(১ম ও ২য় কিস্তি)

এ বছর অর্থাৎ ডিভি- ২০১০ এর আবেদন করে যারা ফার্স্ট লেটার পাননি বা পাওয়ার অপেক্ষায় আছেন তাদের উদ্দেশ্যে বলছি- যারা পেয়েছেন তো পেয়েছেন আর যারা পাননি ইন্শাআল্লাহ আগামী আগস্ট-২০১০ এর মধ্যে পেয়ে যাবেন আশা করছি।
যারা ফার্স্ট লেটার পেয়েছেন বা পাবেন, তাদেরকে ফার্স্ট লেটার পাওয়ার পর অতি দ্রুত কিছু কার্য সমাধান করতে হবে। আমার নিজের এবং আমার সাথে পাওয়া কিছু ঘনিষ্ট ব্যক্তির কিছু বাস্তব অভিজ্ঞতার আলোকে তা ধারাবাহিকভাবে বিস্তারিত বলার চেষ্টা করবো।

যারা সিঙ্গেল পারসন হিসেবে আবেদন করেছেন প্রথমে তাদের উদ্দেশে বলছি-
ফার্স্ট লেটার হাতে পাওয়ার ২/১ দিন পূর্বেই কিংবা পাওয়ার পর পর আপনার ফার্স্ট লেটার পৌঁছার ঠিকানায় কিছু লোক এসে ভীড় করবে, যারা এই সমস্ত ফরম পূরণের অফিস খুলে বসেছে কিংবা ঐ শ্রেণীর লোকদের দালাল। এরা আপনাকে নানা প্রলোভন ও বিষয়টা খুবই কঠিন বুঝিয়ে আপনাকে প্রতারণার ফাঁদে আটকানোর চেষ্টা করবে। কিন্তু সাবধান ! আপনি কোন প্রকারেই এদের কোন কথায় কান দিবেন না- প্রভাবিত হবেন না। ওরা আপনাকে বিনে পয়সায় সকল কাজ করে দেওয়ারও প্রতিশ্র“তি দিবে। পরে এমন একটা সময় আসবে যখন আপনি স্বপ্নের আমেরিকা যাওয়ার জন্যই হোক আর যেকোন কারনেই হোক মোটা অংকের একটা টাকা তাদের হাতে তুলে দিতে বাধ্য থাকবেন। (ব্যপারটা কীভাবে, কতপ্রকারে ঘটতে পারে তা পরে বলছি)

যা-ই হোক আপনি আপনার সিদ্ধানে অটল যে, আপনি নিজে নিজেই (যদিও তাদের মাধ্যমে করালেও সমস্ত কাজগুলোই আপনাকেই করতে হবে, তারা শুধু আপনাকে বলে দেবে কোথায় যেতে হবে, আর এখানে আমি সেটিই বলে দিচ্ছি) আপনার সমস্ত কাজগুলো সারবেন এবং প্রায় এক থেকে দেড়লক্ষ টাকা প্রাথমিক অবস্থাতেই সেভ করতে পারবেন কোন প্রকার ঝামেলা ছাড়াই।
ফার্স্ট লেটারের মোট চার থেকে ছয় টি ফরম থাকে। যেগুলো আপনাকে পূরণ করে কিংবা না করেই আমেরিকান এ্যাম্বাসী কর্তৃক প্রদত্ত নির্দিষ্ট ঠিকানায় অবশ্যই পৌঁছানোর ব্যবস্থা করতে হবে আপনাকে।
পেইজ গুলো হচ্ছে-

১. কেস নাম্বার এর শীট
যেটার মধ্যে শুধুমাত্র আপনার ডাক ঠিকানা ও একটি বারকোড সহ একটি নাম্বার লেখা থাকবে। যে নাম্বার ও বারকোডের ভিত্তিতে তারা নিশ্চিত হতে পারবে যে, আপনিই এই চিঠির মালিক এবং এই চিঠির পরিপ্রেক্ষিতে আপনিই ডিভি-২০১০ বিজয়ীদের একজন।

২. সাপ্লিমেন্টাল রেজিস্ট্রেশন ফরম
যে ফরমটাতে আপনার শুধুমাত্র কয়েকটি তথ্য সন্নিবেশ করতে হবে। যেমন-
ক) আপনার নাম
খ) কেস নাম্বার
গ) স্থানীয় আমেরিকান এ্যাম্বাসীর ঠিকানা ঘ) আপনার দেশ (যেখান থেকে আপনি আমেরিকা যেতে চান)
ঙ) শিক্ষাগত যোগ্যতা (এখানে শুধূ নির্দিষ্ট যোগ্যতার ঘরে টিক চিহ্ন দিতে হবে)
চ) স্কুল/কলেজ/বিশ্ববিদ্যালয়ের নাম, শিক্ষা গ্রহণের সময় এবং যে সার্টিফিকেটগুলো আপনি অর্জন করেছেন সেগুলোর নাম।
ছ) এখানে কাজের যোগ্যতা/অভিজ্ঞতার জন্য হ্যাঁ/না ঘরে টিক চিহ্ন দিতে হবে।
জ) চ-নং -এ হ্যাঁ ঘরে টিক চিহ্ন দিলে এই ঘরে কাজের যোগ্যতা/অভিজ্ঞতার বর্ণনা লিখতে হবে। চ-নং -এ না ঘরে টিক চিহ্ন দিলে এই ঘরে শুধুমাত্র প্রযোয্য নহে লিখতে হবে।
ঝ) চ-নং -এ হ্যাঁ ঘরে টিক চিহ্ন দিলে এই ঘরে কাজ/চাকুরী দাতার নাম, ঠিকানা ও কাজ/চাকুরী করার সময় উল্লেখ করতে হবে। চ-নং -এ না ঘরে টিক চিহ্ন দিলে এই ঘরে শুধুমাত্র প্রযোয্য নহে লিখতে হবে।
ঞ) এখানে আপনার স্বাক্ষর ও তারিখ দিতে হবে, যা পরবর্তীর (সর্বশেষ সাক্ষাতকার) জন্য খুবই গুরুত্বপূর্ণ।

৩. পার্ট-১। এখানে আপনাকে প্রায় ২৬টি ঘর নির্ভুলভাবে পূরণ করতে হবে, যা অত্যন্ত গুরুত্বপূর্ণ।

৪. পার্ট-২। এই ফরমটিতে প্রায় ২২টি ঘর পূরণ করতে হবে, যা অত্যন্ত গুরুত্বপূর্ণ।
৫. পার্ট-১। পরিবার সহ আবেদনকারীদের জন্য। এখানে আপনাকে প্রায় ২৬টি ঘর নির্ভুলভাবে পূরণ করতে হবে, যা অত্যন্ত গুরুত্বপূর্ণ।
৬. পার্ট-২। পরিবার সহ আবেদনকারীদের জন্য। এই ফরমটিতে প্রায় ২২টি ঘর পূরণ করতে হবে, যা অত্যন্ত গুরুত্বপূর্ণ।

এবার যারা পরিবার কিংবা ছেলে-মেয়ে সহ আবেদন করেছেন তাদের উদ্দেশে বলছি-

পরিবার কিংবা ছেলে-মেয়ে সহ আবেদন করেছেন তাদের ক্ষেত্রে শুধুমাত্র পার্ট-১ ও পার্ট-২ ফরম দুইটাতে আবেদনকারী যাদেরকে সঙ্গে নিয়ে যেতে চান বলে আবেদন করেছেন তাদের তথ্যগুলো লিখবেন। আবেদনকারী ঠিক যেমন ভাবে লিখেছেন তার নিজের ফরমে।

পরবর্তীতে আমি চেষ্টা করবো সমস্ত পূরণকৃত আবেদন ফরমের একটা করে প্রতিলিপি উপস্থাপন করতে।

এবার কী কালী বা কলম/পেন্সিলে ফরমগুলো পূরণ করবেন ?
অবশ্যই বলপয়েন্ট কলমের কালো কালীতে সুন্দর হস্তাক্ষরে কোন প্রকার কাটা-ছেঁড়া না করে আমেরিকান ইংরেজিতে, বড় হাতের অক্ষরে লিখতে হবে।
তবে সবচেয়ে ভালো হবে, যদি আপনি টাইপ করে লিখেন। এক্ষেত্রে ইলেক্ট্রিক টাইপ মেশিন ব্যবহার করাটাই শ্রেয়। আপনার কাছে ফরমের মূল কপি একটা করেই। তাই এক্ষেত্রে প্রথমেই ফরম গুলো কয়েক কপি করে ফটোকপি করে নিয়ে প্রতিলিপি করে নেওয়া ভালো।
ইলেক্ট্রিক টাইপ মেশিনে টাইপ করতে হলে আপনি যেতে পারেন প্রেস ক্লাবের বিপরীতে অথবা বায়তুল মোকাররমের পূর্ব গেইটে ছাউনির নিচে বসা টাইপ রাইটারদের কাছে। ওদের যথেষ্ট অভিজ্ঞতা আছে। এদের মধ্যে দু/এক জন বেশ অভিজ্ঞ। সিঙ্গেল-১৫০/২০০/=, পরিবার সহ-২০০/২৫০/=।

এবার ফরম পূরণ হলো। এখন আপনার ফটোগ্রাফ।
আপনার ফার্স্ট লেটারে প্রদত্ত ঠিকানার যে কোন একটা স্টুডিও থেকে (পরিবার সহ হলে প্রত্যেকের) ডিভি সাইজ- ৪ কপি, পাসপোর্ট সাইজ- ৪ কপি, স্ট্যাম্প সাইজ- ২ কপি করে ছবি নিয়ে রাখুন। এর মধ্য থেকে সিঙ্গেল আবেদনকারীগন তাদের নিজের একটি করে দুইটি ছবি পার্ট-১ ও পার্ট-২ এর ডান পার্শ্বে উপরের কোনায় ছবির দুই পার্শ্বে স্কচ্ টেপ দিয়ে লাগিয়ে দিন। ছবির পেছনে হালকা করে আপনার নাম, জন্ম তাং ও কেস নাম্বার লিখে দিন যেন অপর পাশে ছবির কোন প্রকার ক্ষতি না হয়।
আর ডাবল আবেদনকারীগন স্বামী-স্ত্রী দুইজনের ছবি পাশাপাশি বসিয়ে লাগিয়ে দিন।
১) অনেকেরই আবেদনপত্র সিঙ্গেল অবস্থায় পাঠানো ছিল কিন্তু ইতোমধ্যে যারা বিবাহিত তারা ডাবল আবেদনকারীগনের মতোই স্বামী-স্ত্রী দুইজনের ছবি পাশাপাশি বসিয়ে লাগিয়ে দিন।
এবং ঠিক তার উল্টোটা-
২) যারা পরিবার সহ আবেদন করেছেন কিন্তু ইতোমধ্যে বিবাহ বিচ্ছেদ বা অন্য যে কোন কারনে এখন সিঙ্গেল অবস্থায় আছেন তারা তাদের নিজের একটি করে দুইটি ছবি পার্ট-১ ও পার্ট-২ এর ডান পার্শ্বে উপরের কোনায় ছবির দুই পার্শ্বে স্কচ্ টেপ দিয়ে লাগিয়ে দিন।
তাদের জন্য ফরম পূরণের বেলায়ও সামান্য একটু ভিন্নতা আছে। (২য় কিস্তি ও ফরম অংশ দেখুন)

বাকী ছবিগুলো সযত্নে রেখে দিন যা শীঘ্রই পরবর্তীতে কাজে লাগবে।

(২য় কিস্তি'র অংশ)
আপনার পাওয়া ফার্স্ট লেটারের খামে ৪-৬ টা ফরম ছাড়াও ডিভি’র যাবতীয় কার্যক্রমের বিস্তারিত বর্ণনা সহ করনীয় বিষয় উল্লেখ পূর্বক বাংলা ও ইংরেজিতে প্রয়োজনীয় কাগজ পত্রের একটি তালিকা দেওয়া আছে। ডিভি’র নির্দেশনা গুলো মনোযোগ সহকারে পড়–ন। কয়েকবার পড়–ন। বার বার পড়–ন। এখানে আপনার দুর্বোধ্য অংশে আন্ডার লাইন করে রাখুন। এবার চলে যান- প্রয়োজনীয় কাগজ পত্রের তালিকায় এখানে মার্ক করে রাখুন কোন কোন কাগজ পত্র গুলি ফার্স্ট লেটারের সময় লাগবে আর কোন কোন কাগজ গুলো এ্যাম্বাসীতে সাক্ষাতকারের সময় লাগবে। এর পূর্বে দেখে নিন আপনার ফরম গুলো ঠিক ভাবে পূরণ করা হয়েছে কি-না। আপনার সুবিধার্থে পূরণকৃত সবকটি ফরমই হুবহু উপস্থাপন করলাম, যদি কিছু মনে না করেন। মিলিয়ে দেখতে পারেন।

আপনি যদি সিঙ্গেল আবেদনকারী হয়ে থাকেন তাহলে শুধুমাত্র
1. BAR CODE SHEET
2. SUPPLEMENTAL
3. PART- I- BIOGRAPHIC DATA
4. PART- II- SWORN STATEMENT
মোট ৪ টি
এবং আপনি যদি পরিবার সহ আবেদনকারী হয়ে থাকেন তাহলে-
1. BAR CODE SHEET
2. SUPPLEMENTAL
3. PART I- BIOGRAPHIC DATA
4. PART II- SWORN STATEMENT
সহ আপনার স্ত্রী বা ছেলে-মেয়েদের জন্য সর্বশেষ ফরম দু’টি অর্থাৎ-
1. PART I- BIOGRAPHIC DATA
2. PART II- SWORN STATEMENT
সহ মোট ৬ টি ফরম আপনাকে পাঠাতে হবে। সঙ্গে প্রয়োজনীয় কাগজপত্র গুলো।
এখানে উল্লেখ করা যেতে পারে-
১) অনেকেরই আবেদনপত্র সিঙ্গেল অবস্থায় পাঠানো ছিল কিন্তু ইতোমধ্যে যারা বিবাহিত।
এবং ঠিক তার উল্টোটা-
২) যারা পরিবার সহ আবেদন করেছেন কিন্তু ইতোমধ্যে বিবাহ বিচ্ছেদ বা অন্য যে কোন কারনে এখন সিঙ্গেল অবস্থায় আছেন।
তাদের জন্য ফরম পূরণের বেলায় সামান্য একটু ভিন্নতা আছে।

১ নং এর বেলায় তাদেরকে অবশ্যই ডাবল হিসেবে ফরম পূরণ করতে হবে। এক্ষেত্রে তাকে প্রয়োজনীয় কাগজপত্রের বেলায় কয়েকটি বেশী কাগজপত্র সংগ্রহ করতে হবে। ২ নং এর বেলায় তাকে প্রয়োজনীয় কাগজপত্র ডাবল হিসেবে প্রেরণ করতে হবে কিন্তু ফরম পূরণ করতে হবে সিঙ্গেল হিসেবে।

কাগজপত্র গুলো কী কী, কীভাবে, কোথায় থেকে তৈরী করতে হবে তা পরে বলছি।
MOHAMMOD SOLAYMAN
c/o.- LATE MOHAMMOD ALAUDDIN ALI SARKAR
CHAPAR KONA, DOAIL
PUBAIL
JAMALPUR
BANGLADESH
2008AS00009568

B A R C O D E

Please return this barcode sheet to facilitate the processing of your case
when you return the DSP 122 and DS 230 (Parts I & II) to the
Kentucky Consular Center (KCC).



CASE NO. 2008 AS 0000 9568.

U. S. Department of State
OMB APPROVAL NO. 1405-0015
EXPIRES: 07/31/2007
ESTIMATED BURDEN: 1 HOUR*
(See Page-2)
SUPPLEMENTAL REGISTRATION FOR
THE DIVERSITY IMMIGRANT VISA PROGRAM

PART I- BIOGRAPHIC DATA
INSTRUCTIONS
The following is a supplemental registration form for the Diversity Immigrant Visa Program under Section 203(c) of the Immigration and Nationality Act.

Clearly print or type all answers in the English language. Answer all questions.

Using the enclosed self-adhesive return address label, immediately send this form along with Form DS- 230 to: Diversity Immigrant Cisa Program, Kentucky Consular Center, 3505 N, Highway 25W, Williamsburg, KY 40769. Failure to follow instructions will disqualify your application.

You will be notified by mail of your appointment date, therefore the answer to question No. 3 must be accurate.

1. NAME (Last, First, Mi)
SOLAYMAN, MOHAMMOD

2. RANK ORDER NUMBER (Case number on envelope) CASE NO. 2008AS00009568

3. CURRENT MAILING ADDRESS (Address at which you receive your mail, Give any change of mailing address here)
C/O- LATE MOHAMMOD ALAUDDIN ALI SARKAR
CHAPARKONA, DOAIL, PUBAIL, JAMALPUR,
BANGLADESH.

Telephone Number (Optional) 01711******

4. NAME OF UNITED STATES CONSULAR OFFICE WHERE YOU PROCESS YOUR APPLICATION
This will usually be the consular office nearest the place you live. However, please note that some U. S, Embassies and Consulates do not process immigrant visas. If you are not sure whether the U.S. Embassy or Consulate nearest you processes immigrant visas, or if you do not know which is the U.S. Embassy or Consulate nearest you, please list the city and country where you live. If you live in the4 United States and plan to adjust status with the Bureau of Citizenship and immigration Services in the U.S., please list “BCIS”; if you live in the United States but you intend to return abroad to be interviewed, please list the U.S. Embassy or Consulate that processes immigrant visas for the aria where you lived before you came to the United States.
U. S. EMBASSY, DHAKA- 1212, BANGLADESH.

5. THE COUNTRY YOU LISTED AS YOUR NATIVE COUNTRY ON YOUR DIVERSITY VISA PROGRAM APPLOICATION
In most cases, this will be the country where you were born. You may also claim the country of birth of your husband or wife, in addition, you may claim the country of birth of either of your parents, if neither of your parents lived in, or was born in, the country where you were born
BANGLADESH

6. EDUCATION
a. Check the highest level of education completed.
 High School, No Degree  High School, No Diploma  Vocational School  College, No Degree  University Degree √  Advanced Degree
 Other ………………...………………………………………………………………………………………………………………………………………………..................

b. Names and addresses of all schools, colleges, and universities attended (include trade and vocational schools)
NAME OF EDUCATIONAL INSTITUTION FROM (mm-yyyy) TO (mm-yyyy) DEGREE (S) OR CERTIFICATE(S) RECEIVED
BOIRA ISRAIL AHAMMAD HIGH SCHOOL 01-1982 06-1992 S. S. C
GOVT. ASHEK MAHMUD COLLEHE 07-1992 06-1995 H. S.C
NARAYANGONJ FINE ART INSTITUTE 07-1998 06-2003 PRE- B. F. A & B. F. A
UNIVERSITY OF DEVELOPMENT ALTERNATIVE 01-2005 12-2006 M. F. A
DSP-122 Page 1 of 2
12-2003

7. WORK EXPERIENCE
a. Within the last 5 years, I have worked at least 2 years in a job that requires at least 2 years of training or experience:
 Yes  No√

b. Occupation- If you answered “yes” to question 7a, give the job title and describe the type of work you did. Be as specific as possible.

N/A
c. Names and addresses of your employers during the past 5 years in the work you described above, and the dates I (beginning and ending months and years) you worked for each.

NAME OF EMPLOYER ADDRESS FROM (mm-yyyy) -- TO (mm-yyyy)
N/A


SIGNED STATEMENT
I certify that only one application was or has been submitted by me or on my behalf for this immigrant visa registration. I further certify that I have read and understand all the questions set forth above and that the answers I have furnished on this form are true and correct to the best of my knowledge and belief. I understand that any false or misleading statement may result in the refusal of a visa of denial of entry into the United States.

MOHAMMOD SOLAYMAN, (Hand Writing Signature) 05-27-2007
............................................................................................. .................................
Signature of Applicant Date (mm-dd-yyyy)

The information asked for on this form is requested pursuant to Section 222 of the immigration and Nationality Act. The U.S. Department of State uses the facts you provide on this form primarily to determine your eligibility for a U.S. Immigrant visa. Individuals who fail to submit this form or who do not provide all the requested information may be denied a U.S. immigrant visa. If you are issued an immigrant visa and are subsequently admitted to the United States as an immigrant, the Bureau of Citizenship and Immigration Services will use the information on this form to issue you a Permanent Resident Card, and, if you so indicate the Social Security Administration will use the information to issue you a social security number and card.

*Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/RPS/DIR), 1800 G Street (Suite 2400), NW, Washington, DC 20522.
DO NOT WRITE IN THIS SPACE – FOR OFFICIAL USE ONLY





Occupation Code ..........................................................................................................................................................................................................................................................
DSP- 122 Page 2 of 2

CASE NO. 2008 AS 0000 9568.

U. S. Department of State
OMB APPROVAL NO. 1405-0015
EXPIRES: 07/31/2007
ESTIMATED BURDEN: 1 HOUR*
(See Page-2)
APPLICATOIN FOR
IMMIGRANT VISA AND
ALIEN REGISTRATION

PART I- BIOGRAPHIC DATA
Instructions: Complete one cop of this form for yourself and each member of your family, regardless of age, who will immigrate with you. Please print or type your answers to all questions. Mark questions that are Not Applicable with “N/A”. If there is insufficient room on the form, answer on a separate sheet using the same numbers that appear on the form. Attach any additional sheets to this form.

Warning: Any false statement or concealment of a material fact may result in your permanent exclusion from the United States. This form (DS-230 Part I) is the first of two parts. This part, together with Form DS-230 Part II, constitutes the complete Application for Immigrant Visa and Alien Registration.

1. Family Name First Name Middle Name
SOLAYMAN, MOHAMMOD

2. Other Names Used of Aliases (If married woman, give maiden name) MASUD

3. Full Name in Native Alphabet (If Roma letters not used) †gvnv¤§` †mvjvqgvb

4. Date of Birth (mm-dd-yyyy)
03-01-1977 5. Age
30 YEARS+ 6. Place of Birth (City of town)
JAMALPUR (Province)
--- (Country)
BANGLADESH

7. Nationality (If dual national, give both)
BANGLADESHI 8. Gender
 Female
 Male√ 9. Marital Status
Single (Never married)  Married√  Widowed Divorced  Separated
Including my present marriage, I have been married ONE times

10. Permanent address in the United States where you intend to live, if known (street address including zip code). Include the name of a person who currently lives there.
SULTAN MAHMOOD
2511, TRATMAN AVE, APT# G-12, BRONX, N.Y.-10461, U.S.A.
Telephone number 718-792-2725.
11. Address in the United States where you want Permanent Resident Card (Green Card) mailed, If different from address in item # 10 (include the name of a person who currently lives there).

SAME AS ITEM # 10

Telephone number
12. Your Present Occupation

PRAIVATE SERVICE 13. Present Address (Street Address) (City of Town) (Province) (Country)
AZIZ MONZIL, 350/A, NAKHAL PARA, DHAKA- 1200.

Telephone number (Home)
01711 ****** Office
N/A

14. Name of Spouse (Maiden of family name) First Name Middle Name
BEGUM MOST HOSNA ARA

Date (mm-dd-yyyy) and place of birth of spouse 11-30-1976 GAIBANDHA BANGLADESH

Address of spouse (If different from your own
AMBIA BHABAN, ROOM # 13, TMSS, GOKUL, BOGRA

Spouse’s occupation
PRIVATE SERVICE
Date of marriage (mm-dd-yyyy)
01-26-2007
15. Father’s Family Name First Name Middle Name
SARKAR LATE MOHMMOD ALAUDDIN ALI

16. Father’s Date of Birth
(mm-dd-yyyy)
N/A Place of Birth
JAMALPUR,
BANGLADESH Current Address
N/A If deceased, give year of death

2005

17. Mother’s Family Name at Birth First Name Middle Name
BEGUM LATE MOMTAZ --

18. Mother’s Date of Birth
(mm-dd-yyyy)
N/A Place of Birth
JAMALPUR,
BANGLADESH Current Address
N/A If deceased, give year of death

2007

DS-230 Part I This Form May be Obtained Free at Consular Offices of the United States of America
07-2004 Previous Editions Obsolete. Page 1 of 4

19. List Names, Dates and Places of Birth, and Addresses of ALL Children.

Name Date (mm-dd-yyyy) Please of Birth Address (If different of Your own)
N/A



20. List below all places you have lived for at least six months since reaching the age of 16, including places in your country of nationality.

City or Town Province Country From/ To (mm-yyyy)
DHAKA --- BANGLADESH 01-2005 TO TILL
NARAYANGONJ --- BANGLADESH 08-1998 TO 12-2004
DHAKA --- BANGLADESH 07-1995 TO 06-1998
JAMALPUR --- BANGLADESH 03-1993 TO 06--1995


21a. Person(s) named in 14 and 19 who will accompany you to the United States now. WIFE

21b. Person(s) named in 14 and 19 who will follow you to the to the United States at a later date N/A

22. List below all employment for the last ten years

Employer Location Job Title From/To (mm-yyyy)
MISSION GROUP HOUSE # 01, ROAD # 02, SECTOR # 03, UTTARA C/A, DHAKA- 1230. MEDIA OFFICER 10-2006 TO TILL



In what occupation do you intend to work in the United States? ANY SUITABLE JOB
23. List below all educational institutions attended

School and Location From/To (mm-yyyy) Course of Study Degree of Diploma
BOIRA ISRAIL AHAMMAD HIGH SCHOOL
01-1982 TO 06-1992 TEN YEARS S.S.C
GOVT. ASHEK MAHMUD COLLEGE
07-1992 TO 06-1995 TWO YEARS H.S.C
NARAYANGONJ FINE ART INSTITUTE
7-1998 TO 06-2003 FOUR YEARS B.F.A
UNIVERSITY OF DEVELOPMENT ALTERNATIVE
01-2005 TO 12-2006 TWO YEARS M.F.A (APPEARED)
Languages spoken or read: BENGALI & ENGLISH
Professional associations to which you belong: N/A

24. Previous Military Service  Yes  No√
Branch N/A Dates of Service (mm-dd-yyyy):: N/A
Rank/Position N/A Military Specialty/Occupation N/A

25. List dates of all previous visits to of residence in the United States. (If never, write “never”) Give type of visa status, if known.
Give DHS “A” number if any.

From/To (mm-yyyy) Location Type of Visa “A” Number (If Known)
NEVER
Signature of Applicant
Mohammod Solayman (Hand Writing Signature) Date (mm-dd-yyyy)
05-27-2007

Privacy Act and Paperwork Reduction Act Statements

The information asked for on this form is requested pursuant to Section 222 of the immigration and Nationality Act. The U.S. Department of State uses the facts you provide on this form primarily to determine your classification and eligibility for a U.S. Immigrant visa. Individuals who fail to submit this form or who do not provide all the requested information may be denied a U.S. immigrant visa. If you are issued an immigrant visa and are subsequently admitted to the United States as an immigrant, the Department of Homeland Security will use the information on this form to issue you a Permanent Resident Card, and, if you so indicate the Social Security Administration will use the information to issue you a social security number and card.

*Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/RPS/DIR) Washington, DC 20520.


DS-230 Part I Page 2 of 4
CASE NO. 2008 AS 0000 9568.

U. S. Department of State
OMB APPROVAL NO. 1405-0015
EXPIRES: 07/31/2007
ESTIMATED BURDEN: 1 HOUR*
APPLICATOIN FOR IMMIGRANT VISA AND
ALIEN REGISTRATION

PART II- SWORN STATEMENT
Instructions: Complete one cop of this form for yourself and each member of your family, regardless of age, who will immigrate with you. Please print or type your answers to all questions. Mark questions that are Not Applicable with “N/A”. If there is insufficient room on the form, answer on a separate sheet using the same numbers that appear on the form. Attach any additional sheets to this form. The fee should be paid in United Satiates dollars or local currency equivalent, or by bank draft.

Warning: Any false statement or concealment of a material fact may result in your permanent exclusion from the United States. Even if you are issued an immigrant visa and are subsequently admitted to the United States, providing false information on this form could be grounds for your prosecution and/or deportation.
This form (DS-230 Part II), together with Form DS-230 Part I, constitutes the complete Application for Immigrant Visa and Alien Registration.

26. Family Name First Name Middle Name
SOLAYMAN MOHAMMOD --

27. Other Names Used of Aliases (If married woman, give maiden name) JULHAS

28. Full Name in Native Alphabet (If Roma letters not used) †gvnv¤§` †mvjvqgvb

29. Name and Address of Petitioner
SOLAYMAN, MOHAMMOD (SELF)
ADDRESS- SAME AS ITEM # 13
Telephone number

01711 ******

30. United States laws governing the issuance of visas require each applicant to state whether or not he or she is a member of any class of individuals excluded from admission into the United States. The excludable classes are described below in general terms. You should read carefully the following list and answer Yes or No each category. The answers you give will assist the consular officer to reach a decision on your eligibility to receive a visa.
Except as Otherwise Provided by Law, Aliens within the Following Classifications are Ineligible to Receive a Visa.
Do Any of the Following Classes Apply to You?

a. An alien who has a communicable disease of public health significance; who has failed to present documentation of
having received vaccinations in accordance with U.S. law: who has of has had a physical of mental disorder that poses  Yes  No√
or is likely to pose a threat to the safety of welfare of the alien of others; or who is a drug abuser or addict.

b. An alien convicted of, or who admits having committed, a crime involving moral turpitude of violation of any aw relating to a controlled substance or who is the spouse, son or daughter of such a trafficker who knowingly has benefited from the trafficking activities in the past five years; who has been convicted of 2 or more offenses for which the aggregate sentences were 5years or more; who is coming to the United States to engage in prostitution or commercialized vice or who has engaged in prostitution or procuring within the past 10 years; who is or has been an illicit trafficker in any controlled substance; who has committed a serious criminal offense in the United States and who has asserted immunity from prosecution; who, while serving as a foreign government official and within the previous 24-month period, was responsible for or directly carried out particularly severe violations of religious freedom; or whom the President has identified as a person who plays a significant role in a severe form of trafficking in persons, who otherwise has knowingly aided, abetted, assisted or colluded with such a trafficker in severe forms of trafficking in persons, or who is the spouse, son or daughter of such a trafficker who knowingly has benefited from the trafficking activities within the past five years.  Yes  No√

c. An alien who seeks to enter the United States to engage in espionage, sabotage, export control violations, terrorist activities, the overthrow of the Government of the United States or other unlawful activity; who is a member of or affiliated with the Communist or other totalitarian party; who participated in Nazi persecutions or genocide; who has engaged in genocide; or who is a member or representative of a terrorist organization as currently designated by the U.S. Secretary of State.  Yes  No√

d. An alien who is likely to become a public charge.  Yes  No√

e. An alien who seeks to enter for the purpose of performing skilled or unskilled labor who has not been certified by the Secretary of Labor; who is a graduate of a foreign medical school seeking to perform medical services who has not passed the NBME exam or its equivalent; or who is a health care worker seeking to perform such work without a certificate from the CGFNS or from an equivalent approved independent credentialing organization.  Yes  No√

f. An alien who failed to attend a hearing on deportation or inadmissibility within the last 5 years; Who seeks or has sought a visa, entry into the United States, or any immigration benefit by fraud or misrepresentation; who knowingly attended in student (F) visa status a U.S. public elementary school or who attended a U.S. public secondary school without reimbursing the school; or who is subject to a civil penalty under INA 274C.  Yes  No√
Privacy Act and Paperwork Reduction Act Statements

The information asked for on this form is requested pursuant to Section 222 of the immigration and Nationality Act. The U.S. Department of State uses the facts you provide on this form primarily to determine your classification and eligibility for a U.S. Immigrant visa. Individuals who fail to submit this form or who do not provide all the requested information may be denied a U.S. immigrant visa. If you are issued an immigrant visa and are subsequently admitted to the United States as an immigrant, the Department of Homeland Security will use the information on this form to issue you a Permanent Resident Card, and, if you so indicate the Social Security Administration will use the information to issue you a social security number and card.

*Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/RPS/DIR) Washington, DC 20520.
Previous Editions Obsolete
ES-230 Part II Page 3 of 4

g. An alien who is permanently ineligible for U.S. citizenship; or who departed the United States to evade military service in time of war.  Yes  No√

h. An alien who was previously ordered removed within the last 5 years or ordered removed a second time within the last 20 years; who was previously unlawfully present and ordered removed within the last 10 years or ordered removed a previously unlawfully present in the United States for more than 180 days but less than one tear or an aggregate of one year within the last 10 years.  Yes  No√

i. An alien who is coming to the United States to practice polygamy; who withholds custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court or intentionally assists another person to do so; who has voted in the United States in violation of any law or regulation; or who renounced U.S. citizenship to avoid taxation.  Yes  No√

j. An alien who is a former exchange visitor who has not fulfilled the 2-year foreign residence requirement.  Yes  No√

k. An alien determined by the Attorney General to have knowingly made a frivolous application for asylum.  Yes  No√

l. An alien who has ordered, carried out or materially assisted in extrajudicial and political killings and other acts of violence against the Haitian people; who has directly or indirectly assisted or supported any of the groups in Colombia known as FARC, ELN, or AUC; who through abuse of a governmental or political position has converted for personal gain, confiscated or expropriated property in Cuba, a claim to which is owned by a national of the United States, has trafficked in such property or has been complicit in such conversion, has committed similar acts in another country, or is the spouse, minor child or agent of an alien who has committed such acts, who has been directly involved in the establishment or enforcement of population controls forcing a woman to undergo an abortion against her free choice of a man or a woman to undergo sterilization against his or her free choice: or who has disclosed or trafficked in confidential U.S business information obtained in connection with U.S. participation in the Chemical Weapons Convention or is the spouse, minor child or agent of such a person.  Yes  No√
31. Have you ever been charged, arrested or convicted of any offense or crime? (If Answer is Yes, please explain)  Yes  No√
32. Have you ever been refused admission to the United States at a port-f-entry? (If Answer is Yes, please explain)  Yes  No√
33a. Have you ever applied for a Social Security Number (SSN)?
 Yes Give The Number ------------------------------  No√

Do you want the Social Security Administration to assign you an SSN (and issue a card) or issue you a new card (if you have an SSN)? You must answer “Yes” to this question and to the “Consent To Disclosure” in order to receive an SSN and/of card.
 Yes√  No 33b. Consent to Disclosure: I authorize disclosure of information from this form to the Department of Homeland Security (DHS), the Social Security Administration (SSA), such other U.S. Government agencies as may be required for the purpose of assigning me an SSN And Issuing me a Social Security card, and I authorize the SSA to share my SSN with the INS.  Yes√  No

The applicant’s response does not limit or restrict the Government’s ability to obtain his or her SSN or other information on this form for enforcement or other purposes as authorized by law.
34. Where you Assisted in Completing this Application?  Yes  No√
(If answer is Yes, give name and address of person assisting you, indicating whether relative, friend, travel agent, attorney, or other)
SELF
DO NOT WRITE BELOW THE FOLLOWING LINE
The consular officer will assist you in answering item 35.
DO NOT SIGN this form until instructed to do so by the consular officer
35. I claim to be:
 A Family-Sponsored Immigrant  I derive foreign state chargeability  Preference -------------------------
 An Employment-Based Immigrant under Sec. 202(b) through my ----------------------  Numerical limitation -------------
 A Diversity Immigrant (foreign state)
 A Special Category (Specify) ------------------------------------------------------
(Returning resident, Hong Kong, Tibetan, Private Legislation, etc.)
I understand that I am required to surrender my visa to the United States Immigration Office at the place where I apply to enter the United States, and that the possession of visa does not entitle me to enter the United States if at that time I am found to be inadmissible under the immigration laws.
I understand that any willfully false or misleading statement or willful concealment of a material fact made by me herein may subject me to permanent exclusion from the United States and, if I am admitted to the United States, may subject me to criminal prosecution and/or deportation.
I, the undersigned applicant for a United States immigrant visa, do solemnly swear (or affirm) that all statements which appear in this application, consisting of Form DS-230 Part I and Part II combined, have been made by me, including the answers to items 1 through 35 inclusive, and that they are true and complete the best of my knowledge and belief. I do further swear (or affirm) that, if admitted into the United States, I will not engage in activities which would be prejudicial to the public interest, or endanger the welfare, safety, or security of the United States; in activities which would be prohibited by the laws of the United States relating to espionage, sabotage, public disorder, or in other activities subversive to the national security; in any activity a purpose of which is the opposition to or the control, or overthrow of, the Government of the United States, by force, violence, or other unconstitutional means.
I understand that completion of this form by persons required by law to register with the Selective Service System (males 18 through 25 years of age) constitutes such registration in accordance with the Military Selective Act.

BLANK
-------------------------------------------------------------------------------------------------
Signature of Applicant


Subscribed and sworn to before me this --------------------------- day of ------------------------------ ---------------- at ----------------------------------------------------
------------------------------------------------
Consular Officer
DS-230 Part II This Form May be Obtained Free at Consular Offices of Page 4of 4
The United States of America
CASE NO. 2008 AS 0000 9568.

U. S. Department of State
OMB APPROVAL NO. 1405-0015
EXPIRES: 07/31/2007
ESTIMATED BURDEN: 1 HOUR*
(See Page-2)
APPLICATOIN FOR
IMMIGRANT VISA AND
ALIEN REGISTRATION

PART I- BIOGRAPHIC DATA
Instructions: Complete one cop of this form for yourself and each member of your family, regardless of age, who will immigrate with you. Please print or type your answers to all questions. Mark questions that are Not Applicable with “N/A”. If there is insufficient room on the form, answer on a separate sheet using the same numbers that appear on the form. Attach any additional sheets to this form.

Warning: Any false statement or concealment of a material fact may result in your permanent exclusion from the United States. This form (DS-230 Part I) is the first of two parts. This part, together with Form DS-230 Part II, constitutes the complete Application for Immigrant Visa and Alien Registration.

1. Family Name First Name Middle Name
TRIPOLY TASLIMA SULTANA

2. Other Names Used of Aliases (If married woman, give maiden name) TRIPOLY

3. Full Name in Native Alphabet (If Roma letters not used) Zvmwjgv myjZvbv wÎcjx

4. Date of Birth (mm-dd-yyyy)
11-30-1976 5. Age
30+ 6. Place of Birth (City of town)
GAIBANDHA (Province)
--- (Country)
BANGLADESH

7. Nationality (If dual national, give both)
BANGLADESHI 8. Gender
 Female√
 Male 9. Marital Status
Single (Never married)  Married√  Widowed Divorced  Separated
Including my present marriage, I have been married ONE times

10. Permanent address in the United States where you intend to live, if known (street address including zip code). Include the name of a person who currently lives there.
SULTAN MAHMOOD
2511, TRATMAN AVE, APT# G-12, BRONX, N.Y.-10461, U.S.A.
Telephone number 718-792-2725.
11. Address in the United States where you want Permanent Resident Card (Green Card) mailed, If different from address in item # 10 (include the name of a person who currently lives there).

SAME AS ITEM # 10

Telephone number
12. Your Present Occupation

PRIVATE SERVICE 13. Present Address (Street Address) (City of Town) (Province) (Country)
AZIZ MONZIL, 350/A, NAKHAL PARA, DHAKA- 1200.

Telephone number (Home)
01711 ****** Office
N/A

14. Name of Spouse (Maiden of family name) First Name Middle Name
SOLAYMAN MOHAMMOD ---

Date (mm-dd-yyyy) and place of birth of spouse 03-01-1977 JAMALPUR BANGLADESH

Address of spouse (If different from your own
AZIZ MONZIL, 179/1, NORTH GORAN, SIPAHI BAGH, DHAKA- 1219. Spouse’s occupation
PRIVATE SERVICE
Date of marriage (mm-dd-yyyy)
01-26-2007
15. Father’s Family Name First Name Middle Name
MIAH MD. GOLJER ALI

16. Father’s Date of Birth
(mm-dd-yyyy)
10-01-1933 Place of Birth
GAIBANDHA,
BANGLADESH Current Address
CHACHIAMIRGONJ, TARAPUR, SHUNDORGONJ, GAIBANDHA If deceased, give year of death

N/A

17. Mother’s Family Name at Birth First Name Middle Name
BEGUM NOOR NAHAR

18. Mother’s Date of Birth
(mm-dd-yyyy)
07-05-1939 Place of Birth
GAIBANDHA,
BANGLADESH Current Address
SAME AS ITEM # 16 If deceased, give year of death

N/A

DS-230 Part I This Form May be Obtained Free at Consular Offices of the United States of America
07-2004 Previous Editions Obsolete. Page 1 of 4

19. List Names, Dates and Places of Birth, and Addresses of ALL Children.

Name Date (mm-dd-yyyy) Please of Birth Address (If different of Your own)
N/A



20. List below all places you have lived for at least six months since reaching the age of 16, including places in your country of nationality.

City or Town Province Country From/ To (mm-yyyy)
BOGRA --- BANGLADESH 09-2006 TO TILL
GAIBANDHA --- BANGLADESH 04-2004 TO 08-2006
RANGPUR --- BANGLADESH 07-2000 TO 03-2004
DINAJPUR --- BANGLADESH 07-1995 TO 06--2000
GAIBANDHA --- BANGLADESH 11-1992 TO 06-1995

21a. Person(s) named in 14 and 19 who will accompany you to the United States now. HUSBAND

21b. Person(s) named in 14 and 19 who will follow you to the to the United States at a later date

22. List below all employment for the last ten years

Employer Location Job Title From/To (mm-yyyy)
T.M.S.S. GOKUL, BOGRA ACCOUNTS OFFICER 09-2006 TO TILL



In what occupation do you intend to work in the United States? ANY SUITABLE JOB
23. List below all educational institutions attended

School and Location From/To (mm-yyyy) Course of Study Degree of Diploma
AMINA GOVT. GIRLS’ HIGH SCHOOL
01-1982 TO 06-1992 TEN YEARS S.S.C
SUNDARGANJ D. W. COLLEGE
07-1992 TO 06-1995 TWO YEARS H.S.C
DINAJPUR GOVT. MOHILA COLLEGE
7-1995 TO 06-2000 THREE YEARS B.S.S. (HONS)
CARMICHAEL COLLEGE, RANGPUR
07-2000 TO 06-2001 ONE YEAR M.S.S
Languages spoken or read: BENGALI & ENGLISH
Professional associations to which you belong: N/A

24. Previous Military Service  Yes  No√
Branch N/A Dates of Service (mm-dd-yyyy):: N/A
Rank/Position N/A Military Specialty/Occupation N/A

25. List dates of all previous visits to of residence in the United States. (If never, write “never”) Give type of visa status, if known.
Give DHS “A” number if any.

From/To (mm-yyyy) Location Type of Visa “A” Number (If Known)
NEVER
Signature of Applicant
Taslima Sultana Tripoly (Hand Writing Signature) Date (mm-dd-yyyy)
05-27-2007

Privacy Act and Paperwork Reduction Act Statements

The information asked for on this form is requested pursuant to Section 222 of the immigration and Nationality Act. The U.S. Department of State uses the facts you provide on this form primarily to determine your classification and eligibility for a U.S. Immigrant visa. Individuals who fail to submit this form or who do not provide all the requested information may be denied a U.S. immigrant visa. If you are issued an immigrant visa and are subsequently admitted to the United States as an immigrant, the Department of Homeland Security will use the information on this form to issue you a Permanent Resident Card, and, if you so indicate the Social Security Administration will use the information to issue you a social security number and card.

*Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/RPS/DIR) Washington, DC 20520.


DS-230 Part I Page 2 of 4

CASE NO. 2008 AS 0000 9568.

U. S. Department of State
OMB APPROVAL NO. 1405-0015
EXPIRES: 07/31/2007
ESTIMATED BURDEN: 1 HOUR*
APPLICATOIN FOR IMMIGRANT VISA AND
ALIEN REGISTRATION

PART II- SWORN STATEMENT
Instructions: Complete one cop of this form for yourself and each member of your family, regardless of age, who will immigrate with you. Please print or type your answers to all questions. Mark questions that are Not Applicable with “N/A”. If there is insufficient room on the form, answer on a separate sheet using the same numbers that appear on the form. Attach any additional sheets to this form. The fee should be paid in United Satiates dollars or local currency equivalent, or by bank draft.

Warning: Any false statement or concealment of a material fact may result in your permanent exclusion from the United States. Even if you are issued an immigrant visa and are subsequently admitted to the United States, providing false information on this form could be grounds for your prosecution and/or deportation.
This form (DS-230 Part II), together with Form DS-230 Part I, constitutes the complete Application for Immigrant Visa and Alien Registration.

26. Family Name First Name Middle Name
TRIPOLY TASLIMA SULTANA

27. Other Names Used of Aliases (If married woman, give maiden name) TRIPOLY

28. Full Name in Native Alphabet (If Roma letters not used) Zvmwjgv myjZvbv wÎcjx

29. Name and Address of Petitioner
SOLAYMAN, MOHAMMOD (HUSBAND)
ADDRESS- SAME AS ITEM # 14
Telephone number

01711 ******

30. United States laws governing the issuance of visas require each applicant to state whether or not he or she is a member of any class of individuals excluded from admission into the United States. The excludable classes are described below in general terms. You should read carefully the following list and answer Yes or No each category. The answers you give will assist the consular officer to reach a decision on your eligibility to receive a visa.
Except as Otherwise Provided by Law, Aliens within the Following Classifications are Ineligible to Receive a Visa.
Do Any of the Following Classes Apply to You?

a. An alien who has a communicable disease of public health significance; who has failed to present documentation of
having received vaccinations in accordance with U.S. law: who has of has had a physical of mental disorder that poses  Yes  No√
or is likely to pose a threat to the safety of welfare of the alien of others; or who is a drug abuser or addict.

b. An alien convicted of, or who admits having committed, a crime involving moral turpitude of violation of any aw relating to a controlled substance or who is the spouse, son or daughter of such a trafficker who knowingly has benefited from the trafficking activities in the past five years; who has been convicted of 2 or more offenses for which the aggregate sentences were 5years or more; who is coming to the United States to engage in prostitution or commercialized vice or who has engaged in prostitution or procuring within the past 10 years; who is or has been an illicit trafficker in any controlled substance; who has committed a serious criminal offense in the United States and who has asserted immunity from prosecution; who, while serving as a foreign government official and within the previous 24-month period, was responsible for or directly carried out particularly severe violations of religious freedom; or whom the President has identified as a person who plays a significant role in a severe form of trafficking in persons, who otherwise has knowingly aided, abetted, assisted or colluded with such a trafficker in severe forms of trafficking in persons, or who is the spouse, son or daughter of such a trafficker who knowingly has benefited from the trafficking activities within the past five years.  Yes  No√

c. An alien who seeks to enter the United States to engage in espionage, sabotage, export control violations, terrorist activities, the overthrow of the Government of the United States or other unlawful activity; who is a member of or affiliated with the Communist or other totalitarian party; who participated in Nazi persecutions or genocide; who has engaged in genocide; or who is a member or representative of a terrorist organization as currently designated by the U.S. Secretary of State.  Yes  No√

d. An alien who is likely to become a public charge.  Yes  No√

e. An alien who seeks to enter for the purpose of performing skilled or unskilled labor who has not been certified by the Secretary of Labor; who is a graduate of a foreign medical school seeking to perform medical services who has not passed the NBME exam or its equivalent; or who is a health care worker seeking to perform such work without a certificate from the CGFNS or from an equivalent approved independent credentialing organization.  Yes  No√

f. An alien who failed to attend a hearing on deportation or inadmissibility within the last 5 years; Who seeks or has sought a visa, entry into the United States, or any immigration benefit by fraud or misrepresentation; who knowingly attended in student (F) visa status a U.S. public elementary school or who attended a U.S. public secondary school without reimbursing the school; or who is subject to a civil penalty under INA 274C.  Yes  No√
Privacy Act and Paperwork Reduction Act Statements

The information asked for on this form is requested pursuant to Section 222 of the immigration and Nationality Act. The U.S. Department of State uses the facts you provide on this form primarily to determine your classification and eligibility for a U.S. Immigrant visa. Individuals who fail to submit this form or who do not provide all the requested information may be denied a U.S. immigrant visa. If you are issued an immigrant visa and are subsequently admitted to the United States as an immigrant, the Department of Homeland Security will use the information on this form to issue you a Permanent Resident Card, and, if you so indicate the Social Security Administration will use the information to issue you a social security number and card.

*Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/RPS/DIR) Washington, DC 20520.
Previous Editions Obsolete
ES-230 Part II Page 3 of 4

g. An alien who is permanently ineligible for U.S. citizenship; or who departed the United States to evade military service in time of war.  Yes  No√

h. An alien who was previously ordered removed within the last 5 years or ordered removed a second time within the last 20 years; who was previously unlawfully present and ordered removed within the last 10 years or ordered removed a previously unlawfully present in the United States for more than 180 days but less than one tear or an aggregate of one year within the last 10 years.  Yes  No√

i. An alien who is coming to the United States to practice polygamy; who withholds custody of a U.S. citizen child outside the United States from a person granted legal custody by a U.S. court or intentionally assists another person to do so; who has voted in the United States in violation of any law or regulation; or who renounced U.S. citizenship to avoid taxation.  Yes  No√

j. An alien who is a former exchange visitor who has not fulfilled the 2-year foreign residence requirement.  Yes  No√

k. An alien determined by the Attorney General to have knowingly made a frivolous application for asylum.  Yes  No√

l. An alien who has ordered, carried out or materially assisted in extrajudicial and political killings and other acts of violence against the Haitian people; who has directly or indirectly assisted or supported any of the groups in Colombia known as FARC, ELN, or AUC; who through abuse of a governmental or political position has converted for personal gain, confiscated or expropriated property in Cuba, a claim to which is owned by a national of the United States, has trafficked in such property or has been complicit in such conversion, has committed similar acts in another country, or is the spouse, minor child or agent of an alien who has committed such acts, who has been directly involved in the establishment or enforcement of population controls forcing a woman to undergo an abortion against her free choice of a man or a woman to undergo sterilization against his or her free choice: or who has disclosed or trafficked in confidential U.S business information obtained in connection with U.S. participation in the Chemical Weapons Convention or is the spouse, minor child or agent of such a person.  Yes  No√
31. Have you ever been charged, arrested or convicted of any offense or crime? (If Answer is Yes, please explain)  Yes  No√
32. Have you ever been refused admission to the United States at a port-f-entry? (If Answer is Yes, please explain)  Yes  No√
33a. Have you ever applied for a Social Security Number (SSN)?
 Yes Give The Number ------------------------------  No√

Do you want the Social Security Administration to assign you an SSN (and issue a card) or issue you a new card (if you have an SSN)? You must answer “Yes” to this question and to the “Consent To Disclosure” in order to receive an SSN and/of card.
 Yes√  No 33b. Consent to Disclosure: I authorize disclosure of information from this form to the Department of Homeland Security (DHS), the Social Security Administration (SSA), such other U.S. Government agencies as may be required for the purpose of assigning me an SSN And Issuing me a Social Security card, and I authorize the SSA to share my SSN with the INS.  Yes√  No

The applicant’s response does not limit or restrict the Government’s ability to obtain his or her SSN or other information on this form for enforcement or other purposes as authorized by law.
34. Where you Assisted in Completing this Application?  Yes√  No
(If answer is Yes, give name and address of person assisting you, indicating whether relative, friend, travel agent, attorney, or other)
HUSBAND
DO VOT WRITE BELOW THE FOLLOWING LINE
The consular officer will assist you in answering item 35.
DO NOT SIGN this form until instructed to do so by the consular officer
35. I claim to be:
 A Family-Sponsored Immigrant  I derive foreign state chargeability  Preference -------------------------
 An Employment-Based Immigrant under Sec. 202(b) through my ----------------------  Numerical limitation -------------
 A Diversity Immigrant (foreign state)
 A Special Category (Specify) ------------------------------------------------------
(Returning resident, Hong Kong, Tibetan, Private Legislation, etc.)
I understand that I am required to surrender my visa to the United States Immigration Office at the place where I apply to enter the United States, and that the possession of visa does not entitle me to enter the United States if at that time I am found to be inadmissible under the immigration laws.
I understand that any willfully false or misleading statement or willful concealment of a material fact made by me herein may subject me to permanent exclusion from the United States and, if I am admitted to the United States, may subject me to criminal prosecution and/or deportation.
I, the undersigned applicant for a United States immigrant visa, do solemnly swear (or affirm) that all statements which appear in this application, consisting of Form DS-230 Part I and Part II combined, have been made by me, including the answers to items 1 through 35 inclusive, and that they are true and complete the best of my knowledge and belief. I do further swear (or affirm) that, if admitted into the United States, I will not engage in activities which would be prejudicial to the public interest, or endanger the welfare, safety, or security of the United States; in activities which would be prohibited by the laws of the United States relating to espionage, sabotage, public disorder, or in other activities subversive to the national security; in any activity a purpose of which is the opposition to or the control, or overthrow of, the Government of the United States, by force, violence, or other unconstitutional means.
I understand that completion of this form by persons required by law to register with the Selective Service System (males 18 through 25 years of age) constitutes such registration in accordance with the Military Selective Act.

BLANK
-------------------------------------------------------------------------------------------------
Signature of Applicant


Subscribed and sworn to before me this --------------------------- day of ------------------------------ ---------------- at -----------------------------------------------