2000 Diversity Immigrant Visa Lottery
United States Department of State
Bureau of Consular Affairs
VISA BULLETIN
Number 90, Volume VII Washington, D.C.
INSTRUCTIONS FOR THE 2000 DIVERSITY IMMIGRANT VISA PROGRAM (DV-2000)
The U.S. diversity immigration program makes available 50,000* permanent residence visas each year to persons meeting the eligibility requirements. Applicants for diversity visas are initially chosen through a random computer-generated lottery drawing. Visas are apportioned among six geographic regions with a greater number of visas going to regions with lower rates of immigration, and no visas going to countries sending more than 50,000 immigrants to the U.S. in the past five years. No one country can receive more than 3,500 diversity visas in any one year. For DV-2000, natives of the following are not eligible to apply:
CANADA, CHINA (mainland and Taiwan, except Hong Kong S.A.R.), COLOMBIA, DOMINICAN REPUBLIC, EL SALVADOR, HAITI, INDIA, JAMAICA, MEXICO, PHILIPPINES, POLAND, SOUTH KOREA, UNITED KINGDOM (except Northern Ireland) and its dependent territories, and VIETNAM.
ENTRIES FOR THE DV-2000 DIVERSITY VISA LOTTERY MUST BE RECEIVED BETWEEN NOON ON THURSDAY, OCTOBER 1, 1998 AND NOON ON SATURDAY, OCTOBER 31, 1998. Entries received before or after these dates will be disqualified regardless of when they are postmarked. Also, entries sent to an incorrect address will be disqualified.
REQUIREMENTS: To enter, an applicant must be able to claim nativity in an eligible country, AND must meet either the education or training requirement of the DV program. Nativity in most cases is determined by the applicant's place of birth. However, if a person was born in an ineligible country but his/her spouse was born in an eligible country, such person can claim the spouse's country of birth rather than his/her own. Also, if a person was born in an ineligible country, but neither of his/her parents was born there or resided there at the time of the birth, such person may be able to claim nativity in one of the parents' country of birth.
Education or Training: To enter, an applicant MUST have EITHER a high school education or its equivalent, defined in the U.S. as successful completion of a 12-year course of elementary and secondary education; OR two years of work experience within the past five years in an occupation requiring at least two years of training or experience to perform. U.S. Department of Labor definitions will apply. If a person does not meet these requirements, he/she should NOT submit an entry to the DV program.
PROCEDURES FOR SUBMITTING AN ENTRY FORM
Only ONE entry form may be submitted by or for each applicant during the registration period. Submission of more than one entry will disqualify the person. The applicant must personally sign the entry, preferably in his/her native alphabet. Failure of the applicant to personally sign his/her own entry will result in disqualification.
COMPLETING THE ENTRY FORM
There is no specific format for the entry. Simply use a plain sheet of paper and type or clearly print in the English alphabet (preferably in the following order):
*The Nicaraguan and Central American Relief Act (NCARA) passed by Congress in November 1997 stipulates that beginning with DV-99, and for as long as necessary, 5,000 of the 55,000 annually-allocated diversity visas will be made available for use under the NCARA program.
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ON A PLAIN SHEET OF PAPER INCLUDE:
The following information must appear on the entry. Failure to provide all
of this information will disqualify the applicant.
1. FULL NAME, with the last (surname/family) name underlined
EXAMPLES: Public, Sara Jane (or) Lopez, Juan Antonio
2. DATE AND PLACE OF BIRTH
Date: Day, Month, Year EXAMPLE: 15 November 1961
Place: City/Town, District/County/Province, Country
EXAMPLE: Munich, Bavaria, Germany
The name of the country should be that which is currently in use for the place where the applicant
was born (Slovenia, rather than Yugoslavia; Kazakstan rather than Soviet Union, for example).
3. THE APPLICANT'S NATIVE COUNTRY IF DIFFERENT FROM COUNTRY OF BIRTH
If the applicant is claiming nativity in a country other than his/her place of birth, this must be
clearly indicated on the entry. This information must match with what is put on the upper left corner of the entry envelope. (See "MAILING THE ENTRY" below.) If an applicant is claiming nativity through spouse or parent, please indicate this on the entry. (See "REQUIREMENTS" section on page 1 for more information on this item.)
4. NAME, DATE AND PLACE OF BIRTH OF THE APPLICANT'S SPOUSE AND CHILDREN
(IF ANY)
5. FULL MAILING ADDRESS
This must be clear and complete, as any communications will be sent there. A telephone number
is optional, but useful.
6. PHOTOGRAPH. Attach a recent, preferably less than 6 months old, photograph of the applicant,
1.5 inches (37 mm) square in size, with the applicant's name printed on the back. The photograph (not a photocopy) should be attached to the entry with clear tape--do NOT use staples or paperclips, which can jam the mail processing equipment.
7. SIGNATURE. Failure to personally sign the entry will disqualify the applicant.
MAILING THE ENTRY
Submit the entry by regular or air mail to the address matching the region of the applicant's country of nativity. Entries sent by express or priority mail, fax, hand, messenger, or any means requiring receipts or special handling will not be processed.
The envelope must be between 6 and 10 inches (15 to 25 cm) long and 3 1/2 and 4 1/2 inches (9 to 11 cm) wide. Postcards are NOT acceptable, nor are envelopes inside express or oversized mail packets. In the upper left hand corner of the envelope the applicant must show his/her country of nativity (see instruction 3 above), followed by the applicant's name and full return address. The applicant must provide both the country of birth and the country of the address, even if both are the same. Failure to provide this information will disqualify the entry. The mailing address for all entries is the same, except for the ZIP (POSTAL) CODE. The address is:
DV-2000 Program National Visa Center
Portsmouth, NH ZIP CODE (see page 3)
U.S.A.
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Use the correct ZIP (POSTAL) CODE for the applicant's region of nativity. For the DV program, the regions are divided as follows: Africa includes all countries on the African continent and adjacent islands; Asia extends from Israel to the northern Pacific islands, and includes Indonesia; Europe extends from Greenland to Russia, and includes all countries of the former USSR; North America includes the Bahamas; Oceania includes Australia, New Zealand, Papua New Guinea and all countries and islands of the South Pacific; South America/Central America/Caribbean extends from Central America (Guatemala) and the Caribbean nations to Chile.
The ZIP (POSTAL) CODES are:
ASIA: 00210
SOUTH AMERICA/CENTRAL AMERICA/CARIBBEAN: 00211
EUROPE: 00212
AFRICA: 00213
OCEANIA: 00214
NORTH AMERICA: 00215
EXAMPLE: An applicant who was born in Australia and now lives in France may submit
one entry to the appropriate Zip (postal) code for Oceania; the envelope should look like this:
6" - 10" or 15 cm - 25 cm
_ _ _ _
Australia
Applicant's Full Name
Street Address
City, Province, Postal Code
France 3 1/2" - 4 1/2"
or
DV-2000 Program
EXAMPLE National Visa Center 9 cm - 11 cm
Portsmouth, NH (see above for appropriate zip)
U.S.A.
_ _ _ _ _ _
(If, for instance, the applicant's country is Australia (in Oceania), the Zip (postal)
code for Australia would be used, that is, 00214.)
Registrants will be selected at random by computer from among all qualified entries. Those selected will be notified by mail during April to July 1999 and will be provided further instructions, including information on fees connected with immigration to the U.S. Persons not selected will NOT be notified. U.S. embassies and consulates will not be able to provide a list of successful applicants. Spouses and unmarried children of successful applicants under age 21 may also apply for visas to accompany or follow to join the principal applicant. DV-2000 visas will be issued between October 1, 1999 and September 30, 2000.
Applicants must meet ALL eligibility requirements under U.S. law in order to be issued visas.
Processing of applications and issuance of diversity visas to successful applicants and their eligible family members MUST occur by September 30, 2000. Family members may not obtain diversity visas to follow to join the applicant in the U.S. after this date.
Important Notice: There is NO initial fee, other than postage, required to enter the DV-2000 program. The use of an outside intermediary or assistance to prepare a DV-2000 entry is entirely at the applicant's discretion. Qualified entries received directly from applicants or through intermediaries have equal chances of being selected by computer. There is no advantage to mailing early, or mailing from any particular locale. Every application received during the mail-in period will have an equal random chance of being selected within its region. However, more than one application per person will disqualify the person from registration.
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FREQUENTLY ASKED QUESTIONS ABOUT DV-2000 REGISTRATION
1. HOW IS THE TERM "NATIVE" DEFINED? ARE THERE ANY BASES UPON WHICH PERSONS WHO HAVE NOT BEEN BORN IN A QUALIFYING COUNTRY MAY BE
ELIGIBLE FOR REGISTRATION?
"Native" ordinarily means someone born within a particular country, regardless of the individual's current
country of residence or nationality.
"Native" also means someone entitled to be "charged" to a particular country under the provisions of Section 202(b) of the Immigration and Nationality Act. Applicants for DV-2000 registration may under Section 202(b) claim chargeability to the country of birth of a spouse; a minor dependent child can be charged to the country of birth of a parent; and an applicant born in a country of which neither parent
was a native or a resident at the time of his/her birth may be charged to the country of birth of either
parent. An applicant who claims the benefit of alternate chargeability must include information to that effect on the application for registration (see number 3 of the application information items on page 2
of this Visa Bulletin), and must show the native country claimed on the upper left hand corner of the envelope in which the registration request is mailed.
2. ARE THERE ANY CHANGES OR NEW REQUIREMENTS IN THE APPLICATION PROCEDURES FOR THIS DIVERSITY VISA REGISTRATION?
The requirements for this DV registration are the same as for the last registration. The information
required on the application and on the envelope in which it is submitted is specified in detail earlier
in this Visa Bulletin. Each application must be signed by the applicant, and a recent photograph of the applicant must be attached. The applicant's name must be printed on the back of the photograph.
3. ARE SIGNATURES AND PHOTOGRAPHS REQUIRED FOR EACH FAMILY MEMBER, OR ONLY FOR THE PRINCIPAL APPLICANT?
The signature and photograph of the principal applicant only are required. NO SIGNATURE OR PHOTOGRAPH IS NEEDED FOR THE SPOUSE OR CHILD(REN) OF A PRINCIPAL APPLICANT.
4. WHY DO CERTAIN COUNTRIES NOT QUALIFY FOR THE DIVERSITY PROGRAM?
Diversity visas are intended to provide an immigration opportunity for persons from countries other than
the main source countries of immigration to the U.S. The law states that no diversity visas shall be
provided for "high admission" countries, that is, countries from which during the previous five years
there were more than 50,000 immigrants in the Family-Sponsored and Employment-Based visa categories. Each year, the Immigration and Naturalization Service (INS) adds the family and employment immigrant admission figures for the previous five years, to identify the countries which must be excluded from the annual diversity lottery. Because there is a separate determination made prior to each lottery application period, the list of countries which do not qualify is subject to change from one year to the next. For the
DV-2000 lottery, one country (HAITI) which was eligible for earlier Diversity visa lotteries has been added
to the list of "high admission" countries for which no diversity visas will be available.
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5. WHAT ARE THE REGIONAL DIVERSITY (DV) VISA LIMITS FOR DV-2000?
The INS determines the DV regional limits for each year according to a formula specified in Section 203(c) of the Immigration and Nationality Act (INA). Once the INS has completed the calculations, the DV-2000 the regional visa limits will be announced.
Because most immigrant visas in other categories go to persons from Asia and the Western Hemisphere, those regions receive only a small number of the diversity visas. Persons from Africa, Europe and Oceania, who receive fewer visas in other categories, are provided the major part of the diversity visas.
6. WHEN WILL THE REGISTRATION FOR THE DV LOTTERY BE HELD EACH YEAR?
The month long registration period will be held each Fall beginning at noon on the first business day in October. The National Visa Center receives between 6 to 7 million qualified entries during a registration mail-in period. The massive volume of entries creates an enormous amount of work in selecting and processing successful registrants. Holding the registration period in the Fall will ensure successful registrants are notified in a more timely manner. This will give both them and our Embassies and Consulates overseas more time to prepare and complete the applications for visa issuance.
7. MAY PERSONS WHO ARE IN THE U.S. APPLY FOR REGISTRATION?
Yes, an applicant may be in the U.S. or in another country, and the application may be mailed in the
U.S. or abroad.
8. IS EACH APPLICANT LIMITED TO ONLY ONE APPLICATION DURING THIS DV-2000 REGISTRATION PERIOD?
Yes, the law allows only ONE application BY OR FOR each person during each registration period; SUBMISSION OF MORE THAN ONE APPLICATION WILL DISQUALIFY THE PERSON FROM REGISTRATION. Applicants may be disqualified at time of registration or at the time of the visa
interview if more than one entry is detected. Submission of an application during one or more previous
DV registration has no effect on entitlement to participate in the DV-2000 lottery, however.
9. MAY A HUSBAND AND A WIFE EACH SUBMIT A SEPARATE APPLICATION?
Yes, if otherwise qualified, a husband and a wife may each submit one application for registration; if
either is registered, the other would be entitled to derivative status. Note: They may not sign for each other, i.e. the husband must sign his application and the wife must sign hers.
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10. MUST EACH APPLICANT SUBMIT HIS/HER OWN REQUEST, OR MAY SOMEONE
ACT ON BEHALF OF AN APPLICANT?
Applicants may prepare and submit their own request for registration, or have someone act on their
behalf. Regardless of whether an application is submitted by the applicant directly, or assistance is
provided by an attorney, friend, relative, etc., ONLY ONE APPLICATION MAY BE SUBMITTED IN THE NAME OF EACH PERSON. The applicant's original signature is required on the application,
regardless whether it is prepared and submitted by the applicant or by someone else. Only one
notification letter will be sent for each case registered, to the address provided on the application.
11. WHAT ARE THE REQUIREMENTS FOR EDUCATION OR WORK EXPERIENCE?
The law and regulations require that every applicant must have at least a high school education or
its equivalent or, within the past five years, have two years of work experience in an occupation
requiring at least two years training or experience. A "high school education or equivalent" is
defined as successful completion of a twelve-year course of elementary and secondary education in
the United States or successful completion in another country of a formal course of elementary and secondary education comparable to a high school education in the United States. Determination of qualifying work experience shall be based upon the most recent edition of the Dictionary of
Occupational Titles published by the Employment and Training Administration of the United
States Department of Labor.
Documentary proof of education or work experience should NOT be submitted with the lottery
application, but must be presented to the consular officer at the time of immigrant visa interview.
12. HOW WILL CASES BE REGISTERED?
At the National Visa Center all mail received will be separated into one of six geographic regions
and individually numbered. After the end of the application period, a computer will randomly select
cases from among all the mail received for each geographic region. Within each region, the first
letter randomly selected will be the first case registered, the second letter selected the second
registration, etc. It makes no difference whether an application is received early or late in the
application period; all applications received during the mail-in period will have an equal chance of
being selected within each region. When a case has been registered, the applicant will immediately
be sent a notification letter by the National Visa Center, which will provide appropriate visa application instructions. The National Visa Center will continue to process the case until those who are registered
are instructed to make formal application at a U.S. consular office or until those able to do so apply
at an INS office in the United States for change of status.
13. MAY REGISTERED APPLICANTS ADJUST THEIR STATUS WITH THE INS?
Yes, provided they are otherwise eligible to adjust status under the terms of Section 245 of the INA, registered applicants who are physically present in the United States may apply to the Immigration
and Naturalization Service (INS) for adjustment of status to permanent resident. Applicants must
ensure that INS can COMPLETE ACTION on their cases before September 30, 2000, since on that
date registrations for the Fiscal Year 2000 DV-2000 program expire.
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14. WILL APPLICANTS WHO ARE NOT REGISTERED BE INFORMED?
No, applicants who are not registered will receive no response to their registration request. Only
those who are registered will be informed. All notification letters are expected to be sent within
about six months of the end of the application period. Anyone who does NOT receive a letter will
know that his/her application has not been registered.
15. HOW MANY APPLICANTS WILL BE REGISTERED?
There are 50,000 DV visas available for Fiscal Year 2000 but more than that number of individuals
will be registered. A total of about 90,000 persons, both principal applicants and their spouses
and children, will be registered. Since it is likely that some of the first 50,000 persons who are
registered will not pursue their cases to visa issuance, this larger figure should ensure use of all
DV-2000 numbers, but it also risks some registrants being left out. All applicants who are registered
will be informed promptly of their place on the list. Each month visas will be issued, visa number availability permitting, to those applicants who are ready for issuance during that month. Once all
of the Fiscal Year 2000 visas have been issued, the program for the year will end. In principle, visa numbers could be exhausted before September 2000. Registered applicants who wish to receive visas
must be prepared to ACT PROMPTLY on their cases. Being selected as a winner in the DV lottery
does not automatically guarantee a visa.
16. IS THERE A MINIMUM AGE FOR APPLICANTS FOR REGISTRATION UNDER THE
DV-2000 PROGRAM?
There is NO minimum age for submission of an application for registration, but the requirement of a
high school education or work experience for each principal applicant at the time of visa issuance will effectively disqualify most persons who are under age 18.
17. WILL THERE BE ANY SPECIAL FEE FOR DV-2000 CASE PROCESSING?
There is NO FEE FOR SUBMITTING A REQUEST FOR REGISTRATION, and NO FEE should be included with the letter sent to the mailing addresses indicated above. A special DV case processing
fee will be payable later by persons whose applications are actually selected and processed for DV-2000
visas. DV-2000 applicants, like all other immigrant visa applicants, must also pay the regular visa fees
at the time of visa issuance. Details of required fees will be included with the visa application
instructions sent to applicants whose cases are registered.
18. ARE DV-2000 APPLICANTS SPECIALLY ENTITLED TO APPLY FOR A WAIVER OF
ANY OF THE GROUNDS OF VISA INELIGIBILITY?
No. Applicants are subject to all grounds of ineligibility specified in the Immigration and Nationality
Act and there are no special provisions for the waiver of any ground of visa ineligibility other than
those ordinarily provided in the Act.
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19. MAY PERSONS WHO ARE ALREADY REGISTERED FOR AN IMMIGRANT VISA
IN ANOTHER CATEGORY APPLY IN THIS REGISTRATION FOR THE DV-2000 CATEGORY?
Yes, such persons may seek DV-2000 status through this registration as well.
20. HOW LONG DO APPLICANTS WHO ARE REGISTERED ON THE BASIS OF THIS DIVERSITY LOTTERY REMAIN ENTITLED TO APPLY FOR VISAS IN THE DV-2000 CATEGORY?
Under the law, persons registered following the DV-2000 lottery are entitled to apply for visa issuance
ONLY DURING FISCAL YEAR 2000, i.e., from October 1999 through September 2000. There
is no carry-over of DV benefit into another year for persons who are registered but who do not obtain
visas during FY-2000. Similarly, spouses and children who derive status from a DV-2000 registration
can only obtain visas in the DV category between October 1999 and September 2000.
LISTS OF QUALIFYING COUNTRIES BY REGION
The lists below show the countries QUALIFIED within each geographic region for this diversity program.
The determination of countries within each region is based on information provided by the Geographer
of the Department of State. The countries which do not qualify for the DV-2000 program were identified
by the Immigration and Naturalization Service according to the formula in Section 203(c) of the Immigration and Nationality Act. Dependent areas overseas are included within the region of the
governing country. The countries which do NOT qualify for this diversity program (because they
are the principal source countries of Family-Sponsored and Employment-Based immigration) are
noted in parentheses after the respective regional lists.
AFRICA
ALGERIA EGYPT
ANGOLA EQUATORIAL GUINEA
BENIN ERITREA
BOTSWANA ETHIOPIA
BURKINA FASO GABON
BURUNDI GAMBIA, THE
CAMEROON GHANA
CAPE VERDE GUINEA
CENTRAL AFRICAN REPUBLIC GUINEA-BISSAU
CHAD KENYA
COMOROS LESOTHO
CONGO LIBERIA
CONGO, DEMOCRATIC LIBYA
REPUBLIC OF THE MADAGASCAR
COTE D'IVIORE (IVORY COAST) MALAWI
DJIBOUTI MALI
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AFRICA (continued)
MAURITANIA SIERRA LEONE
MAURITIUS SOMALIA
MOROCCO SOUTH AFRICA
MOZAMBIQUE SUDAN
NAMIBIA SWAZILAND
NIGER TANZANIA
NIGERIA TOGO
RWANDA TUNISIA
SAO TOME AND PRINCIPE UGANDA
SENEGAL ZAMBIA
SEYCHELLES ZIMBABWE
ASIA
AFGHANISTAN LAOS
BAHRAIN LEBANON
BANGLADESH MALAYSIA
BHUTAN MALDIVES
BRUNEI MONGOLIA
BURMA NEPAL
CAMBODIA OMAN
HONG KONG SPECIAL PAKISTAN
ADMINISTRATIVE REGION QATAR
INDONESIA SAUDI ARABIA
IRAN SINGAPORE
IRAQ SRI LANKA
ISRAEL SYRIA
JAPAN THAILAND
JORDAN UNITED ARAB EMIRATES
NORTH KOREA YEMEN
KUWAIT
(Asia countries which do not qualify for this year's diversity program:
CHINA - mainland born and Taiwan born, INDIA, SOUTH KOREA, PHILIPPINES,
and VIETNAM.) [The HONG KONG S.A.R. does qualify and is listed above.]
[Macau will become ineligible on December 20, 1999. All DV-2000 visas for Macau-born
selected entries must be issued by that date.]
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EUROPE
ALBANIA LITHUANIA
ANDORRA LUXEMBOURG
ARMENIA MACEDONIA, THE FORMER
AUSTRIA YUGOSLAV REPUBLIC OF
AZERBAIJAN MALTA
BELARUS MOLDOVA
BELGUIM MONACO
BOSNIA AND HERZEGOVINA MONTENEGRO
BULGARIA NETHERLANDS
CROATIA including components and
CYPRUS dependent areas overseas
CZECH REPUBLIC NORTHERN IRELAND
DENMARK NORWAY
including components and PORTUGAL
dependent areas overseas including components and
ESTONIA dependent areas overseas*
FINLAND ROMANIA
FRANCE RUSSIA
including components and SAN MARINO
dependent areas overseas SERBIA
GEORGIA SLOVAKIA
GERMANY SLOVENIA
GREECE SPAIN
HUNGARY SWEDEN
ICELAND SWITZERLAND
IRELAND TAJIKISTAN
ITALY TURKMENISTAN
KAZAKSTAN TURKEY
KYRGYZSTAN UKRAINE
LATVIA UZBEKISTAN
LICHTENSTEIN VATICAN CITY
(European countries not qualified for this year's diversity program:
GREAT BRITAIN and POLAND. GREAT BRITAIN (UNITED KINGDOM) includes the following dependent areas: ANGUILLA, BERMUDA, BRITISH VIRGIN ISLANDS, CAYMAN ISLANDS, FALKLAND ISLANDS, GIBRALTAR, MONTSERRAT, PITCAIRN, ST. HELENA, TURKS AND CAICOS ISLANDS. Note that for purposes of the diversity program only, Northern Ireland is treated separately; Northern Ireland does qualify and is listed among the qualifying areas.
*Macau-born selected registrants must receive their visas by December 20, 1999 in order to qualify for
DV-2000.
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NORTH AMERICA
BAHAMAS, THE
(In North America, CANADA does not qualify for this year's diversity program.)
OCEANIA
AUSTRALIA NEW ZEALAND
including components and including components and
dependent areas overseas dependent areas overseas
FIJI PALAU
KIRIBATI PAPUA NEW GUINEA
MARSHALL ISLANDS SOLOMON ISLANDS
MICRONESIA, FEDERATED TONGA
STATES OF TUVALU
NAURU WESTERN SAMOA
VANUATU
SOUTH AMERICA, CENTRAL AMERICA, AND THE CARIBBEAN
ANTIGUA AND BARBUDA HONDURAS
ARGENTINA NICARAGUA
BARBADOS PANAMA
BELIZE PARAGUAY
BOLIVIA PERU
BRAZIL SAINT KITTS AND NEVIS
CHILE SAINT LUCIA
COSTA RICA SAINT VINCENT AND
CUBA THE GRENADINES
DOMINICA SURINAME
ECUADOR TRINIDAD AND TOBAGO
GRENADA URUGUAY
GUATEMALA VENEZUELA
GUYANA
(Countries in this region which do not qualify for this year's diversity program:
COLOMBIA, DOMINICAN REPUBLIC, EL SALVADOR, HAITI, JAMAICA, and MEXICO.)
CA/VO: June 22, 1998
SAMPLE ENTRY FORM
As stated on page 1 there is no specific format for the DV entry form. The following sample form is provided to help facilitate the entry process, but other formats may be used. SEE PAGE 2 OF THIS BULLETIN FOR SPECIFIC DETAILS/EXAMPLES OF HOW THIS (OR ANY OTHER) FORM SHOULD BE FILLED OUT.. Failure to provide all of the required information will disqualify the applicant.
1. FULL NAME: ______________________________ _____________________________
LAST (surname/family) FIRST
2. DATE OF BIRTH: ____________________________
Day, Month, Year
PLACE OF BIRTH: __________________________________________________________
City/Town, District/County/Province, Country
3. APPLICANT'S NATIVE COUNTRY IF DIFFERENT FROM COUNTY OF BIRTH:
____________________________________________________________________________
(See "REQUIREMENTS" section on page 1 for more information on this item.)
4. NAME, DATE AND PLACE OF BIRTH OF THE APPLICANT'S SPOUSE AND CHILDREN
(IF ANY)
_____________________________ _________________________ _________________________
Name Date of birth(day,month,year) Place of birth
_____________________________ _________________________ _________________________
Name Date of birth(day,month,year) Place of birth
Attach information on additional child(ren) as necessary.
5. FULL MAILING ADDRESS: ___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
____________________________
6. PHOTOGRAPH: (Attach a recent, preferably less than 6 months old, photograph of the applicant,
1.5 inches (37 mm) square in size, with the applicant's name printed on the back.
The photograph (not a photocopy) should be attached to the entry with clear
tape--do NOT use staples or paperclips, which can jam the mail processing equipment.)
7. SIGNATURE: ________________________________________________________
Failure to personally sign the entry will disqualify the applicant.
