• Mail Orders: Print this form, fill out, attach your PAYMENT for the document preparation service:
  Call (732) 873-9600 and mail to:

Immigration and Visas International
21 Clyde Road, Suite 201
Somerset, NJ 08873-5043
        USA

• Fax: Fill out this form and fax to (732) 873-9787.
• Telephone: Call (732) 873-9600.

INFORMATION ABOUT THE U.S. CITIZEN / PERMANENT RESIDENT (Sponsor)

1.  Family Name ______________   First Name ________________ Middle Name________________

2. Address: ______________________________________________

______________________________________________

______________________________________________

______________________________________________

______________________________________________

3. Place of Birth: City ________________ State _____________ Country __________________

4. Date Of Birth: Day: ________________ Month: _______________ Year: ____________

5. Sex: ( ) Female ( ) Male

6. Marital Status: ( )Married ( )Single ( )Widowed ( )Divorced

7. Other Names Used: (Including maiden name): ________________________________________

8. Date and place of present marriage (if married): _____________________________________

9. A) Social Security Number: ___________________________

B) Alien Registration number: ___________________________

10. Names of Prior Husbands/Wives:___________________________________________________

11. Date(s) Marriages(s) Ended: ____________________________________________________

12. If you are a U.S. Citizen, complete the following: I am a U.S. Citizen through:
( ) Birth in the U.S.
( ) Naturalization (give number/date/place of certificate:

__________________________________________________________
( ) Through Parents
If you obtained a certificate in your own name (give number/date/place

of certificate): ______________________________________________________
13. If you are a lawful permanent resident alien, complete the following:
(date/place of admission for adjustment to permanent residence and

class of admission): _______________________________________________________
Did you obtain permanent residence through marriage to a U.S. Citizen? ( ) Yes ( ) No
INFORMATION ABOUT THE ALIEN RELATIVE

Alien Relative Relationship (person(s) that is being sponsored): ____________________
example: Fiance, wife, child, brother, sister, father, or mother.

1. Family Name______________ First Name______________ Middle Name _______________

2. Address: ______________________________________________

______________________________________________

______________________________________________

______________________________________________

______________________________________________

3. Place of Birth: City __________________ State ______________ Country ______________

4. Date Of Birth: Day: ______________ Month: _______________ Year: ______________

5. Sex: ( ) Female ( ) Male

6. Marital Status: ( ) Married ( ) Single ( ) Widowed ( ) Divorced

7. Other Names Used: (Including maiden name):______________________________________

8. Date and place of present marriage (if married)_____________________________________

9. A) Social Security Number: ___________________________

B) Alien Registration number: __________________________

10. Names of Prior Husbands/Wives: _________________________________________

11. Date(s) Marriages(s) Ended: _____________________________________________

12. Has your relative ever been in the U.S.? ( ) Yes ( ) No

13. If your relative is currently in the U.S. complete the following:
My relative last arrived as: (visitor, student, without inspection, crewman,

stowaway etc.)_________________________
Arrival/Departure record Number (I-94): ___________________________

Date arrived (Month/Day/Year): _____________________

Date authorized stay expires/expired as shown on Form I-94/I95: __________________

14. Name and address of present employer (if any): __________________________________

Date this employment began:(Month/Day/Year)_________________________________

15. Has your relative ever been under immigration proceedings? ( ) Yes ( ) No

Where ______________________________ When ____________________________
( ) Exclusion ( ) Deportation ( ) Recession ( ) Judicial Proceedings

List husband/wife and all children of your relative (if your relative is your husband/wife
list only his/her children):

Name: __________________________ Relationship: _____________________

Date of Birth: __________________ Country of Birth: ______________________

Name: __________________________ Relationship: _____________________

Date of Birth: __________________ Country of Birth: ______________________

16. Address in the United States where your relative intends to live:

______________________________________

______________________________________

______________________________________

______________________________________

17. Your Relative's address abroad:

______________________________________

______________________________________

______________________________________

______________________________________

18. If your relative's native alphabet is other than Roman letters, write his or name:______

______________________________________________________________________

19. If filing for your husband/wife, give last address at which you both lived together:

______________________________________

______________________________________

______________________________________

______________________________________

20. Check the appropriate box below and give the information required for the box you checked:
( ) Your relative will apply for a visa abroad at the American Consulate in:

City: __________________________ Country: __________________________
( ) Your relative is in the United States and will apply for adjustment of status to that
of a lawful Permanent Resident in the office of the Immigration and Naturalization
Services at :

City: ___________________________ Country: __________________________


D. Other Information


If separate petitions are also being submitted for other relatives, give names of each and
relationship:

Name: __________________________________________________

Relationship: _____________________________________________

Name: __________________________________________________

Relationship: _____________________________________________

Have you ever filed a petition for this or any other alien before? ( ) Yes ( ) No
If yes, give name place and date of filing, and result:___________________________

________________________________________________________________________


Signature: ____________________________ Date: _______________

Phone number: __( _______ )______________________