A Bravenet.com Contact Form

PETITIONER IMMIGRANT VISA QUESTIONNAIRE

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Telephone number *

Your email address *

I am (Select only one box) * US Citizen Lawful Permanent Resident

If you are a US citizen , select how you acquired your citizenship * Birth in the US Naturalization Parents

Have you obtained a Certificate of Naturalization or Certificate of Citizenship * Yes No

If Yes: Certificate Number

Place of Issuance

Date of Issuance date_range

If you are a lawful permanent resident: Class of Admission

Date of Admission date_range

Place of Admission

Did you gain lawful permanent resident status through marriage to a U.S. citizen or lawful permanent resident? Yes No

2. For child of parent select your relationship to the beneficiary (the one being petitioned) Child was born to the parents who were married to each other at the time of the child's birth Stephchild/ Stepparent Child was born to parents who were not married to each other at the time of the child's birth Child was born to the parents who were married to each other at the time of the child's birth

3. If your beneficiary is your brother/sister, are you related by adoption No Yes

Your Family Name (Last Name) *

Your Middle Name *

Your Given Name ( First Name) *

Provide all other names your have ever used & reason for name change

Gender * Male Female

Date of Birth * date_range

City/Town/ Village of Birth *

Country of Birth *

4. Did you gain lawful permanent resident status or citizenship through adoption * No Yes

1. Alien Registration Number if applicable)

2.USCIS Online Acct Number

3. U.S. Social Security Number

Mailing Address Street Number and Name *

Apartment , Suite, Floor Number

City/Town *

State/ Province *

Country and Zip/Postcode *

Is your current mailing address the same as your physical address * Yes No

If "No" Physical address Street Number and Name

Apartment , Suite, Floor Number

City/Town

State/ Province

Country and Zip/Postcode

Provide your physical addresses for the last five years, whether inside or outside the United States. Physical address 2

Provide your physical addresses for the last five years, whether inside or outside the United States. Physical address 3

How many times have you been married *

Name all your spouse (if applicable) Spouse 1

Place of your current marriage City/Town

State/ Province

Country

If filing for your spouse, provide the last address at which you physically lived together. If you never lived together, type or print, "Never lived together"

Date from: date_range

Date To: date_range

Name all your spouse (if applicable) Spouse 2

Have you EVER been employed in the last 5 years whether inside or outside of US * Yes No Self employed Retired

Employer/ Company name

Address Street Number and Name

Apartment , Suite, Floor Number

City/Town

State/ Province

Country and Zip/Postcode

Start Date date_range

End Date

Employer 2

Address Street Number and Name

City/Town

State/ Province

Country and Zip/Postcode

Start Date date_range

End Date date_range

Your Ethnicity (Select only one box) * Hispanic or Latino Not Hispanic or Latino

Height *

Weight *

INFORMATION ABOUT BENEFICIARY

Beneficiary's Family Name *

Beneficiary's Given Name/s *

Beneficiary's Middle Name *

Provide all other names the beneficiary has ever used, including aliases, maiden name, and nicknames.

City/Town/Village of Birth *

Country of Birth *

Date of Birth * date_range

Gender * Male Female

Has anyone else ever filed a petition for the beneficiary. * Yes No Unknown-Select "Unknown" only if you do not know, and the beneficiary also does not know, if anyone else has ever filed a petition for the beneficiary.

Beneficiary's Physical Address *

Apartment, Suite, Floor number *

City/ Town *

State/ Province *

Country/ Zip Code/Postcode *

Beneficiary Phone Number *

Beneficiary Email address *

How many times has the beneficiary been married? *

If currently married date of current marriage date_range

Place of beneficiary's current marriage City/Town

State/ Province

Country

Names of Beneficiary's Prervious Spouses ( if any) Spouse 1 Family Name

First Name

Middle Name

Date marriage ended date_range

Spouse 2 Family Name

First Name/s

Middle Name

Date marriage ended date_range

Beneficiary Parent 1 First Name *

Middle Name *

Last Name *

Date of birth * date_range

Country of birth *

Gender * Male Female

Beneficiary Parent 2 First Name *

Middle Name *

Last Name *

Date of birth * date_range

Gender * Male Female

Children of Beneficiary

Beneficiary's Children( if any) Child 1 Family Name

First Name/s

Middle Name

Date of birth date_range

Country of birth

Gender Male Female

Child 2 Family Name

First Name/s

Middle Name

Date of birth date_range

Country of birth

Gender Male Female

Other Children: Please follow above format, separated by coma

Beneficiary Address in Home Country *

City *

Province/ State *

Country & Postcode *

Starting from * date_range

End date * date_range

Other address BENEFICIARY lived whether inside or outside of US in the last 5 years *

Starting from * date_range

End date * date_range

Is the beneficiary EVER been employed * Yes- answer the questions below Self-employed- answer the questions below Retired No

Beneficiary's Employment Information: Name of Current Employer/company

Position

Employer's Address

Apartment, Suite, Floor number

City/ Town

State/ Province

Country/ Zip Code/Postcode

Date of Employment Began date_range

Date of Employment Ended date_range

Past Employment Name

Past Employment Position

Past Employment address

Start Date date_range

End Date date_range

Was the beneficiary EVER in the United States? * Yes No

If the beneficiary is currently in the United States, he/she arrived on what kind of visa

If yes : Date of arrival date_range

Date authorized stay expired, or will expire date_range

Dorm I-94 Arrival-Departure Record Number

Passport Number *

Was the beneficiary EVER in immigration proceedings? Yes No

If you answered Yes select the type of proceedings and provide the location and date of the proceedings Removal Exclusion/ Deportation Rescission Other Judicial Proceedings

City/ Town & State

Date date_range

If the beneficiary is in the United States and will apply for adjustment of status to that of a lawful permanent resident at the USCIS office in

The beneficiary is overseas and will apply in US Embassy in:

Have you EVER previously filed a petition for this beneficiary or any other alien? * Yes No

If you answered Yes, provide the name, place, date of filing

Result Approved Denied Withdrawn Pending Decision

If you are also submitting separate petitions for other relatives, provide the names of and your relationship to each relative.

Relationship

Provide additional information here

ATTACH PROOF OF CITIZENSHIP

END OF THE QUESTIONNAIRE