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Client Information Form

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Legal Name (Last Name First Middle)
Date of Birth (mm/dd/yy)

Other names used
Citizen of
Place of Birth (City, State, Country)
Permanent address abroad
Passport and Visa Information
Means of travel into U.S.
Date of arrival
Arrival at
Visa Class
Passport (Country, Number, Issuance Date, Expiration Date)

Visa Stamp (Consulate Issued, Number, Issuance Date, Expiration Date)
Employment: last 5 years
Name of the Company - City, Country - Occupation/Job Title - Start & End Date

Last Employer abroad - Name - City - State - Country - Occupation - mm/yy
Family: Spouse and all children (Full Name - Relationship - Date of Birth - Place of Birth - Current Address
Father - U.S. Citizen
U.S. Permanent Resident
Mother - U.S. Citizen
U.S. Permanent Resident
DOB Child - U.S. Citizen
U.S. Permanent Resident
DOB Child - U.S. Citizen
U.S. Permanent Resident
DOB Child - U.S. Citizen
U.S. Permanent Resident
Education (School - City, Stata - Country - Field of Study - From/to (mm/yy) Degree  
I hereby certify that the above information is true and correct to the best of my knowledge.

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