Form I-360 - Petition For Amerasian, Widow(Er), Or Special Immigrant Page 5

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Part 5. Information About the Spouse and Children of the Beneficiary (continued)
3.
Person 2
Family Name (Last Name)
Given Name (First Name)
Middle Name
Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A-Number (if any)
A-
Child
4.
Person 3
Family Name (Last Name)
Given Name (First Name)
Middle Name
Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A-Number (if any)
A-
Child
5.
Person 4
Family Name (Last Name)
Given Name (First Name)
Middle Name
Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A-Number (if any)
Child
A-
6.
Person 5
Family Name (Last Name)
Given Name (First Name)
Middle Name
Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A-Number (if any)
Child
A-
7.
Person 6
Family Name (Last Name)
Given Name (First Name)
Middle Name
Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A-Number (if any)
Child
A-
Form I-360 12/23/16 N
Page 5 of 19

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