Form I-589 - Application For Asylum And For Withholding Of Removal Page 11
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12Supplement A, Form I-589
A-Number (If available)
Date
Applicant's Name
Applicant's Signature
List All of Your Children, Regardless of Age or Marital Status
(NOTE: Use this form and attach additional pages and documentation as needed, if you have more than four children)
1. Alien Registration Number (A-Number)
2. Passport/ID Card Number
3. Marital Status (Married, Single,
4. U.S. Social Security Number
(if any)
(if any)
Divorced, Widowed)
(if any)
5. Complete Last Name
6. First Name
7. Middle Name
8. Date of Birth (mm/dd/yyyy)
9. City and Country of Birth
10. Nationality (Citizenship)
11. Race, Ethnic, or Tribal Group
12. Gender
Male
Female
13. Is this child in the U.S. ?
Yes (Complete Blocks 14 to 21.)
No (Specify location):
15. Date of last entry into the
17. Status when last admitted
14. Place of last entry into the U.S.
16. I-94 Number (If any)
U.S. (mm/dd/yyyy)
(Visa type, if any)
19. What is the expiration date of his/her
20. Is your child in Immigration Court proceedings?
18. What is your child's current status?
authorized stay, if any? (mm/dd/yyyy)
Yes
No
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
Yes (Attach one photograph of your child in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
1. Alien Registration Number (A-Number)
2. Passport/ID Card Number
3. Marital Status (Married, Single,
4. U.S. Social Security Number
(if any)
(if any)
Divorced, Widowed)
(if any)
5. Complete Last Name
6. First Name
7. Middle Name
8. Date of Birth (mm/dd/yyyy)
9. City and Country of Birth
10. Nationality (Citizenship)
11. Race, Ethnic, or Tribal Group
12. Gender
Male
Female
13. Is this child in the U.S. ?
Yes (Complete Blocks 14 to 21.)
No (Specify location):
15. Date of last entry into the
17. Status when last admitted
14. Place of last entry into the U.S.
16. I-94 Number (If any)
U.S. (mm/dd/yyyy)
(Visa type, if any)
19. What is the expiration date of his/her
20. Is your child in Immigration Court proceedings?
18. What is your child's current status?
authorized stay, if any? (mm/dd/yyyy)
Yes
No
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
Yes (Attach one photograph of your child in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
Form I-589 Supplement A (Rev. 05/16/17) N
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