I-589 Form Table of Changes

TABLE OF CHANGES – FORM
Form I-589, Application for Asylum and for Withholding of Removal
OMB Number: 1615-0067
06/09/2020
Reason for Revision: Global Asylum Rule
Legend for Proposed Text:
• Black font = Current text
• Red font = Changes
Expires 09/30/2022
Edition Date 09/10/2019
Current Page Number
and Section
Page 1,
Start Here

Page 5-6,
Part B. Information
About Your Application

Current Text

Proposed Text

[Page 1]

[Page 1]

START HERE – Type or print in black ink.
See the instructions for information about
eligibility and how to complete and file this
application. There is no filing fee for this
application.

START HERE – Type or print in black ink.
See the instructions for information about
eligibility and how to complete and file this
application. There is no filing fee for this
application.

NOTE: Check this box if you also want to
apply for withholding of removal under the
Conventional Against Torture.

NOTE: Check this box if you also want to
apply for withholding of removal under the
Convention Against Torture (CAT) regulations.
Refer to Instructions, Part 1: Filing
Instructions, Section II, Basis of Eligibility,
Part B for more information.

[Page 5]

[Page 5]

Part B. Information About Your Application

Part B. Information About Your Application

(NOTE: Use Form I-589 Supplement B, or
attach additional sheets of paper as needed to
complete your responses to the questions
contained in Part B.)

(NOTE: Use Form I-589 Supplement B, or
attach additional sheets of paper as needed to
complete your responses to the questions
contained in Part B.)

When answering the following questions about
your asylum or other protection claim
(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 of
your claim to asylum or other protection. To
the best of your ability, provide specific dates,
places, and descriptions about each event or
action described. You must attach documents
evidencing the general conditions in the country
from which you are seeking asylum or other
protection and the specific facts on which you
are relying to support your claim. If this
documentation is unavailable or you are not
1

When answering the following questions about
your asylum or other protection claim
(withholding of removal under 241(b)(3) of the
INA (statutory withholding of removal) or
withholding of removal under the CAT
regulations), you must provide a detailed and
specific account of the basis of your claim to
asylum or other protection. To the best of your
ability, provide specific dates, places, and
descriptions about each event or action
described. You must attach documents
evidencing the general conditions in the country
from which you are seeking asylum or other
protection and the specific facts on which you
are relying to support your claim. If this

providing this documentation with your
application, explain why in your responses to
the following questions.

documentation is unavailable or you are not
providing this documentation with your
application, explain why in your responses to
the following questions.

Refer to Instructions, Part 1: Filing Instructions,
Section II, "Basis of Eligibility," Parts A - D,
Section V, Completing the Form," Part B, and
Section VII, "Additional Evidence That You
Should Submit," for more information on
completing this section of the form.

Refer to Instructions, Part 1: Filing Instructions,
Section II, "Basis of Eligibility," Parts A - D,
Section V, Completing the Form," Part B, and
Section VII, "Additional Evidence That You
Should Submit," for more information on
completing this section of the form.

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

1. Why are you applying for asylum and for
statutory withholding of removal, or for
withholding of removal under the CAT
regulations? Check the appropriate box(es)
below and then provide detailed answers to the
questions below.

I am seeking asylum or withholding of removal
based on:

I am seeking asylum or withholding of removal
based on:

Race
Religion
Nationality
Political opinion
Membership in a particular social group
Torture Convention

Race
Religion
Nationality
Political opinion
Membership in a particular social group
Torture Convention

[New]

If you are claiming membership in a particular
social group(s), identify the particular social
group(s):
[Fillable Field]

A. Have you, your family, or close friends or
colleagues ever experienced harm or
mistreatment or threats in the past by anyone?
No
Yes

A. Have you, your family, friends, colleagues,
or other similarly situated persons ever
experienced harm, mistreatment, or threats in
the past by anyone?
No
Yes

If “Yes,” explain in detail:
1. What happened;

If “Yes,” explain in detail:
1. What happened.
[Fillable field]

2. When the harm or mistreatment or threats
occurred;

2. When the harm, mistreatment, or threats
occurred.
[Fillable field]

3. Who caused the harm or mistreatment or
threats; and

3. Who caused the harm, mistreatment, or
threats.

[New]

[Fillable field]
If the entity or person(s) who caused the harm,
mistreatment, or threats is not the government
or a government actor, you must explain
whether the government was unable or
unwilling to control the entity or persons that
2

caused the harm, mistreatment, or threats.
Explain whether you ever reported the harm,
mistreatment, or threats to the government or a
government actor. If so, describe what you
reported, to whom, and any outcome of the
report. If you did not report the harm,
mistreatment, or threats to the government or a
government actor, explain why not.
[Fillable field]
4. Why you believe the harm or mistreatment
or threats occurred.
[Fillable field]

4. Why you believe the harm, mistreatment, or
threats occurred. If you are seeking asylum or
statutory withholding of removal based on one
or more of the protected grounds listed above
(race, religion, nationality, political opinion, or
membership in a particular social group), you
must explain why you believe the harm,
mistreatment, or threats you experienced were
on account of one or more of the protected
grounds.
[Fillable field]

B. Do you fear harm or mistreatment if you
return to your home country?
No
Yes

B. Do you fear harm or mistreatment if you
return to your home country?
No
Yes

If "Yes," explain in detail:
1. What harm or mistreatment you fear;

If "Yes," explain in detail:
1. What harm or mistreatment you fear.
[Fillable field]

2. Who you believe would harm or mistreat
you; and

2. Who you believe would harm or mistreat
you.

[New]

[Fillable field]
If the entity or person(s) who you believe would
harm or mistreat you is not the government or a
government actor, you must explain whether the
government would be unable or unwilling to
control the entity or person(s) that caused the
harm or mistreatment. Explain whether you
believe the government or a government actor
would be able and willing to protect you against
the harm or mistreatment you fear, and why or
why not.
[Fillable field]

3. Why you believe you would or could be
harmed or mistreated.
[Fillable field]

3

3. Why you believe you would or could be
harmed or mistreated. If you are seeking asylum
or statutory withholding of removal based on
one or more of the protected grounds listed
above (race, religion, nationality, political
opinion, or membership in a particular social
group), you must explain why you believe the
harm or mistreatment you fear are on account of

one or more of the protected grounds.
[Fillable field]
[Page 6]

[Page 6]

2. Have you or your family members ever been
accused, charged, arrested, detained,
interrogated, convicted and sentenced, or
imprisoned in any country other than the United
States (including for an immigration law
violation)?
No
Yes

[Moved down]

If "Yes," explain the circumstances and reasons
for the action.
[Fillable field]
3.A. Have you or your family members ever
belonged to or been associated with any
organizations or groups in your home country,
such as, but not limited to, a political party,
student group, labor union, religious
organization, military or paramilitary group,
civil patrol, guerrilla organization, ethnic group,
human rights group, or the press or media?
No
Yes
If "Yes," describe for each person the level of
participation, any leadership or other positions
held, and the length of time you or your family
members were involved in each organization or
activity.
[Fillable field]
3.B. Do you or your family members continue
to participate in any way in these organizations
or groups?
No
Yes
If "Yes," describe for each person your or your
family members' current level of participation,
any leadership or other positions currently held,
and the length of time you or your family
members have been involved in each
organization or group.
[Fillable field]
C. Have you, your family, friends, colleagues,
or other similarly situated persons ever been
subjected to torture in the past?
No
Yes

[New]

If “Yes,” explain in detail:
1. What happened.
[Fillable field]
4

2. When the torture occurred.
[Fillable field]
3. Who caused the harm, which, along with
other factors, amounted to torture.
[Fillable field]
If the entity or person(s) who caused the harm
was not the government or a public official
acting in an official capacity or other person
acting in an official capacity, you must explain
whether the harm was inflicted by or at the
instigation of, or with the consent or
acquiescence of, a public official acting in an
official capacity or other person acting in an
official capacity.
[Fillable Field]
If the entity or person(s) who caused the harm
was not the government or a government actor,
explain whether the government or a public
official acting in an official capacity or other
person acting in an official capacity had
awareness of the harm, how the government or
a public official acting in an official capacity or
other person acting in an official capacity
became aware of the harm, and whether the
government or a public official acting in an
official capacity or other person acting in an
official capacity acted to prevent such harm.
[Fillable Field]
If the entity or person(s) who caused the harm
was not the government or a public official
acting in an official capacity or other person
acting in an official capacity, explain whether
there is a connection between the government
or a public official acting in an official capacity
or other person acting in an official capacity and
the entity or person(s) who caused the harm,
and if so, describe the how they are connected.
[Fillable Field]
4. Why you believe the torture occurred.
[Fillable field]
4. Are you afraid of being subjected to torture
in your home country or any other country to
which you may be returned?
No
Yes

D. Are you afraid of being subjected to torture
in your home country or any other country to
which you may be returned?
No
Yes

If "Yes," explain why you are afraid and
describe the nature of torture you fear, by
whom, and why it would be inflicted.

If "Yes," explain in detail:

5

1. The nature of the harm you fear.

[Fillable field]

[Fillable field]
2. Who would harm you.

[New]

[Fillable field]
If the entity or person(s) you believe would
harm you is not the government or a public
official acting in an official capacity or other
person acting in an official capacity, you must
explain whether the harm would or could be
inflicted by or at the instigation of, or with the
consent or acquiescence of, a public official
acting in an official capacity or other person
acting in an official capacity.
[Fillable field]
If the entity or person(s) you fear is not the
government or a public official acting in an
official capacity or other person acting in an
official capacity, explain whether the
government or a public official acting in an
official capacity or other person acting in an
official capacity would become aware of the
torture, how the government or a public official
acting in an official capacity or other person
acting in an official capacity would become
aware of the torture, and how the government or
a public official acting in an official capacity or
other person acting in an official capacity would
respond.
[Fillable field]
If the entity or person(s) you fear is not the
government or a public official acting in an
official capacity or other person acting in an
official capacity, explain whether there is a
connection between the government or a public
official acting in an official capacity or other
person acting in an official capacity and the
entity or person(s) you fear, and if so, describe
the how they are connected.
[Fillable field]
3. Why you believe you would be tortured.
[Fillable field]
2. Have you or your family members ever been
accused, charged, arrested, detained,
interrogated, convicted and sentenced, or
imprisoned in any country other than the United
States (including for an immigration law
violation)?
No
Yes

[Moved from earlier section]

6

If "Yes," explain the circumstances and reasons
for the action.
[Fillable field]
3.A. Have you or your family members ever
belonged to or been associated with any
organizations or groups in your home country,
such as, but not limited to, a political party,
student group, labor union, religious
organization, military or paramilitary group,
civil patrol, guerrilla organization, ethnic group,
human rights group, or the press or media?
No
Yes
If "Yes," describe for each person the level of
participation, any leadership or other positions
held, and the length of time you or your family
members were involved in each organization or
activity.
[Fillable field]
3.B. Do you or your family members continue
to participate in any way in these organizations
or groups?
No
Yes
If "Yes," describe for each person your or your
family members' current level of participation,
any leadership or other positions currently held,
and the length of time you or your family
members have been involved in each
organization or group.
[Fillable field]

Page 7-8,
Part C. Additional
Information About Your
Application

[Page 7]

[Page 7]

Part C. Additional Information About Your
Application

Part C. Additional Information About Your
Application

(NOTE: Use Form I-589 Supplement B, or
attach additional sheets of paper as needed to
complete your responses to the questions
contained in Part C.)

(NOTE: Use Form I-589 Supplement B, or
attach additional sheets of paper as needed to
complete your responses to the questions
contained in Part C.)

1. Have you, your spouse, your child(ren), your
parents or your siblings ever applied to the U.S.
Government for refugee status, asylum, or
withholding of removal?
No
Yes

1. Have you ever applied to the U.S.
Government for refugee status or for asylum
and withholding of removal?
No
Yes

If "Yes," explain the decision and what
happened to any status you, your spouse, your
child(ren), your parents, or your siblings
received as a result of that decision. Indicate
whether or not you were included in a parent or
spouse's application. If so, include your parent
or spouse's A-number in your response. If you
have been denied asylum by an immigration
7

2. Have your spouse, your child(ren), your
parents, or your siblings ever applied to the U.S.
Government for refugee status or for asylum
and withholding of removal?
No
Yes
3. Have you ever been included as a dependent
in a spouse’s or parent’s application to the U.S.

judge or the Board of Immigration Appeals,
describe any change(s) in conditions in your
country or your own personal circumstances
since the date of the denial that may affect your
eligibility for asylum.
[Fillable field]

Government for refugee status or for asylum
and withholding of removal?
No
Yes
If you answered "Yes" to Item Number 1.,
Item Number 2. and/or Item Number 3.,
explain the decision and what happened to any
status you, your spouse, your child(ren), your
parents, or your siblings received as a result of
that decision.
[Fillable field]
If you answered “Yes” to Item Number 1.,
Item Number 2. and/or Item Number 3., also
provide your relative’s name, date of birth, and
A-Number, if available.
[Fillable field]
First Name
Middle Name
Last Name
Date of Birth
A-Number
If you have ever been denied asylum by an
immigration judge or the Board of Immigration
Appeals, you must describe in this application
any change(s) in conditions in your country or
your own personal circumstances since the date
of the denial that may affect your eligibility for
asylum. For guidance in answering this
question, see Instructions, Part 1: Filing
Instructions, Section I. Who May Apply and
Filing Deadlines and Part 1: Filing
Instructions, Section V. Completing the
Form, Part C.
[Fillable field]

2.A. After leaving the country from which you
are claiming asylum, did you or your spouse or
child(ren) who are now in the United States
travel through or reside in any other country
before entering the United States?
No
Yes

4.A. After leaving the country from which you
are claiming asylum, did you, your spouse,
child(ren), or other family members, such as
your parents or siblings, who are now in the
United States travel through or reside in any
other country before entering the United States?
No
Yes

2.B. Have you, your spouse, your child(ren), or
other family members, such as your parents or
siblings, ever applied for or received any lawful
status in any country other than the one from
which you are now claiming asylum?
No
Yes

4.B. Have you, your spouse, your child(ren), or
other family members, such as your parents or
siblings, ever applied for, received, or could
have applied for, but did not, any lawful status
in any country other than the one from which
you are now claiming asylum?
No
Yes

8

If "Yes" to either or both questions (2A and/or
2B), provide for each person the following: the
name of each country and the length of stay, the
person's status while there, the reasons for
leaving, whether or not the person is entitled to
return for lawful residence purposes, and
whether the person applied for refugee status or
for asylum while there, and if not, why he or
she did not do so.
[Fillable field]

If "Yes" to either or both questions (Item
Number 4.A. and/or Item Number 4.B.),
provide for each person the following: the name
of every country you, your spouse, your
child(ren), or other family members, such as
your parents or siblings, traveled through or
resided in, the dates you traveled through or
resided in those countries, the length of stay, the
person's status while there, and the reasons for
leaving.
[Fillable Field]
Indicate whether you, your spouse, your
child(ren), or other family members, such as
your parents or siblings, ever applied for
protection from persecution or torture, including
refugee status or asylum, while in any countries,
and if not, why you or he or she did not do so.
If you, your spouse, your child(ren), or your
family members, such as your parents or
siblings, ever applied for any lawful status,
including refugee status or asylum, in any
country other than the one from which you are
now claiming asylum, explain the outcome of
the application.
[Fillable Field]
Indicate whether you, your spouse, your
child(ren), or other family members, such as
your parents or siblings, applied to, were
offered the opportunity to apply to, or had the
opportunity available to reside in any country,
in any permanent legal immigration status or
any non-permanent, potentially indefinitely
renewable legal immigration status (including
asylee, refugee, or similar status, but excluding
status such as of a tourist) in any country
through which you traveled prior to arriving in
or entering the United States.
[Fillable field]

3. Have you, your spouse or your child(ren)
ever ordered, incited, assisted or otherwise
participated in causing harm or suffering to any
person because of his or her race, religion,
nationality, membership in a particular social
group or belief in a particular political opinion?
No
Yes

5. Have you, your spouse or your child(ren)
ever ordered, incited, assisted or otherwise
participated in causing harm or suffering to any
person because of his or her race, religion,
nationality, membership in a particular social
group or belief in a particular political opinion?
No
Yes

If "Yes," describe in detail each such incident
and your own, your spouse's, or your
child(ren)'s involvement.
[Fillable field]

If "Yes," describe in detail each such incident
and your own, your spouse's, or your
child(ren)'s involvement.
[Fillable field]

[Page 8]

[Page 8]
9

4. After you left the country where you were
harmed or fear harm, did you return to that
country?
No
Yes

6. After you left the country where you were
harmed or fear harm, did you return to that
country?
No
Yes

If "Yes," describe in detail the circumstances of
your visit(s) (for example, the date(s) of the
trip(s), the purpose(s) of the trip(s), and the
length of time you remained in that country for
the visit(s).)
[Fillable field]

If "Yes," describe in detail the circumstances of
your visit(s) (for example, the date(s) of the
trip(s), the purpose(s) of the trip(s), and the
length of time you remained in that country for
the visit(s).)
[Fillable field]

5. Are you filing this application more than 1
year after your last arrival in the United States?
No
Yes

7. Are you filing this application more than 1
year after your last arrival in the United States?
No
Yes

If "Yes," explain why you did not file within the
first year after you arrived. You must be
prepared to explain at your interview or hearing
why you did not file your asylum application
within the first year after you arrived. For
guidance in answering this question, see
Instructions, Part 1: Filing Instructions, Section
V. "Completing the Form," Part C.
[Fillable field]

If "Yes," explain why you did not file within the
first year after you arrived. You must be
prepared to explain at your interview or hearing
why you did not file your asylum application
within the first year after you arrived. For
guidance in answering this question, see
Instructions, Part 1: Filing Instructions, Section
V. "Completing the Form," Part C.
[Fillable field]

6. Have you or any member of your family
included in the application ever committed any
crime and/or been arrested, charged, convicted,
or sentenced for any crimes in the United States
(including for an immigration law violation)?
No
Yes

8. Have you or any member of your family
included in the application ever committed any
crime and/or been arrested, charged, convicted,
or sentenced for any crimes in the United States
(including for an immigration law violation)?
No
Yes

If "Yes," for each instance, specify in your
response: what occurred and the circumstances,
dates, length of sentence received, location, the
duration of the detention or imprisonment,
reason(s) for the detention or conviction, any
formal charges that were lodged against you or
your relatives included in your application, and
the reason(s) for release. Attach documents
referring to these incidents, if they are available,
or an explanation of why documents are not
available.
[Fillable field]

If "Yes," for each instance, specify in your
response: what occurred and the circumstances,
dates, length of sentence received, location, the
duration of the detention or imprisonment,
reason(s) for the detention or conviction, any
formal charges that were lodged against you or
your relatives included in your application, and
the reason(s) for release. Attach documents
referring to these incidents, if they are available,
or an explanation of why documents are not
available.
[Fillable field]

[New]

The following questions focus on adverse
discretionary factors related to asylum
eligibility. You must answer Item Numbers
9.A. – 10.I. as it relates to you and any member
of your family included in the application. For
guidance in answering these questions, see
Instructions, Part 1: Filing Instructions,
Section V. Completing the Form, Part C.
Additional Information about your
Application.
10

9.A. Have you or any member of your family
included in the application ever unlawfully
entered or unlawfully attempted to enter into the
United States?
No
Yes
9.B. Did you or any member of your family
included in the application fail to seek
protection from persecution or torture, including
refugee status or asylum, in any country through
which you transited before entering the United
States?
No
Yes
9.C. Have you or any member of your family
included in the application used fraudulent
documents to enter the United States?
No
Yes
If “Yes”, specify in your response: what
occurred, the circumstances, dates, and the
reason(s) for the circumstances.
[Fillable field]
If you answered “Yes” to Item Numbers 9.A.,
9.B., and/or 9.C., do any of the corresponding
exceptions (for example, entry or attempted
entry was made in immediate flight from
persecution or satisfying the definition of victim
of a severe form of trafficking in persons) apply
to you or any member of your family included
in the application?
No
Yes
If “Yes”, please specify in your response: why
you believe you or any member of your family
included in the application meet one of the
exceptions, what occurred, the circumstances,
dates, and the reason(s) for the circumstances.
[Fillable Field]
10.A. Did you or any member of your family
included in the application, immediately prior to
arriving in the United States or en route to the
United States from your or their country of
citizenship, nationality, or last lawful habitual
residence, spend more than 14 days in any one
country?
No
Yes
10.B. Do you or any member of your family
included in the application have a conviction or
sentence that was reversed, vacated, expunged,
or modified?
No
11

Yes
10.C. Did you or any member of your family
included in the application transit through more
than one country between your or their country
of citizenship, nationality, or last habitual
residence and the United States?
No
Yes
10.D. Did you or any member of your family
included in the application accrue more than
one year of unlawful presence in the United
States prior to filing an asylum application?
No
Yes
10.E. At the time this application is filed, have
you failed to timely file any required federal,
state, or local income taxes, or timely file a
request for an extension of time to file?
No
Yes
10.F. At the time this application is filed, have
you failed to satisfy any outstanding federal,
state, or local income tax obligations?
No
Yes
10.G. At the time this application is filed, do
you have income that would result in tax
liability that has not been reported to the
Internal Revenue Service?
No
Yes
10.H. Have you or any member of your family
included in the application had two or more
prior asylum applications denied for any
reason?
No
Yes
10.I. Have you or any member of your family
included in the application withdrawn a prior
asylum application, been found to have
abandoned a prior asylum application, failed to
attend an interview regarding an asylum
application, or were subject to a final order of
removal, deportation, or exclusion, and did not
file a motion to reopen?
No
Yes
If you answered “Yes” to any of the questions
in Item Numbers 10.A. - 10.I., please specify
in your response: what occurred, details
regarding the circumstances, and dates.
[Fillable field]
12

If you answered “Yes” to any of the questions
in Item Numbers 10.A. - 10.I., do any of the
corresponding exceptions (for example,
applying for protection from persecution or
torture in another country or satisfying the
definition of victim of a severe form of
trafficking in persons) apply to you or any
member of your family included in the
application?
No
Yes
If you answered “Yes”, please specify in your
response: why you believe you or any member
of your family included in the application meet
one of the exceptions, what occurred, the
circumstances, dates, and the reason(s) for the
circumstances.
[Fillable Field]
If you answered “Yes” to any of the questions
in Item Numbers 10.A. - 10.I., if applicable,
provide any information related to extraordinary
circumstances that would warrant a favorable
exercise of discretion, and explain any
exceptional or extremely unusual hardship that
would result from a denial of your asylum
application.
[Fillable field]

Page 9,
Part D. Your Signature

[Page 9]

[Page 9]

Part D. Your Signature

Part D. Your Signature

I certify, under penalty of perjury under the
laws of the United States of America, that this
application and the evidence submitted with it
are all true and correct. Title 18, United States
Code, Section 1546(a), provides in part:
Whoever knowingly makes under oath, or as
permitted under penalty of perjury under
Section 1746 of Title 28, United States Code,
knowingly subscribes as true, any false
statement with respect to a material fact in any
application, affidavit, or other document
required by the immigration laws or regulations
prescribed thereunder, or knowingly presents
any such application, affidavit, or other
document containing any such false statement
or which fails to contain any reasonable basis in
law or fact - shall be fined in accordance with
this title or imprisoned for up to 25 years. I
authorize the release of any information from
my immigration record that U.S. Citizenship
and Immigration Services (USCIS) needs to
determine eligibility for the benefit I am
seeking.

I certify, under penalty of perjury under the
laws of the United States of America, that this
application and the evidence submitted with it
are all true and correct. Title 18, United States
Code, Section 1546(a), provides in part:
Whoever knowingly makes under oath, or as
permitted under penalty of perjury under
Section 1746 of Title 28, United States Code,
knowingly subscribes as true, any false
statement with respect to a material fact in any
application, affidavit, or other document
required by the immigration laws or regulations
prescribed thereunder, or knowingly presents
any such application, affidavit, or other
document containing any such false statement
or which fails to contain any reasonable basis in
law or fact - shall be fined in accordance with
this title or imprisoned for up to 25 years. I
authorize the release of any information from
my immigration record that U.S. Citizenship
and Immigration Services (USCIS) needs to
determine eligibility for the benefit I am
seeking.

13

[Staple your photograph here or the photograph
of the family member to be included on the
extra copy of the application submitted for that
person.]

[Staple your photograph here or the photograph
of the family member to be included on the
extra copy of the application submitted for that
person.]

WARNING: Applicants who are in the
United States unlawfully are subject to
removal if their asylum or withholding
claims are not granted by an asylum officer
or an immigration judge. Any information
provided in completing this application may
be used as a basis for the institution of, or as
evidence in, removal proceedings even if the
application is later withdrawn.

WARNING: Applicants who are in the
United States unlawfully are subject to
removal if their asylum or withholding
claims are not granted by an asylum officer
or an immigration judge. Any information
provided in completing this application may
be used as a basis for the institution of, or as
evidence in, removal proceedings even if the
application is later withdrawn.

Applicants determined to have knowingly
made a frivolous application for asylum will
be permanently ineligible for any benefits
under the Immigration and Nationality Act.
You may not avoid a frivolous finding simply
because someone advised you to provide false
information in your asylum application.

If an asylum officer determines that you have
knowingly made a frivolous application for
asylum, that determination may be used as a
basis for the institution of, or as evidence in,
removal proceedings. If, pursuant to a final
administrative order, an immigration judge
or the Board of Immigration Appeals
determines that you have knowingly made a
frivolous application for asylum, you will be
permanently ineligible for any benefits under
the Immigration and Nationality Act. You
may not avoid a frivolous finding simply
because someone advised you to provide false
information in your asylum application.

If filing with USCIS, unexcused failure to
appear for an appointment to provide
biometrics (such as fingerprints) and your
biographical information within the time
allowed may result in an asylum officer
dismissing your asylum application or
referring it to an immigration judge. Failure
without good cause to provide DHS with
biometrics or other biographical information
while in removal proceedings may result in
your application being found abandoned by
the immigration judge. See sections
208(d)(5)(A) and 208(d)(6) of the INA and 8
CFR sections 208.10, 1208.10, 208.20,
1003.47(d) and 1208.20.

If filing with USCIS, unexcused failure to
appear for an appointment to provide
biometrics (such as fingerprints) and your
biographical information within the time
allowed or unexcused failure to appear for
an asylum interview may result in an asylum
officer dismissing your asylum application or
referring it to an immigration judge. Failure
without good cause to provide DHS with
biometrics or other biographical information
while in removal proceedings may result in
your application being found abandoned by
the immigration judge. See sections
208(d)(5)(A) and 208(d)(6) of the INA and 8
CFR sections 208.10, 1208.10, 208.20,
1003.47(d) and 1208.20.

Print your complete name.
Write your name in your native alphabet.

Print your complete name.
Write your name in your native alphabet.

Did your spouse, parent, or child(ren) assist you
in completing this application?
No
Yes (If "Yes," list the name and relationship.)
(Name) [x2]
(Relationship) [x2]

Did your spouse, parent, or child(ren) assist you
in completing this application?
No
Yes (If "Yes," list the name and relationship.)
(Name) [x2]
(Relationship) [x2]

Did someone other than your spouse, parent, or
child(ren) prepare this application?
No
Yes (If "Yes,"complete Part E.)

Did someone other than your spouse, parent, or
child(ren) prepare this application?
No
Yes (If "Yes,"complete Part E.)

14

Page 10,
Part F. To Be
Completed at Asylum
Interview, if Applicable

Page 10,
Part G. To Be
Completed at Removal
Hearing, if Applicable

Asylum applicants may be represented by
counsel. Have you been provided with a list of
persons who may be available to assist you, at
little or no cost, with your asylum claim?
No
Yes

Asylum applicants may be represented by
counsel. Have you been provided with a list of
persons who may be available to assist you, at
little or no cost, with your asylum claim?
No
Yes

Signature of Applicant (The person in Part A.I.)
Sign your name so it all appears within the
brackets

Signature of Applicant (The person in Part A.I.)
Sign your name so it all appears within the
brackets

[Page 10]

[Page 10]

Part F. To Be Completed at Asylum
Interview, if Applicable

Part F. To Be Completed at Asylum
Interview, if Applicable

NOTE: You will be asked to complete this part
when you appear for examination before an
asylum officer of the Department of Homeland
Security, U.S. Citizenship and Immigration
Services (USCIS).

NOTE: You will be asked to complete this part
when you appear for examination before an
asylum officer of the Department of Homeland
Security, U.S. Citizenship and Immigration
Services (USCIS).

I swear (affirm) that I know the contents of this
application that I am signing, including the
attached documents and supplements, that they
are all true or/not all true to the best of my
knowledge and that correction(s) numbered
[Fillable field] to [Fillable field] were made by
me or at my request. Furthermore, I am aware
that if I am determined to have knowingly made
a frivolous application for asylum I will be
permanently ineligible for any benefits under
the Immigration and Nationality Act, and that I
may not avoid a frivolous finding simply
because someone advised me to provide false
information in my asylum application.

I swear (affirm) that I know the contents of this
application that I am signing, including the
attached documents and supplements, that they
are all true or/not all true to the best of my
knowledge and that correction(s) numbered
[Fillable field] to [Fillable field] were made by
me or at my request. I am aware that if an
asylum officer determines that I knowingly
made a frivolous application for asylum, such
determination may be used as a basis for the
institution of, or as evidence in, removal
proceedings. Furthermore, I am aware that if,
pursuant to a final administrative order, an
immigration judge or the Board of Immigration
Appeals determines that I have knowingly made
a frivolous application for asylum, I will be
permanently ineligible for any benefits under
the Immigration and Nationality Act, and that I
may not avoid a frivolous finding simply
because someone advised me to provide false
information in my asylum application.

Signed and sworn to before me by the above
named applicant on:
Signature of Applicant
Date (mm/dd/yyyy)
Write Your Name in Your Native Alphabet
Signature of Asylum Officer

Signed and sworn to before me by the above
named applicant on:
Signature of Applicant
Date (mm/dd/yyyy)
Write Your Name in Your Native Alphabet
Signature of Asylum Officer

[Page 10]

[Page 10]

Part G. To Be Completed at Removal
Hearing, if Applicable

Part G. To Be Completed at Removal
Hearing, if Applicable

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

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

15

hearing.

hearing.

I swear (affirm) that I know the contents of this
application that I am signing, including the
attached documents and supplements, that they
are all true or/not all true to the best of my
knowledge and that correction(s) numbered
[Fillable field] to [Fillable field] were made by
me or at my request. Furthermore, I am aware
that if I am determined to have knowingly made
a frivolous application for asylum I will be
permanently ineligible for any benefits under
the Immigration and Nationality Act, and that I
may not avoid a frivolous finding simply
because someone advised me to provide false
information in my asylum application.

I swear (affirm) that I know the contents of this
application that I am signing, including the
attached documents and supplements, that they
are all true or/not all true to the best of my
knowledge and that correction(s) numbered
[Fillable field] to [Fillable field] were made by
me or at my request. Furthermore, I am aware
that if, pursuant to a final administrative order,
an immigration judge or the Board of
Immigration Appeals determines that I have
knowingly made a frivolous application for
asylum, I will be permanently ineligible for any
benefits under the Immigration and Nationality
Act, and that I may not avoid a frivolous finding
simply because someone advised me to provide
false information in my asylum application.

Signed and sworn to before me by the above
named applicant on:
Signature of Applicant
Date (mm/dd/yyyy)
Write Your Name in Your Native Alphabet
Signature of Immigration Judge

16

Signed and sworn to before me by the above
named applicant on:
Signature of Applicant
Date (mm/dd/yyyy)
Write Your Name in Your Native Alphabet
Signature of Immigration Judge