Immigration I589 Form

IMMIGRATION I-589 — APPLICATION FOR ASYLUM AND WITHHOLDING OF REMOVAL

Applicant Name:    Alien Registration No.:    Date of Birth:

Country of Nationality:    Current Mailing Address:

Representative Name (if any):    Representative Bar/ID No.:

RECITALS

WHEREAS, Applicant seeks asylum and withholding of removal under applicable immigration statutes and treaties on the basis of a well-founded fear of persecution in Applicant's country of nationality; and

WHEREAS, Applicant asserts persecution on account of one or more protected grounds, including but not limited to race, religion, nationality, political opinion, or membership in a particular social group; and

WHEREAS, Applicant submits supporting evidence, affidavits, and declarations in support of the application and hereby requests protective relief from removal, including withholding of removal and protection under applicable conventions against torture where appropriate.

NOW, THEREFORE, in consideration of the matters set forth herein, Applicant submits this Application for Asylum and Withholding of Removal and certifies under penalty of perjury the truthfulness and completeness of the information provided.

1. APPLICANT IDENTIFICATION

2. BASIS FOR RELIEF

Applicant alleges a well-founded fear of persecution on account of one or more protected grounds. Please select all grounds asserted and provide details below.

Race    Religion    Nationality    Political opinion    Membership in a particular social group

Has Applicant previously applied for asylum or withholding to any government agency or court?   Yes    No

3. ENTRY, STATUS, AND IMMIGRATION HISTORY

Date of most recent entry to the United States:    Port of Entry or Location:

Current immigration status (if any):

4. CRIMINAL HISTORY AND SECURITY MATTERS

Has Applicant ever been arrested, charged, or convicted for any offense?   Yes    No

Does Applicant admit to or assert involvement with any organization the government deems a threat to national security?   Yes    No

5. SUPPORTING DOCUMENTS AND EVIDENCE

Applicant submits the following supporting materials. Check all that apply:

Identity documents (passport, birth certificate)
Affidavits and witness statements
Medical or psychological records
Police reports or arrest records
Country condition reports or similar evidence
Other (describe below)

6. INTERPRETER AND PREPARER INFORMATION

7. DECLARATION AND CERTIFICATION

I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct to the best of my knowledge and belief. I understand that making a false statement in this application may subject me to penalties, including denial of relief and potential removal proceedings.

Applicant hereby authorizes the release and exchange of information necessary to adjudicate this application and acknowledges duty to provide any material change in circumstances to the adjudicating authority in a timely manner.

8. NOTICES, GOVERNING LAW, AND MISCELLANEOUS PROVISIONS

Notices: Any notice or communication required or permitted under this Application shall be sent to the current mailing address provided above. Applicant must promptly notify the adjudicating authority of any change in address.

Governing Law: This application is submitted under and governed by the immigration laws and regulations applicable to asylum and withholding of removal, as interpreted by competent courts and administrative authorities.

Entire Agreement: This Application, together with attachments and declarations submitted in support, contains the entire statement of Applicant regarding the matters alleged herein and supersedes any prior separate statements to the extent inconsistent.

Severability: If any provision of this Application is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Amendments and Waiver: This Application may be amended in writing. No waiver of any provision will be effective except in a writing signed by Applicant or Applicant's authorized representative.

9. AUTHORIZATION TO CONTACT AND REPRESENTATION

Applicant authorizes the representative named above to receive copies of notices and to act on Applicant's behalf in matters related to this Application. Representative accepts responsibility to notify Applicant of all case developments and to maintain confidentiality of case materials consistent with professional responsibilities.

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