Information Form, Diversity Lottery 2001
1. Name:
_________________________________________________
Last, First, Middle
2. Date of Birth:
__________/___________/__________
Day, Month, Year
3. Place of Birth (City, Province or other political subdivision and Country):
_________________________________________________________
4. Are Spouse & Children applying? Yes / No
Include(1) Full Name(Last,First,Middle) (2) Date of Birth (3)Place of Birth(city,province,country)
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
5. Current Place of Residence & Mailing Address:
______________________________________________________________
No. & Name of Street, Apartment No. ______________________________________________________________
City, State/Province, Country, Zip Code
6. Applicant's Native Country if Different from Country of Birth
____________________________________________________________
7.PHOTOGRAPH: (Attach a recent, preferably less than 6 months old, photograph of the applicant, 1.5 inches (37 mm) square in size, with the applicant's name printed on the back. The photograph (not a photocopy) should be attached to the entry with clear tape--do NOT use staples or paperclips, which can jam the mail processing equipment.)
8. SIGNATURE: ________________________________________________________
Use the following example when you mail your Envelope.
Make sure to put the current DV Program year, eg: DV 2001, DV 2002...
This information is provided for those who needs help and learn about Diversity Immigrant Visa Program(DV-2001).
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