Form I-131 - Application For Travel Document - Citizenship And Immigration Services
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1
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5Application for Travel Document
USCIS
Department of Homeland Security
Form I-131
U.S. Citizenship and Immigration Services
OMB No. 1615-0013
Expires 12/31/2018
Receipt
Action Block
To Be Completed
For
by an Attorney/
USCIS
Representative,
Use
if any.
Only
Fill in box if G-28 is
Document Hand Delivered
attached to represent
By:
Date:
/
/
/
the applicant.
Document Issued
Attorney State
Re-entry Permit (Update
Refugee Travel Document
Address in Part 1
Mail To
License Number:
"Mail To" Section)
(Update "Mail To" Section)
(Re-entry &
US Consulate at:
Refugee
Single Advance Parole
Multiple Advance Parole
Only)
Intl DHS Ofc at:
Valid Until:
/
/
/
►
Start Here. Type or Print in Black Ink
Part 1. Information About You
1.a. Family Name
Other Information
(Last Name)
1.b.
Given Name
3.
Alien Registration Number (A-Number)
(First Name)
►
A-
1.c.
Middle Name
4.
Country of Birth
Physical Address
2.a.
In Care of Name
5.
Country of Citizenship
2.b.
Street Number
6.
Class of Admission
and Name
2.c. Apt.
Ste.
Flr.
7.
Gender
Male
Female
2.d.
City or Town
►
8.
Date of Birth
(mm/dd/yyyy)
2.e.
State
2.f.
ZIP Code
9.
U.S. Social Security Number (if any)
2.g. Postal Code
►
2.h.
Province
2.i.
Country
Form I-131 12/23/16 N
Page 1 of 5
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