(THE FOLLOWING IS A TRANSLATION OF FORM I-589, THE APPLICATION FOR POLITICAL ASYLUM AND

RETENTION OF EXPULSION. THE FORM SUBMITTED MUST BE WRITTEN IN ENGLISH. HE

FORM IN ENGLISH IS BELOW.)
It is very important that you answer each question since with this information, your case will be better handled.
If you cannot answer or do not know the answer to a question, please provide an explanation why not.
Department of Homeland Security
US Citizenship and Immigration Services OMB Bo. 1615-0067; Expires December 31,
US Department of Justice 2007
Executive Office of Immigration Review
Form I-589, Application for Asylum
and
START HERE – Please use a typewriter or write in black ink. See instructions forWithholding
information on of Removal
eligibility and how to
complete and submit this application. There is NO fee to submit this application.
Part A. YO. Information about you
1. Foreigner registration number(s) (A#) (If you have one) 2. US Social Security Number (If you have one)

3. Full surname 4. First name 5. Middle name

6. What other names have you used? (Includes maiden names and any aliases.)

7. US address (Where you physically reside.)

Phone number ( )
Address (number and street) Apartment number

City State ZIP code (postal)

8. Mailing address in the US (If different from the address in No. 7) Phone number ( )

In care of (If applicable) :

Address (number and street) Department number

City State ZIP code (postal)

9. Sex: □ Male □ Feminine 10. Marital status: □ Single □ Married □ Divorced □ Widowed
11. Date of birth (month/day/year) 12. City and country where you were born

13. Current nationality (citizenship) 14. Nationality when born 15. Race, ethnicity or tribal group 16. Religion

17. Check the appropriate box, whichever applies: a. □ I have never been in immigration court proceedings b. □ I am currently in
immigration court proceedings
c. □ I am not in procedures now , but I have been in procedures in the past
18. Complete 18 “a”, “b”, and “c”.
a. When was the last time you left your country? (month day Year) _____________________
b. What is your current I-94 number, if you have one? _____________
c. Please list each of your entries into the US, starting with your most recent entry.
Write the date (month/day/year), place, and your immigration status for each entry. (Attach additional sheets if necessary.)
Date ________________ Place _________________ Migratory state __________________ Expiration date state
Date ________________ Place _________________ Migratory state __________________ migratory:
Date ________________ Place _________________ Migratory state __________________
19. Which country issued or issued your most 20. Passport number: 21. Expiration date
recent passport or travel document? (month/day/year)
Number of travel document:

22. What is your native language? (Includes 23. Do you have fluent knowledge of 24. What other languages do you speak fluently?
dialect, if applicable.) English? □ Yes □ No

NOTE: Please check the box if you also wish to request withholding. the Convention against Torture. □
For EOIR use only.
[Do not write in this box.]
Action: Decision:
Interview date: Date
Rejection date: ________________
Asylum officer number: _____________ ______ Referral date: _____________________

Form I-589 (Revised December 14, 2006) Page 1

For EOIR use only. [Do not
write in this box.]
Part A. II. Information about your spouse and your sons/daughters.
Your husband/wife.______□ I am not married. (Skip to His Children , below.)
1. Foreigner registration number 2. Passport/ID card number (If you have 3. Date of birth 4. US Social Security Number
(A#) (If you have it) one) (month/day/year) (If you have one)

5. Full surname 6. First name 7. Middle name 8. Maiden name

9. Date of marriage (month/day/year) 10. Marriage location 11. City and country of birth [of your spouse]

12. Nationality (citizenship) 13. Race, ethnicity or tribal group 14. Sex

□ Male □ Female
15. Is this person in the US?

□ Yes (Complete number boxes 16 through 24.) □ No (Specify your location.)

16. Place where [your 17. Date of last entry into the 18. I-94 number (If 19. Your immigration status the last time you were
spouse] entered the US. US (month/day/year) you have one) admitted to the US (Visa type, if applicable)

20. What is your spouse's 21. When does your stay or 22. Is your husband in 23. If you were previously in the US, what
current immigration status? authorized stay expire, if applicable? immigration court was the date of your last entry? (month day
(month day Year) proceedings? Year)
□ Yes □ No
24. If you are currently in the US, is your spouse included in this application? (Check the appropriate box.)
□ Yes (Staple a photo of your husband to the top right corner of page 9 of the extra copy of the application being submitted for this
person.)
□ No
Your sons/daughters. Please provide the following information for all of your sons and daughters, regardless of their ages, locations, or
marital statuses.
□ I do not have sons/daughters (Advance to Part A. III., Information about his life. )
□ Yes I have sons/daughters. Total number of sons/daughters: .
( NOTE: Use Supplement A of the I-589 or attach additional sheets of paper and documentation if you have more than four children. )
1. Foreigner registration number 2. Passport/ID card number (If 3. Marital status (Married, single, 4. US Social Security Number (If
(A#) (If you have it) you have one) divorced, widowed) you have one)

5. Full surname 6. First name 7. Middle name 8. Date of birth (month/day/year)

9. City and country of birth
13. Is this child in the US? □
Yes (Complete boxes 16
14. Place where your child
entered the US.
10. Nationality (citizenship) 11. Race, ethnicity or tribal group 12. Sex
□ Male □ Female
USA?
up to 24.) □ No (Specify your location.)
15. Date of your last entry into 16. I-94 number (If 17. Immigration status of your child the last time
the US (month/day/year) you have one) he/she was admitted to the US (Visa type, if
applicable)

18. What is your child's current 19. When does your stay or authorized stay 20. Is your child in immigration court
immigration status? expire, if applicable? (month day Year) proceedings?
□ Yes □ No
21. If you are currently in the US, is this child included in this application? (Check the appropriate box.)
□ Yes (Staple a photo of your child to the top right corner of page 9 of the extra copy of the application being submitted for this
person.)
□ No

Form I-589 (Revised December 14, 2006) Page 2

Part A. II. Information about your spouse and your sons/daughters. (Continuation.)
1. Foreigner registration number 2. Passport/ID card number (If 3. Marital status (Married, single, 4. US Social Security Number (If
(A#) (If you have it) you have it) divorced, widowed) you have one)

5. Full surname 6. First name 7. Middle name

8. Date of birth (month/day/year)
9. City and country of birth 10. Nationality (citizenship) 11. Race, ethnicity or tribal group 12. Sex
□ Male □ Female
13. Is this child in the US?
□ Yes (Complete boxes 16 through 24.) □ No (Specify your location.)
14. Place where your child 15. Date of your last entry into 16. I-94 number (If you 17. Immigration status of your child the last
entered the US. the US (month/day/year) have one) time he/she was admitted to the US (Visa
type, if applicable)
18. What is your child's current immigration 19. When does your stay or authorized stay 20. Is your child in immigration court
status? expire, if applicable? (month day Year) proceedings?
□ Yes □ No
21. If you are currently in the US, is this child included in this application? (Check the appropriate box.)
□ Yes (Staple a photo of your child to the top right corner of page 9 of the extra copy of the application being submitted for this
person.)
□ No
1. Foreigner registration number 2. Passport/ID card number (If 3. Marital status (Married, single, 4. US Social Security Number (If
(A#) (If you have it) you have one) divorced, widowed) you have one)

5. Full surname 6. First name 7. Middle name

8. Date of birth (month/day/year)
9. City and country of birth 10. Nationality (citizenship) 11. Race, ethnicity or tribal group 12. Sex
□ Male □ Female
13. Is this child in the US?
□ Yes (Complete boxes 16 through 24.) □ No (Specify your location.)
14. Place where your child 15. Date of your last entry into 16. I-94 number (If you 17. Immigration status of your child the last
entered the US. the US (month/day/year) have one) time he/she was admitted to the US (Visa
type, if applicable)
18. What is your child's current immigration 19. When does your stay or authorized stay 20. Is your child in immigration court
status? expire, if applicable? (month day Year) proceedings?
□ Yes □ No
21. If you are currently in the US, is this child included in this application? (Check the appropriate box.)
□ Yes (Staple a photo of your child to the top right corner of page 9 of the extra copy of the application being submitted for this
person.)
□ No
1. Foreigner registration number 2. Passport/ID card number (If 3. Marital status (Married, single, 4. US Social Security Number (If
(A#) (If you have it) you have one) divorced, widowed) you have one)

5. Full surname 6. First name 7. Middle name

8. Date of birth (month/day/year)
9. City and country of birth 10. Nationality (citizenship) 11. Race, ethnicity or tribal group 12. Sex
□ Male □ Female
13. Is this child in the US?
□ Yes (Complete boxes 16 through 24.) □ No (Specify your location.)
14. Place where your child 15. Date of your last entry into 16. I-94 number (If you 17. Immigration status of your child the last
entered the US. the US (month/day/year) have one) time he/she was admitted to the US (Visa
type, if applicable)
18. What is your child's current immigration 19. When does your stay or authorized stay 20. Is your child in immigration court
status? expire, if applicable? (month day Year) proceedings?
□ Yes □ No
21. If you are currently in the US, is this child included in this application? (Check the appropriate box.)
□ Yes (Staple a photo of your child to the top right corner of page 9 of the extra copy of the application being submitted for this
person.)
□ No

Form I-589 (Revised December 14, 2006) Page 3

Part A. III. Information about his life.
1. Please provide the last address where you lived before coming to the US. If your last address is not in the country where
If you fear persecution, you also need to provide your last address in the country where you fear persecution. ( NOTE: Use I-589
Supplement B or attach additional sheets of paper, if necessary.)
Number and Street (If Department, Province or Dates
City Town Country
available) State From (month/year) To (month/year)

2. Provide the following information about your residences during the last five years. Put your current address first. ( NOTE: Use I-589
Supplement B or attach additional sheets of paper, if necessary.)
Department, Province or Dates
Number and Street City Town Country
State From (month/year) To (month/year)

3. Provide the following information about your education, starting with the most recent. ( NOTE: Use I-589 Supplement B or attach
additional sheets of paper, if necessary.)
attended
school name Level of study Postal address
From (month/year) To (month/year)

4. Provide the following information about your employment during the last five years starting with the most recent. ( NOTE: Use I-589
Supplement B or attach additional sheets of paper, if necessary.)
Dates
Name and mailing address of your employer Supposed
From (month/year)|To (month/year)

5. Provide the following information about your parents and brothers and sisters. Check the box if they are deceased. ( NOTE: Use I-589
Supplement B or attach additional sheets of paper, if necessary.)
Full name City/Town and Country where you were Where do you live now?
Mother □ Has died
Father □ Has died
Brother/sister □ Has died
Brother/sister □ Has died
Brother/sister □ Has died
Brother/sister □ Has died

Form I-589 (Revised December 14, 2006) Page 4

Part B. Information about your request.
( NOTE: Use Supplement B to the I-589 or attach additional sheets of paper as necessary to complete your answers to the questions
contained in Part B.)
In answering the following questions about your asylum and other claim for protection (withholding of removal under 241(b)(3) of the INA
or withholding of removal under the Convention Against Torture) you must provide a detailed and specific account of the basis for your
claim. claim asylum or other protection. To the best of your ability, provide dates, places, and descriptions of each written event or action.
You must attach documents that prove the general conditions in the country from which you are requesting asylum or other protection, and
the specific facts on which you are relying to support your claim. If this documentation is not available or if you are not submitting this
documentation with your application, please explain why in your answers to the following questions.

1. Why are you requesting asylum or withholding of removal under section 241(b)(3) of the INA, or withholding of removal under the
Convention Against Torture? Check the appropriate box(es) and then provide detailed answers to questions A and B below:

I am requesting asylum or withholding of removal based on:

(1)Race □ Political opinion

(2)Religion □ Membership in a particular social group
(3)Nationality □ Convention Against Torture
TO. Have you, your family, or your good friends or colleagues suffered harm, abuse, or threats in the past from anyone?
□ No □
(1) Yes
If you answered
(2) “yes,” explain in detail:
(3)
What happened;
(4) When the harm, abuse, or threats occurred;
Who caused the damage, abuse, or threats; and
Why you believe the harm, abuse, or threats happened.

b. Do you fear harm or mistreatment if you return to your

country of□origin?
No □
Yes
If you answered “yes,” explain in detail:
(1) What harm or mistreatment you fear;
(2) Who you believe will harm or mistreat you; and
(3) Why you believe you would or could be harmed or mistreated.
Part B. Information about your request. (Continuation.)
2. Have you or any member of your family ever been accused, charged, arrested, detained, interrogated, convicted and sentenced, or
imprisoned in a country other than the US?

□ No □ Yes
If “yes,” explain the circumstances and reasons.

3. TO. Have you or any member of your family ever belonged to, or been associated with, any organization or group in your home
country for example, but not limited to: a political party, a student group, a labor union, an organization religious, a military or
paramilitary group or civil self-defense patrol, guerrilla organization, ethnic group, human rights group, or the press or media?

Form I-589 (Revised December 14, 2006) Page 5

 □ No □
Yes
If “yes,” describe for each person their level of involvement, any management or other positions, and the length of their time with each
organization or activity.

b. Do you or your relative continue to participate in any way with the group or organization?

□ No □
Yes
If you answered “yes,” describe for each person you or your relative the level of your current involvement, any current management or
other positions, and the length of your time with each organization or group.

4. Do you fear being tortured in your country of origin or in any other country to which you may be returned?

□ No □ Yes
If you answered “yes,” explain why you are afraid and describe the torture you fear, who would do it, and why they would do it.

Form I-589 (Revised December 14, 2006) Page 6

Part C. Additional information about your request.
( NOTE: Use Supplement B to the I-589 or attach additional sheets of paper as necessary to complete your answers to the questions
contained in Part C.)
1. Have you, your spouse, your sons/daughters, your parents, or your brothers/sisters ever applied to the US government for refugee status,
asylum, or withholding of removal?
2.A. After □ leaving
No the country □from which you are seeking asylum, did you or your spouse or sons/daughters who now live in the US travel
If youtoanswered
or live in“yes,”
any other Yes
explain the decision
country and whatthe
before entering US? □ No
happened to the immigration status of you, your spouse, □ your
Yes sons/daughters,
your parents, or your brothers/sisters as a result of that decision. Please indicate if you were included in your father, mother, or spouse's
b. Have you,
application; yourwere
If you spouse, your sons/daughters
included, please indicateor
theother
alienrelatives, suchnumber
registration as your(A
parents or brothers/sisters,
number) ever requested
of your father, mother, or in
or spouse received
your any
legal immigration status in any country other than the one in which you currently want to request asylum? □ No
response. If you have been denied asylum by an Immigration Judge or the Board of Immigration Appeals , please describe any □ Yes
changes
in conditions in your country of origin or in your personal circumstances since the date you were denied asylum that could affect your
Ifeligibility for asylum.
you answered “yes” to either or both of the questions (2A and/or 2B), please provide for each person the following: name of the country
and the time spent there, the person's legal immigration status while there, their reasons for leaving, whether the person can return for
reasons of legal residence, and whether the person applied for refugee or asylum status while there, and if not, why not.

3. Have you, your spouse, or your sons/daughters ever ordered, incited, aided, or otherwise participated in causing harm to you?
or suffering to any person because of their race, religion, nationality, political opinion or membership of a social group?

□ No □
Yes
If you answered “yes,” describe in detail each incident and the involvement of you or your spouse or
sons/daughters.

Form I-589 (Revised December 14, 2006) Page 7

Part C. Additional information about your request. (Continued.)
4. After leaving the country where you were mistreated or fear being mistreated, have you returned to that country?

□ No □ Yes
If you answered “yes,” please describe in detail the circumstances of your visit(s) (for example, the date(s) of your trip(s), the
purpose of your trip(s), and the length of time you stayed in the country for the visit(s).

5. You are submitting this application more than one year after your last arrival in the US.

□ No □
Yes
If you answered “yes,” explain why you did not file it during the first year after arriving. You must be prepared to explain at your
interview or hearing why you did not submit your asylum application during the first year after arriving.

6. Have you or any member of your family included in this application ever committed any crime and/or been arrested, charged,
convicted and sentenced for any crime in the US?

□ No □
Yes
If you answered “yes,” for each incident, please specify in your response: what occurred and the circumstances, dates, length of
sentence received, location, length of detention or incarceration, reasons for detention or conviction, charges you or your relatives were
included in this application, and the reason(s) you were released. Attach documents pertaining to these incidents, if available, or an
explanation why the documents are not available.

Form I-589 (Revised December 14, 2006) Page 8

Part D: Your Signature
I certify, under penalties of perjury under the laws of the United States, that this application and the evidence
Staple your
presented with it are true and correct. Title 18, United States Federal Code, Section 1546(a), provides in part: Any
photograph here,
person who, under oath or as permitted under penalty of perjury under Section 1746 of Title 28, United States
or
Federal Code. , intentionally gives any false statement as true, with respect to a material fact in any application,
the photo of his
affidavit, or other document required by immigration laws or rules ordered thereunder, or who intentionally presents
relative who
any such application, declaration or other document containing Any false statement, or one that does not contain any
will be included
reasonable basis in law or fact, will be fined in accordance with this title or imprisoned for a maximum of 25 years. I
in
authorize the release of any information from my immigration record that U.S. Citizenship and Immigration Services
the extra copy of
(USCIS) needs to determine my eligibility for the benefit I am applying for.
application
NOTICE: Applicants who are in the U.S. illegally are subject to deportation if their claims for asylum or
presented for
withholding of removal are not approved by an asylum officer or immigration judge. Any information submitted in completing this
application may be used as a basis for the introduction of, or as evidence in, deportation proceedings even if the application is
withdrawn after submission. Any applicant who is determined to have made a frivolous application for asylum will be permanently
ineligible for all benefits, according to the Immigration and Nationality Act (INA). You cannot avoid a determination of frivolity
just because someone told you to submit false information on your asylum application. If you are submitting this application to
USCIS, failure to appear for an appointment to have your biological measurements (such as fingerprints) and biographical
information taken within the permitted time could result in an asylum officer denying your asylum application or refer your case
to an immigration judge. Failure to provide your biological measurements or other biographical information to DHS, without good
reason, while you are in removal proceedings may result in an immigration judge finding your application abandoned. See sections
208(d)(5)(A) and 208(d)(6) of the INA and 8 CFR (Code of Federal Rules), sections 208.10, 1208.10, 208.20, 1003.47(d) and 1208.20.
Write your full name in print. Write your name in your native alphabet.

Did your spouse, father, mother or child(ren) assist you in completing this application?

□ No □ Yes (If “Yes,” give the person's name and your relationship to him/her.)

(Name) (Relationship) (Name) (Relationship)

Did anyone else who is not your spouse, father, mother or child(ren) prepare this application? □ No □ Yes (If “Yes,” complete Part E.)

Asylum seekers can be represented by a lawyer. You have received a list of

people who might be available to help you, at little or no cost, with your asylum application? □ No □ Yes

Signature of the applicant (The person named in Part AI)

[ ]
Sign your name so it fits in the parentheses Date (month/day/year)

Part E: Statement from the person who prepared the form, if not the applicant or his/her spouse, father,
mother or child.
I declare that I have prepared this application at the request of the person named in Part D, and that the responses presented are based on all
information of which I am aware, or that was presented to me by the applicant, and that The completed application was read to the
applicant in his/her native language or in a language he/she understands, for verification before he/she signed it in my presence. I am aware
that intentionally submitting false information on this Form I-589 could also subject me to civil penalties under 8 USC. (US Federal Code)
1324c and/or criminal penalties under 18 USC 1546(a).
Signature of the preparer of the form: Full name in letter of the preparer

Preparer's postal address: Number and Street

Daytime phone number )
No. of Apartment City State ZIP code

Form I-589 (Revised December 14, 2006) Page 9

Part F: Will be completed during the asylum interview, if applicable.
NOTE: You will be asked to complete this Part when you appear for your interview before an asylum officer from the Department of
Homeland Security, Citizenship and Immigration Services (USCIS).

I swear (declare) that I have knowledge of the content of this application that I sign, including the attached documents and supplements,
that it is □ all true or □ not all true to the best of my knowledge and that corrections numbered a were made by me or to me petition.
Furthermore, I am aware that if it is determined that I have intentionally made a frivolous application for asylum, I will be permanently
ineligible for any benefits under the Immigration and Nationality Act (INA) and that I cannot avoid a determination of frivolity solely
because someone tells me advised to submit false information in my asylum application.

Signed and sworn to before me by the aforesaid applicant on:

Signature of the applicant Date

(month/day/year)

Write your name in your native alphabet Signature of the asylum

officer

PART G: Will be completed during the deportation hearing, if applicable.

NOTE: You will be asked to complete this Part when you appear before a judge at the US Department of Justice, Executive Office for
Immigration Review (EOIR), for a hearing.

I swear (declare) that I have knowledge of the content of this application that I sign, including the attached documents and supplements,
that it is □ all true or □ not all true to the best of my knowledge and that corrections numbered a were made by me or to me petition.
Furthermore, I am aware that if it is determined that I have intentionally filed a frivolous application for asylum, I will be permanently
ineligible for any benefits under the Immigration and Nationality Act (INA) and that I cannot avoid a determination of frivolity solely
because someone tells me advised to submit false information in my asylum application.

Signed and sworn to before me by the aforesaid applicant on:

Signature of the applicant Date

(month/day/year)

Write your name in your native Signature of the immigration judge

alphabet

Form I-589 (Revised December 14, 2006) Page 10

 Supplement A, Form I-589
Number A # (If available) Date

Name of the applicant Signature of the applicant

It includes information for each of your sons and daughters, regardless of their age or marital status.
(NOTE: Use this form and attach additional pages and documents as necessary, if you have more than four
children.)
1. Foreigner registration number 3. Marital status (married, single, 4. US Social Security Number (If
(A#) (If you have one) 2. Passport or identification card divorced, widowed) you have one)
number (If you have one)

5. Full surname 6. First name 7. Middle name

8. Date of birth (month/day/year)
9. City and country of birth 10. Nationality (Citizenship) 11. Race, ethnicity, or indigenous 12. Sex
group □ Male □ Female

13. Is this child in the US? □ Yes (Complete tables 14 to 21.) □ No (Specify your location.)
14. Place of last entry into the US 15. Date of last entry into the US 16. I-94 document number (if 17. Immigration status at the time
(month/day/year) applicable) of last entry (Visa type, if
applicable)

18. What is your child's current 19. When does this child's authorized stay 20. Is this child in deportation proceedings in
immigration status? expire, if applicable? (month day Year) immigration court?
□ Yes □ No
21. If you are in the US, will this child be included in this petition? (Check the appropriate box.)
□ Yes (Attach a photo of your child to the top right corner of page 9 of the extra copy of the application submitted for this person.)
□ No
1. Foreigner registration number 3. Marital status (married, single, 4. US Social Security Number (If
(A#) (If you have one) 2. Passport or identification card divorced, widowed) you have one)
number (If you have one)

5. Full surname 6. First name 7. Middle name

8. Date of birth (month/day/year)
9. City and country of birth 10. Nationality (Citizenship) 11. Race, ethnicity, or indigenous 12. Sex
group □ Male □ Female

13. Is this child in the US? □ Yes (Complete tables 14 to 21.) □ No (Specify your location.)
14. Place of last entry into the US 15. Date of last entry into the US 16. I-94 document number (if 17. Immigration status at the time
(month/day/year) applicable) of last entry (Visa type, if
applicable)

18. What is your child's current 19. When does this child's authorized stay 20. Is this child in deportation proceedings in
immigration status? expire, if applicable? (month day Year) immigration court?
□ Yes □ No
21. If you are in the US, will this child be included in this petition? (Check the appropriate box.)
□ Yes (Attach a photo of your child to the top right corner of page 9 of the extra copy of the application submitted for this person.)
□ No

Form I-589 Supplement A (Revised 12-14-2006)

 Supplement B, Form I-589
Additional information related to your asylum claim.
A# number (if available) Date

Name of the applicant Signature of the applicant

NOTE: Use this page as a continuation of any additional information requested. Please copy blank and complete
as necessary.
Part

Question no.

Form I-589 Supplement B (Revised 12-14-2006)