LAW OFFICES OF

MOREL R. CALLUENG

527 W. 7th Street, Suite 204

Los Angeles, CA 90014
Telephone: (213) 689-8825
Facsimile: (213) 622-1145
Email: dynamiclegal@sbcglobal.net

Beneficiary Questionnaire (Alien being Sponsored)

Personal Information:
Name: (Last, First, Middle)
Date of Birth:
City & Country of Birth:
U.S. Address: 381 Gary Dr. Richlands, VA. 24641-2582
Social Security #:
Male: _______ Female: _______
Telephone Number:________________________
Address Outside the U.S.:________________________________________________________________________
From: Month_________Year _______ To: Month ________ Year__________
Alien Number:__________________________: Email:______________________________
Arrival in the United States:
Date Arrived:___________________________ Place/Airport of Arrival:____________________________
Type of Visa:___________________________ Expiration of Stay:_______________________________
I-94 (Arrival/Departure Record) Number:___________________ Name on I-94:_____________________
Tourist Visa Number:________________ Date Issued: _______ Embassy that Issued:_______________
Current Immigration Status:_______________________ Date of Expiration:________________________
Family Information:
Fathers Name: (Last, First, Mid.) _______________________________________________________
Date of Birth: _____________ City & Country of Birth: ____________________________________
City & Country of Residence: _________________________________________________________
Mothers Name: (Maiden, First, Mid.) ___________________________________________________
Date of Birth: _____________ City & Country of Birth: _____________________________________
City and Country of Residence:________________________________________________________
Marital Status Information:
Husband or Wife Name: ____________________________________________________________
Date of Birth: ______________
City & Country of Birth: _________________________
Date of Marriage: _______________ Place of Marriage: _______________________________
How Many Times How you been married? __________List all marriages
Former Husband or Wife Name: ____________________________________________________________
Date of Birth: ______________
City & Country of Birth: _________________________
Date of Marriage: _______________ Place of Marriage: _______________________________
Date of Termination of Marriage:_________ Place of Termination of Marriage: ________________
Former Husband or Wife Name: ____________________________________________________________
Date of Birth: ______________
City & Country of Birth: _________________________
Date of Marriage: _______________ Place of Marriage: _______________________________
Date of Termination of Marriage:_________ Place of Termination of Marriage:
Former Husband or Wife Name: ____________________________________________________________
Date of Birth: ______________
City & Country of Birth: _________________________
Date of Marriage: _______________ Place of Marriage: _______________________________
Date of Termination of Marriage:_________ Place of Termination of Marriage:
Children:

Name____________________________________ Date of Birth_______________________________

Place of Birth:_____________________________________
Name____________________________________ Date of Birth_______________________________
Place of Birth:_____________________________________
Name____________________________________ Date of Birth_______________________________
Place of Birth:_____________________________________
Residence Information:
List Residence for the last 5 years:
Street & Number, City, Country
From
To
_______________________________________________
____/____
____/____
_______________________________________________
____/____
____/____
_______________________________________________
____/____
____/____
_______________________________________________
____/____
____/____
Last address outside of United States:
___________________________________________________________________________________
___________________________________________________________________________________
From : ____/____ To: ____/____
Employment Information:
List Employment for the last 5 years:
Name & Address of Employer
Occupation & Salary
From
To
____________________________________
___________________
___/___
___/___
____________________________________
___________________
___/___
___/___
____________________________________
___________________
___/___
___/___
____________________________________
___________________
___/___
___/___
Criminal Case:
Have you ever been charged of any crime?_______________________________
If yes, please state the case?__________________________________________
Where arrested?__________________________________________________
Date Arrested?___________________________________________________
Convicted or not?_______________________________________________
Please of guilt or not? _______________________________________________
I certify that the information provided herein is true and correct.
______________________
Signature
Supporting Documents from Beneficiary:
1. NSO Birth Certificate
2. Valid unexpired Passport
3. I-94 (Arrival Departure Record)
4. U.S. Tourist Visa
5. Certified Marriage Certificate
6. Four (4) Passport size pictures
7. Medical Examination Report
8. Divorce decree or any other document terminating the previous marriage (all-if applicable if more than 1 marriage)
9. Filing fees payable to USCIS:
a. $420.00 family based petition
b. $1070.00 adjustment of status application with employment authorization document, biometrics
and advance parole

LAW OFFICES OF
MOREL R. CALLUENG
527 W. 7th Street, Suite 204
Los Angeles, CA 90014
Telephone: (213) 689-8825
Facsimile: (213) 622-1145
Email: dynamiclegal@sbcglobal.net
Petitioner/Sponsor Questionnaire (U.S. Citizen Parent or Spouse)
Personal Information:
Name: (Last, First, Mid.) _____________________________________________________________
Date of Birth: ____________ City & Country of Birth: ___________________________________
Address: ____________________________________________________________________________
Social Security #: _____________________________ Male: _______ Female: _______
Last Address outside of the United
States:____________________________________________________________________________________________
______________________________________________________________________________
Telephone Number:_______________________________________________________
Alien Number:_____________________________
If. Naturalized United States citizen-Naturalization Certificate Number:_________________________
Place of Naturalization:____________________________ Date of Naturalization:______________________
Did you get your green card through marriage:_____________________________________
Family Information:
Fathers Name: (Last, First, Mid.) _______________________________________________________
Date of Birth: _____________ City & Country of Birth: ____________________________________
City & Country of Residence: _________________________________________________________
Mothers Name: (Maiden, First, Mid.) ___________________________________________________
Date of Birth: _____________ City & Country of Birth: _____________________________________
City and Country of Residence:_______________________________________________________
Husband or Wife Name: ____________________________________________________________
Date of Birth: ______________
City & Country of Birth: _________________________
Date of Marriage: _______________ Place of Marriage: _______________________________
How Many Times How you been married? __________List all marriages
Former Husband or Wife Name: ____________________________________________________________
Date of Birth: ______________
City & Country of Birth: _________________________
Date of Marriage: _______________ Place of Marriage: _______________________________
Date of Termination of Marriage: _______________ Place of Termination of Marriage:__________________
Former Husband or Wife Name: ____________________________________________________________
Date of Birth: ______________
City & Country of Birth: _________________________
Date of Marriage: _______________ Place of Marriage: _______________________________
Date of Termination of Marriage: _______________ Place of Termination of Marriage
Name____________________________________ Date of Birth_______________________________
Place of Birth:_____________________________________
Name____________________________________ Date of Birth_______________________________
Place of Birth:_____________________________________
Name____________________________________ Date of Birth_______________________________
Former Husband or Wife Name: ____________________________________________________________
Date of Birth: ______________
City & Country of Birth: _________________________
Date of Marriage: _______________ Place of Marriage: _______________________________

Date of Termination of Marriage: _______________ Place of Termination of Marriage

Residence Information:
List Residence for the last 5 years:
Street & Number, City, Country
From
To
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
__________________________________________
____/____

____/____
____/____
____/____
____/____
____/____

____/____
____/____
____/____
____/____

Employment Information:
List Employment for the last 5 years:
Name & Address of Employer
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________

Occupation & Salary

From
To
___________________
___/___
___/___
___________________
___/___
___/___
___________________
___/___
___/___
___________________
___/___
___/___
___________________
___/___
___/___

Last Tax Return Filed:__________________________________________________________

Income Reported in the Last Tax return:___________________________________________
Number of Dependents in the Tax Return:_________________________________________
I certify that the information provided herein is true and correct.
______________________
Signature
Supporting Documents from Husband (U.S. citizen sponsor):
1. Proof of U.S. citizenship - Naturalization Certificate, birth certificate if born in the U.S.
2. Most recent or latest tax return
3. Most recent or latest W-2
4. Certificate of employment, business license if self-employed
5. Two (2) passport size photographs
6. Divorce decree, if applicable or any other document terminating the previous marriage (all-if applicable if more than 1
marriage)