Form I-730 Form I-730 Refugee/Asylee Relative Petition

OMB No. 1615-0037; Expires 01/31/2015

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

I-730, Refugee/Asylee Relative Petition

DO NOT WRITE IN THIS BLOCK - FOR USCIS OFFICE ONLY
Action Stamp

Section of Law
207 (c)(2) Spouse

Receipt

207 (c)(2) Child
208 (b)(3) Spouse
208 (b)(3) Child

Remarks

Reserved

Beneficiary Not Previously Claimed
Beneficiary Previously Claimed On:

(e.g., Form I-590, Form I-589, etc.)

Yes

CSPA Eligible:

N/A

No

START HERE - Type or print legibly in black ink.
My Status:

Refugee
Asylee

The beneficiary is my:

Lawful Permanent Resident based on previous Refugee status
Lawful Permanent Resident based on previous Asylee status
Spouse
Biological Child

Unmarried child who is a (n):

(

Number of relatives for whom I am filing separate Form I-730s:
Part 1. Information About You, the Petitioner

Stepchild

Adopted Child

)

of

Part 2. Information About Your Alien Relative, the Beneficiary

Family Name (Last name), Given Name (First name), Middle Name:

Family Name (Last name), Given Name (First name), Middle Name:

Address of Residence (Where you physically reside)
Street Number and Name:
Apt. Number

Address of Residence (Where the beneficiary physically resides)
Apt. Number
Street Number and Name:

City:

State or Province:

City:

State or Province:

Country:

Zip/Postal Code:

Country:

Zip/Postal Code:

Mailing Address (If different from residence) - C/O:
Apt. Number:

Street Number and Name:

Mailing Address (If different from residence) - C/O:
Apt. Number

Street Number and Name:

City:

State or Province:

City:

Country:

Zip/Postal Code:

Country:

State or Province:
Zip/Postal Code:

Telephone Number including Country and City/Area Code:

Telephone Number including Country and City/Area Code:

Your E-Mail Address, if available:

The Beneficiary's E-Mail Address, if available:

Gender: a.
b.

Male

Male

Gender:

Country of Citizenship/Nationality:

Female
b.
Country of Birth:

Female

Country of Birth:

a.

Date of Birth (mm/dd/yyyy):

U.S. Alien Registration Number: U.S. Social Security Number
(If applicable):
A-

Date of Birth (mm/dd/yyyy):
Country of Citizenship/Nationality:

U.S. Alien Registration Number:

U.S. Social Security Number
(If applicable):

AForm I-730 (01/15/13) N Page 1

Part 1. Information About You, the Petitioner
(Continued)

Part 2. Information About Your Alien Relative, the
Beneficiary (Continued)

Other Name(s) Used (Including maiden name):

Other Name(s) Used (Including maiden name):

If married, Name of Spouse, Date (mm/dd/yyyy), and Place of
Present Marriage:

If married, Name of Spouse, Date (mm/dd/yyyy), and Place of
Present Marriage:

If previously married, name(s) of prior spouse(s):

If previously married, name(s) of Prior Spouse(s):

Date(s) (mm/dd/yyyy) and Place(s) Previous Marriage(s) Ended:
Please provide documentation indicating how marriage(s) ended
(e.g., death certificate, divorce certificate, etc.):

Date(s) (mm/dd/yyyy) and Place(s) Previous Marriage(s) Ended:
Please provide documentation indicating how marriage(s) ended
(e.g., death certificate, divorce certificate, etc.):

Date (mm/dd/yyyy) and Place Asylee Status was granted in the
United States

OR
Date (mm/dd/yyyy) and Place you received your approval for
Refugee Status while living abroad

If You Were Approved for Refugee Status, Date (mm/dd/yyyy)
and Place Admitted to the United States as a Refugee:

Beneficiary is currently in the United States.
Beneficiary is outside the United States and will apply for
travel authorization at a USCIS Office or a U.S. Embassy or
consulate in:
City and Country

To Be Completed By
Attorney or Representative, if any.
Fill in box if G-28 is attached to represent the petitioner.
Volag Number:
Attorney State License
Number:

Part 2. Information About Your Alien Relative, the Beneficiary (Continued)
Name and mailing address of the beneficiary written in the language of the country where he or she now resides:
Family Name:

Given Name:

Middle Name:

Address - C/O:
Apt. Number:

Street Number and Name:
City/State or Province:

Country:

Zip/Postal Code:

Check the box, a through d, that applies:
a.
The beneficiary has never been in the United States
b.
c.
d.

The beneficiary is now in immigration court proceedings in the
United States Where?
The beneficiary has never been in immigration court proceedings in the United States
The beneficiary is not now in immigration court proceedings in the
United States, but has been in the past. Where?

What is the beneficiary's native language?

Is the beneficiary fluent in English? What other language(s) does the beneficiary speak
fluently:
No
Yes

Form I-730 (01/15/13) N Page 2

Part 2. Information About Your Alien Relative, the Beneficiary (Continued)
List each of the beneficiary's entries into the United States; if any, beginning with the most recent entry. Submit a copy of each I-94
and/or copy of the beneficiary's passport showing all the entry and exit stamps for each entry. Attach an additional sheet if the
beneficiary has more than two entries into the United States:
Date of Arrival (mm/dd/yyyy): Place (City and State):

Status:

I-94 Number:

Date Status Expires (mm/dd/yyyy):

Travel Document Number:

Expiration Date for Passport
or Travel Document:

Passport Number:

Country of Issuance for Passport or Travel Document:

Date of Arrival (mm/dd/yyyy): Place (City and State):

Status:

I-94 Number:

Date Status Expires (mm/dd/yyyy):

Travel Document Number:

Expiration Date for Passport
or Travel Document:

Passport Number:

Country of Issuance for Passport or Travel Document:

Part 3. 2-Year Filing Deadline
Are you filing this application more than 2 years after the date you were admitted to the United States as a refugee or granted asylee
Yes
status?
No
If you answered "Yes" to the previous question, explain the delay in filing and submit evidence to support your explanation (Attach
additional sheets of paper if necessary):

Part 4. Warning
WARNING: Any beneficiary who is in the United States illegally is subject to removal if Form I-730 is not granted by USCIS. Any
information provided in completing this petition may be used as a basis for the institution of, or as evidence in, removal
proceedings, even if the petition is later withdrawn. Unexcused failure by the beneficiary to appear for an appointment to provide
biometrics (such as fingerprints and photographs) and biographical information within the time allowed may result in denial of
Form I-730. Information provided on this form and biometrics and biographical information provided by the beneficiary may also
be used in producing an Employment Authorization Document if the beneficiary is granted derivative refugee or asylee status.

Form I-730 (01/15/13) N Page 3

Read the information on penalties in the instructions and the warning in Part 4 before completing this section and
sign below. If someone other than the beneficiary helped you to prepare this petition, that person must complete
Part 7.

Part 5. Signature of Petitioner

I certify or, if outside the United States, I swear or affirm, under penalty of perjury under the laws of the United States of America, that this petition and the evidence
submitted with it is all true and correct. I authorize the release of any information from my record that U.S. Citizenship and Immigration Services needs to determine
eligibility for the benefit I am seeking.

Signature

Print Full Name

Date (mm/dd/yyyy)

Daytime Telephone Number

NOTE: If you do not completely fill out this form or if you fail to submit the required documents listed in the instructions, your relative may not be found eligible for the
requested benefit and this petition may be denied.

Part 6. Signature of Beneficiary,
if in the United States

Read the information on penalties in the instructions and the warning in Part 4 before completing this
section and sign below. If someone other than the petitioner helped you to prepare this petition, that person
must complete Part 7.

NOTE: If the beneficiary is not currently in the United States, this section should be left blank.
I certify under penalty of perjury under the laws of the United States of America, that this petition and the evidence submitted with it is all true and correct. I authorize
the release of any information from my record that U.S. Citizenship and Immigration Services needs to determine eligibilty for the benefit I am seeking.

Signature

Print Full Name

Date (mm/dd/yyyy)

Daytime Telephone Number

NOTE: If you do not completely fill out this form or if you fail to submit the required documents and biometrics listed in the instructions, you may not be found eligible
for the requested benefit and this petition may be denied.

Part 7. Signature of Person Preparing Form, If Other Than Petitioner or Beneficiary Above
I declare that I prepared this petition at the request of
knowledge.

Signature

Print Full Name

(name of person(s) above), and it is based on all of the information of which I have

Date (mm/dd/yyyy)

Firm Name and Address

Daytime Telephone Number
E-Mail Address (If any)

Part 8. To Be Completed at Interview of Beneficiary, If Applicable (14 years of age or older)
Beneficiaries in the United States will be interviewed by USCIS officers. Their petitioners may also be interviewed. Beneficiaries living overseas will be interviewed
by a USCIS officer or a DOS consular officer.
I swear (affirm) that I know the contents of this petition that I am signing, including the attached documents and supplements, and that they are
all true or
not all true to the best of my knowledge and that correction(s) numbered
to
were made
by me or at my request. With these corrections, the information on this form is now true.
Signed and sworn before me by the beneficiary named herein on:

Signature of Beneficiary

Write your Name in your Native Alphabet
Beneficiary Approved for Travel, Admission Code:

Date (mm/dd/yyyy)

Signature of USCIS Officer or DOS Consular Officer

CBP Action Block

Petition Returned to Service Center via NVC

Form I-730 (01/15/13) N Page 4