Fill and Sign the Omb No 11150057 Registration for Classification as Form

U.S. Department of Justice Type or print the following information. (Read instructions on reverse) A File No.: (Last) (Middle) (First) 1. Name: 2. Present address: Present nationality: (Province) (Country) Place of birth (City or Town) 3. Date of birth: (Month/Day/Year) On or about (Month/Day/Year): 4. Country from which I fled or was displaced: 5. Reasons (State in detail): is: My present immigration status in 6. (country in which residing) Evidence of my immigration status is: (Describe) 7. Name of spouse: 9. Nationality of spouse: 10. My spouse will will not accompany me to the United States. 11. Name of child (ren) Date of birthPlace of birth Present address (if different) Place a mark (x) in front of name of each child who will accompany you to the United States. 12. Schooling or education Name and location of school Type Dates attendedTitle of degree or diploma 13. Military service Country Branch and organization Dates Serial No. Rank attained Immigration and Naturalization Service OMB No. 1115-0057 8. Present address of spouse ( if different): Form I-590 (Rev. 04/12/2000) Y Page 1 Registration for Classification as Refugee have not been charged with a violation of law. (If you have ever been charged with a violation of law, give date, place and nature of 14. Political, professional or social organizations of which I am now or have been a member or with which I am now or have been affiliated since my 16th birthday (If you have never been a member of any organization, state "None." ) 15. I each charge and the final result.) have not been in the United States. (If you have ever been in the United States, show the dates of entry and departure and the have 16. I purpose of your entry (visitor, permanent resident, student, seaman, etc.). File or Alien Registration Number: 17. I have the following close relatives in the United States: Name Relationship Present address 18. I am being sponsored by (Name and address of United States sponsor): Signature of registrant: Date: , do swear (affirm) that I know the contents of this registration subscribed by me including the attached documents, that the same I, are true to the best of my knowledge, and that corrections numbered ( ) to ( ) were made by me or at my request, and that this registration was signed by me with my full, true name: (Complete and true signature of registrant) on Subscribed and sworn to before me by the above-named registrant at (Month/Day/Year) (Signature and title of officer) APPROVED INTERVIEW DATE DATE AT Immigration Officer Officer in Charge INSTRUCTIONS This form should be executed, signed and submitted to the Officer in Charge of the nearest overseas office of the United States Immigration and Naturalization Service. When your name has been reached as a registrant you will be furnished additional instructions. Registration - A separate Registration Form must be executed by each registrant and submitted in one copy. A Registration Form in behalf of a child under 14 years of age shall be executed by the parent of guardian. Public reporting burden for this collection of information is estimated to average 35 minutes per response. If you have comments regarding the accurac y of this estimate or suggestions for simplifying this form, you can write to the U.S. Department of Justice, Immigration and Naturalization Service, 425 I Street, N.W.; Room 4034, Washington, D.C. 20536, OMB No. 1115-0057. Form I-590 (Rev. 04/12/2000) Y Page 2 have DO NOT WRITE BELOW THIS LINE