Form I-590 Registration for Classification as Refugee

OMB No. 1615-0068; Expires 12/31/06

I-590, Registration for
Classification as Refugee

Department of Homeland Security
U.S. Citizenship and Immigration Services

Type or print the following information in black ink. (Read instructions on Page 2.)
A File No:
1. Name:

(First)

(Middle)

(Last)

2. Present Address: (Street Number and Name/Town or City/State or Province/Country)
3.

Date of Birth: (mm/dd/yyyy)

4.

Country from which I fled or was displaced:

Place of Birth (City or Town)

Province

Country

Present Citizenship/Nationality

On or about (mm/dd/yyyy):

5. Reasons (State in detail):

6. My present immigration status in

is:
(Country in which residing)

Evidence of my immigration status is:
(Describe)
7.

10.

8. Present Address of Spouse (if different):

Name of Spouse:

My Spouse:

will

11. Name of Child (ren)

9. Citizenship/Nationality of Spouse:

will not accompany me to the United States:
Date of Birth (mm/dd/yyyy)

Present Address (if different):

Place of Birth

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 Attended

Title of Degree or Diploma

13. Military Service
Country

Branch and Organization

Dates

Serial No.

Rank Attained

Form I-590 (Rev. 01/27/06) Y

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

have

16. I

have

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 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 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

Present Address

Relationship

18. I am being sponsored by (Name and Address of Sponsor in United States ):

Signature of Registrant:

Date:

Do not write below this line. For Government use only.
I,
, do swear (affirm) that I know the contents of this registration subscribed by me, including the attached documents, that the
same 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))

Subscribed and sworn to before me by the above-named registrant at

on

(Month/Day/Year-mm/dd/yyyy)

(Signature and Title of Officer)
Interview

Approved

Date

Date

Action Block

At

Immigration Officer

Officer in Charge

Instructions

Execution of Form -This form should be executed, signed and submitted to the District Director or Officer in Charge of the nearest overseas office of U.S. Citizenship
and Immigration Services. When your name has been reached as a Registrant, you will be furnished additional instructions.
Registration - A separate registration Form I-590 must be executed by each Registrant and submitted in one copy. A registration Form I-590 on behalf of a child under
14 years of age shall be executed by the parent of guardian.
Public Reporting Burden - A person is not required to respond to a collection of information unless it displays a currently valid OMB control number. This collection
of information is estimated to average 35 minutes per response. If you have comments regarding the accuracy of this estimate or suggestions for simplifying this form,
write to: U.S. Citizenship and Immigration Services, Regulatory Management Division, 111 Massachusettes Avenue, N.W., Washington, D.C. 20529; OMB No.
1615-0068. Do not mail your completed applicaton to this address.
Form I-590 (Rev. 01/27/06) Y Page2