knowledge. Applicant understands that knowingly providing false information may result in denial of relief and potential legal penalties.

Applicant acknowledges receipt of a copy of this form and the fee terms described herein and consents to Representative's representation as detailed above by signing below.

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