Fillable and for Withholding of Removal I-589, Application for (American Immigration Lawyers Association)

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and for Withholding of Removal I-589, Application for (American Immigration Lawyers Association)

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9. Mailing Address in the U.S. (if different than the address in Item Number 8)
8. Residence in the U.S. (where you physically reside)
Telephone Number
Telephone Number
(
Department of Homeland Security
U.S. Citizenship and Immigration Services
18. Check the box, a through c, that applies:
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.
Part A.I. Information About You
1. Alien Registration Number(s) (A-Number) (if any) 2. U.S. Social Security Number (if any)
4. Complete Last Name
7. What other names have you used (include maiden name and aliases)?
Street Number and Name
City
12. Date of Birth (mm/dd/yyyy)
14. Present Nationality (Citizenship)
5. First Name 6. Middle Name
)
Apt. Number
State
Zip Code
Apt. Number
Street Number and Name
Zip Code
City
State
10. Gender:
Male Female
11. Marital Status:
Single Married Divorced Widowed
13. City and Country of Birth
15. Nationality at Birth 16. Race, Ethnic, or Tribal Group
17. Religion
I have never been in Immigration Court proceedings.
I am not now in Immigration Court proceedings, but I have been in the past.
I am now in Immigration Court proceedings.
a.
c.b.
Form I-589 (Rev. 09/10/19)
NOTE: Check this box if you also want to apply for withholding of removal under the Convention Against Torture (CAT)
( )
In Care Of (if applicable):
U.S. Department of Justice
Executive Office for Immigration Review
OMB No. 1615-0067; Expires 09/30/2022
I-589, Application for Asylum
and for Withholding of Removal
3. USCIS Online Account Number (if any)
For EOIR use only.
For
USCIS
use only.
Action: Decision:
Asylum Officer ID No.:
Approval Date:
Denial Date:
Referral Date:
Interview Date:
regulations. Refer to Instructions, Part 1: Filing Instructions, Section II, Basis of Eligibility, Part B for more information.
19. Complete 19 a through c.
a. When did you last leave your country? (mm/dd/yyyy) b. What is your current I-94 Number, if any?
c. List each entry into the U.S. beginning with your most recent entry. List date (mm/dd/yyyy), place, and your status for each entry.
(Attach additional sheets as needed.)
Date
Place
Status
Date Place Status
Date Place Status
Date Status Expires
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20. What country issued your last passport or travel
document?
21. Passport Number
Travel Document Number
22. Expiration Date
(mm/dd/yyyy)
23. What is your native language (include dialect, if applicable)?
24. Are you fluent in English?
Yes No
25. What other languages do you speak fluently?
24. If in the U.S., is your spouse to be included in this application? (Check the appropriate box.)
15. Is this person in the U.S.?
14. Gender
1. Alien Registration Number (A-Number)
(if any)
5. Complete Last Name
9. Date of Marriage (mm/dd/yyyy)
12. Nationality (Citizenship)
16. Place of last entry into the U.S.
20. What is your spouse's
current status?
2. Passport/ID Card Number
(if any)
3. Date of Birth (mm/dd/yyyy)
4. U.S. Social Security Number
(if any)
6. First Name 7. Middle Name 8. Other names used (include
maiden name and aliases)
10. Place of Marriage 11. City and Country of Birth
13. Race, Ethnic, or Tribal Group
Male Female
No (Specify location):
17. Date of last entry into the
U.S. (mm/dd/yyyy)
18. I-94 Number (if any)
19. Status when last admitted
(Visa type, if any)
21. What is the expiration date of his/her
authorized stay, if any? (mm/dd/yyyy)
23. If previously in the U.S., date of
previous arrival (mm/dd/yyyy)
22. Is your spouse in Immigration
Court proceedings?
Yes No
Yes (Attach one photograph of your spouse in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
Yes (Complete Blocks 16 to 24.)
I am not married. (Skip to Your Children below.)Your spouse
Part A.II. Information About Your Spouse and Children
Your Children. List all of your children, regardless of age, location, or marital status.
I have children.
Total number of children:
.
(NOTE: Use Form I-589 Supplement A or attach additional sheets of paper and documentation if you have more than four children.)
I do not have any children. (Skip to Part. A.III., Information about your background.)
13. Is this child in the U.S. ?
5. Complete Last Name
9. City and Country of Birth
6. First Name 7. Middle Name 8. Date of Birth (mm/dd/yyyy)
10. Nationality (Citizenship) 11. Race, Ethnic, or Tribal Group
12. Gender
1. Alien Registration Number
(A-Number)
(if any)
2. Passport/ID Card Number
(if any)
3. Marital Status (Married, Single,
Divorced, Widowed)
4. U.S. Social Security Number
(if any)
Male Female
Yes (Complete Blocks 14 to 21.) No (Specify location):
14. Place of last entry into the U.S.
15. Date of last entry into the
U.S. (mm/dd/yyyy)
16. I-94 Number (If any)
17. Status when last admitted
(Visa type, if any)
18. What is your child's current status?
19. What is the expiration date of his/her
authorized stay, if any? (mm/dd/yyyy)
20. Is your child in Immigration Court proceedings?
Yes No
Part A.I. Information About You (continued)
Form I-589 (Rev. 09/10/19) Page 2
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Form I-589 (Rev. 09/10/19) Page 3
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
Yes (Attach one photograph of your child in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
13. Is this child in the U.S. ?
5. Complete Last Name
9. City and Country of Birth
6. First Name 7. Middle Name 8. Date of Birth (mm/dd/yyyy)
10. Nationality (Citizenship)
12. Gender
14. Place of last entry into the U.S.
15. Date of last entry into the
U.S. (mm/dd/yyyy)
16. I-94 Number (If any)
17. Status when last admitted
(Visa type, if any)
18. What is your child's current status?
19. What is the expiration date of his/her
authorized stay, if any? (mm/dd/yyyy)
20. Is your child in Immigration Court proceedings?
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
Yes No
Yes (Attach one photograph of your spouse in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
1. Alien Registration Number (A-Number)
(if any)
2. Passport/ID Card Number
(if any)
3. Marital Status (Married, Single,
Divorced, Widowed)
4. U.S. Social Security Number
(if any)
Male
Female
Yes (Complete Blocks 14 to 21.)
No (Specify location):
11. Race, Ethnic, or Tribal Group
Part A.II. Information About Your Spouse and Children (Continued)
13. Is this child in the U.S. ?
5. Complete Last Name
9. City and Country of Birth
6. First Name 7. Middle Name 8. Date of Birth (mm/dd/yyyy)
10. Nationality (Citizenship) 11. Race, Ethnic, or Tribal Group
12. Gender
14. Place of last entry into the U.S.
15. Date of last entry into the
U.S. (mm/dd/yyyy)
16. I-94 Number (If any)
17. Status when last admitted
(Visa type, if any)
18. What is your child's current status?
19. What is the expiration date of his/her
authorized stay, if any? (mm/dd/yyyy)
20. Is your child in Immigration Court proceedings?
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
1. Alien Registration Number (A-Number)
(if any)
2. Passport/ID Card Number
(if any)
3. Marital Status (Married, Single,
Divorced, Widowed)
4. U.S. Social Security Number
(if any)
Male Female
Yes No
Yes (Attach one photograph of your spouse in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
Yes (Complete Blocks 14 to 21.)
No (Specify location):
13. Is this child in the U.S. ?
5. Complete Last Name
9. City and Country of Birth
6. First Name 7. Middle Name 8. Date of Birth (mm/dd/yyyy)
10. Nationality (Citizenship) 11. Race, Ethnic, or Tribal Group
12. Gender
1. Alien Registration Number (A-Number)
(if any)
2. Passport/ID Card Number
(if any)
3. Marital Status (Married, Single,
Divorced, Widowed)
4. U.S. Social Security Number
(if any)
Male Female
Yes (Complete Blocks 14 to 21.)
No (Specify location):
14. Place of last entry into the U.S.
15. Date of last entry into the
U.S. (mm/dd/yyyy)
16. I-94 Number (If any)
17. Status when last admitted
(Visa type, if any)
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Form I-589 (Rev. 09/10/19) Page 4
Part A.II. Information About Your Spouse and Children (continued)
18. What is your child's current status?
19. What is the expiration date of his/her
authorized stay, if any? (mm/dd/yyyy)
20. Is your child in Immigration Court proceedings?
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
Yes No
Yes (Attach one photograph of your spouse in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
Part A.III. Information About Your Background
1. List your last address where you lived before coming to the United States. If this is not the country where you fear persecution, also list the last
address in the country where you fear persecution. (List Address, City/Town, Department, Province, or State and Country.)
(NOTE: Use Form I-589 Supplement B, or additional sheets of paper, if necessary.)
Number and Street
(Provide if available)
City/Town Department, Province, or State Country
Dates
From (Mo/Yr) To (Mo/Yr)
2. Provide the following information about your residences during the past 5 years. List your present address first.
(NOTE: Use Form I-589 Supplement B, or additional sheets of paper, if necessary.)
Number and Street City/Town Department, Province, or State Country
Dates
From (Mo/Yr) To (Mo/Yr)
3. Provide the following information about your education, beginning with the most recent school that you attended.
(NOTE: Use Form I-589 Supplement B, or additional sheets of paper, if necessary.)
Name of School Type of School Location (Address)
Attended
From (Mo/Yr) To (Mo/Yr)
4. Provide the following information about your employment during the past 5 years. List your present employment first.
(NOTE: Use Form I-589 Supplement B, or additional sheets of paper, if necessary.)
Name and Address of Employer Your Occupation
Dates
From (Mo/Yr) To (Mo/Yr)
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Form I-589 (Rev. 09/10/19) Page 5
Part A.III. Information About Your Background (continued)
5. Provide the following information about your parents and siblings (brothers and sisters). Check the box if the person is deceased.
(NOTE: Use Form I-589 Supplement B, or additional sheets of paper, if necessary.)
Full Name
Mother
Father
Sibling
City/Town and Country of Birth Current Location
Deceased
Deceased
Deceased
Sibling Deceased
Sibling Deceased
Sibling Deceased
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.
Religion
Nationality
Political opinion
Membership in a particular social group
Torture Convention
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.)
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 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.
I am seeking asylum or withholding of removal based on:
Race
If you are claiming membership in a particular social group(s), identify the particular social group(s):
A. Have you, your family, friends, colleagues, or other similarly situated persons ever experienced harm, mistreatment, or threats in the past by
anyone?
Yes
2. When the harm, mistreatment, or threats occurred.
3. Who caused the harm, mistreatment, or threats.
No
If “Yes,” explain in detail:
1. What happened.
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B. Do you fear harm or mistreatment if you return to your home country?
Yes
Form I-589 (Rev. 09/10/19) Page 6
No
Part B. Information About Your Application (continued)
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 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.
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.
2. Who you believe would harm or mistreat you.
1. What harm or mistreatment you fear.
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.
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.
C. Have you, your family, friends, colleagues, or other similarly situated persons ever been subjected to torture in the past?
2. When the torture occurred.
3. Who caused the harm, which, along with other factors, amounted to torture.
YesNo
If “Yes,” explain in detail:
1. What happened.
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Part B. Information About Your Application (continued)
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.
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.
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.
D. Are you afraid of being subjected to torture in your home country or any other country to which you may be returned?
YesNo
2. Who would harm you.
If "Yes," explain in detail:
1. The nature of the harm you fear.
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.
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.
Form I-589 (Rev. 09/10/19) Page 7
4. Why you believe the torture occurred.
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Form I-589 (Rev. 09/10/19) Page 8
Part B. Information About Your Application (Continued)
3. Why you believe you would be tortured.
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)?
Yes
If "Yes," explain the circumstances and reasons for the action.
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?
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.
3.B. Do you or your family members continue to participate in any way in these organizations or groups?
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.
No
No
No
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.
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(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 ever applied to the U.S. Government for refugee status or for asylum and withholding of removal?
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. Government for refugee status or for asylum and
withholding of removal?
Yes
Part C. Additional Information About Your Application
No
YesNo
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.
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.
Family Name (Last Name) Given Name (First Name) Middle Name
Date of birth (mm/dd/yyyy) Alien Registration Number (A-Number)
A-
►
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.
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
4.B. Have you, your spouse, your child(ren), or other family members, such as your parents or siblings, ever apply for, receive, 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
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.
Form I-589 (Rev. 09/10/19) Page 9
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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?
Yes
If "Yes," describe in detail each such incident and your own, your spouse's, or your child(ren)'s involvement.
Form I-589 (Rev. 09/10/19) Page 10
No
Part C. Additional Information About Your Application (continued)
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.
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.
6. After you left the country where you were harmed or fear harm, did you return to that country?
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).)
No
7. Are you filing this application more than 1 year after your last arrival in the United States?
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.
No
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Part C. Additional Information About Your Application (continued)
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)?
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.
Form I-589 (Rev. 09/10/19) Page 11
No
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.
Yes
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
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?
Yes
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
If “Yes”, specify in your response: what occurred, the circumstances, dates, and the reason(s) for the circumstances.
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?
YesNo
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.
Yes
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
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
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Part C. Additional Information About Your Application (continued)
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
No
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?
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
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.
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.
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.
Form I-589 (Rev. 09/10/19) Page 12
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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.
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.
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 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.
Did your spouse, parent, or child(ren) assist you in completing this application?
Yes (If "Yes," list the name and relationship.)
(Name) (Relationship) (Name) (Relationship)
Did someone other than your spouse, parent, or child(ren) prepare this application?
Yes (If "Yes,"complete Part E.)
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?
Yes
Signature of Applicant (The person in Part. A.I.)
Sign your name so it all appears within the brackets
[ ]
Form I-589 (Rev. 09/10/19) Page 13
No
No
No
Attorney State Bar Number (if
applicable)
Select this box if
Form G-28 is
attached.
Attorney or Accredited Representative
USCIS Online Account Number (if any)
To be completed by an
attorney or accredited
representative (if any).
Date (mm/dd/yyyy)
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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).
Signed and sworn to before me by the above named applicant on:
Date (mm/dd/yyyy)
Signature of Asylum OfficerWrite Your Name in Your Native Alphabet
Signature of Applicant
Form I-589 (Rev. 09/10/19) Page 14
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 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
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:
Date (mm/dd/yyyy)
Signature of Immigration Judge
Write Your Name in Your Native Alphabet
Signature of Applicant
Daytime Telephone Number
Part E. Declaration of Person Preparing Form, if Other Than Applicant, Spouse, Parent, or Child
I declare that I have prepared this application at the request of the person named in Part D, that the responses provided are based on all information of
which I have knowledge, or which was provided to me by the applicant, and that the completed application was read to the applicant in his or her
native language or a language he or she understands for verification before he or she signed the application in my presence. I am aware that the
knowing placement of false information on the Form I-589 may also subject me to civil penalties under 8 U.S.C. 1324c and/or criminal penalties
under 18 U.S.C. 1546(a).
Signature of Preparer Print Complete Name of Preparer
Apt. Number City State Zip Code
Address of Preparer: Street Number and Name
)(
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.
I swear (affirm) that I know the contents of this application that I am signing, including the attached documents and supplements, that they are
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.
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.
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PRODUCTION
06/11/2020
Supplement A, Form I-589
A-Number (If available) Date
Applicant's Name Applicant's Signature
List All of Your Children, Regardless of Age or Marital Status
(NOTE: Use this form and attach additional pages and documentation as needed, if you have more than four children)
Form I-589 Supplement A (Rev. 09/10/19)
13. Is this child in the U.S. ?
5. Complete Last Name
9. City and Country of Birth
6. First Name 7. Middle Name 8. Date of Birth (mm/dd/yyyy)
10. Nationality (Citizenship) 11. Race, Ethnic, or Tribal Group
12. Gender
14. Place of last entry into the U.S.
15. Date of last entry into the
U.S. (mm/dd/yyyy)
16. I-94 Number (If any)
17. Status when last admitted
(Visa type, if any)
18. What is your child's current status?
19. What is the expiration date of his/her
authorized stay, if any? (mm/dd/yyyy)
20. Is your child in Immigration Court proceedings?
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
1. Alien Registration Number (A-Number)
(if any)
2. Passport/ID Card Number
(if any)
3. Marital Status (Married, Single,
Divorced, Widowed)
4. U.S. Social Security Number
(if any)
Male Female
Yes No
Yes (Attach one photograph of your child in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
Yes (Complete Blocks 14 to 21.)
No (Specify location):
13. Is this child in the U.S. ?
5. Complete Last Name
9. City and Country of Birth
6. First Name 7. Middle Name 8. Date of Birth (mm/dd/yyyy)
10. Nationality (Citizenship)
11. Race, Ethnic, or Tribal Group
12. Gender
14. Place of last entry into the U.S.
15. Date of last entry into the
U.S. (mm/dd/yyyy)
16. I-94 Number (If any)
17. Status when last admitted
(Visa type, if any)
18. What is your child's current status?
19. What is the expiration date of his/her
authorized stay, if any? (mm/dd/yyyy)
20. Is your child in Immigration Court proceedings?
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
1. Alien Registration Number (A-Number)
(if any)
2. Passport/ID Card Number
(if any)
3. Marital Status (Married, Single,
Divorced, Widowed)
4. U.S. Social Security Number
(if any)
Male Female
Yes No
Yes (Attach one photograph of your child in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
Yes (Complete Blocks 14 to 21.)
No (Specify location):
DRAFT
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PRODUCTION
06/11/2020
Supplement B, Form I-589
Additional Information About Your Claim to Asylum
Applicant's Signature
Date
A-Number (if available)
Applicant's Name
NOTE: Use this as a continuation page for any additional information requested. Copy and complete as needed.
Part
Question
Form I-589 Supplement B (Rev. 09/10/19)
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and for Withholding of Removal I-589, Application for (American Immigration Lawyers Association)

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Completed 20 November 2020

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