Re: Diversity Visa Green Card Lottery Program October 1, 2013-November 2, 2013

Size: px
Start display at page:

Download "Re: Diversity Visa Green Card Lottery Program October 1, 2013-November 2, 2013"

Transcription

1 September 23, 2013 Re: Diversity Visa Green Card Lottery Program October 1, 2013-November 2, 2013 Dear Client: I am writing to advise that the registration period for the next Diversity Immigrant Visa Lottery will start on October 1, 2013 and will end at noon, Eastern Standard Time (EST) on November 2, If you wish to have us assist with your application, we require the following be completed and returned to our office at your earliest convenience but no later than October 25, Applications received after this date may not be processed. 1. Service Contract: Please review, complete and sign. 2. Legal Fee: As indicated on Page 1 of the Data Sheet, thi s may be paid via check, money order or credit card (Mastercard, Visa or American Express). 3. Data Sheet (4 pages): Please complete all sections and sign. If you are applying as a married couple, only one Data Sheet is required. We will process one application for each spouse. 4. Photographs (2 photographs per person): The photo requirements for the DV Lottery are complex, requiring digitized photos meeting very exact specifications. Our office will scan your hard copy photos to ensure they meet Department of State specifications. Therefore, please provide two recent passport style photographs of yourself, your spouse and each child, including all natural children as well as all legally-adopted and stepchildren, who are unmarried and under the age of 21 years, even if you are no longer married to the child s parent, and even if the child does not currently reside with you and/or will not immigrate with you. Group photos will not be accepted. The size of these photographs must be 2 inches square, or 50 x 50 mm, facing forward. Color or black and white photographs are acceptable. The photo background must be plain white or off-white. You must print the full name and date of birth of each family member on the back of each photo. We must receive all of the above items in order to process and file your application for the DV Visa Program. Should you have any further questions, please do not hesitate to contact the Lottery Department at (310) or at: lotteryinfo@wolfsdorf.com. Sincerely, Bernard P. Wolfsdorf Attorney at Law

2 SERVICE AGREEMENT Please review this service agreement carefully, and if satisfactory, sign and return it together with your retainer. This Service Agreement is made on (date) between the Client (the term Client includes the undersigned, sponsor, petitioner, beneficiary, employer or agent of these parties) and Bernard P. Wolfsdorf, a Professional Law Corporation (hereinafter the Attorney ). 1. The Client hereby retains the said Attorney to prepare and submit an application for the Diversity Immigrant (DV) Program for (please print or type name). 2. The Client hereby agrees to pay to said Attorney the total legal fee of -- a) $150 for one adult applicant, or b) $200 for a married couple (exclusive of miscellaneous charges such as government filing fee, photocopies, long distance/overseas telephone calls, mail, courier, and international facsimiles). Late Applications, (those received within the last 10 days of the close of registration program), will be charged a $50 rush fee. To submit an application for the Diversity Lottery Program, payment to be made as follows: a non-refundable retainer in the amount of total legal fee due upon commencement of the case. 3. The Client understands and agrees that the above-mentioned fees relate to preparing and filing the application only and does not include work performed such as immigrant visa processing at a Consulate abroad or adjustment of status in the United States. Retaining said Attorney for such additional services after successful selection is optional for client. The agreement does not include any legal services in connection with any expedite or appeal, nor does it include services concerning rescheduling of interviews, overcoming grounds of removal or obtaining waivers of ineligibility for any reason including overstays. Legal services are limited only to those listed in this agreement based on the law and facts in effect as of the date of this agreement. 4. If there is any disagreement or dispute between the Client and the Attorney concerning fees, this retainer agreement, or any other claim which arises out of our representation of you, it is hereby agreed such dispute will be submitted to binding arbitration under Section 1280 of the Code of Civil Procedure of the State of California relating to arbitration of contract disputes. The prevailing party shall be entitled to reasonable attorney's fees and costs incurred in such arbitration. Client and undersigned agree that this contract shall be governed and construed according to the law of California, which shall have exclusive jurisdiction in regard to matters arising from this Agreement. 5. That both Attorney and the Client will use their best efforts in furthering the purposes of the Agreement but the Client understands and agrees that the fees set forth are payable in full at the times indicated above and that Attorney is entitled to cease providing services if fees are outstanding. Client understands that the DV Program regulations provide for random selection and, therefore, results are unpredictable. Fees are deemed due whether Attorney is or is not successful in his efforts on behalf of the Client, and that no assurances or guarantee of success has been given or requested, the fees being fully earned solely by the Attorney furnishing his best efforts in the Client s behalf. If client withdraws from the case after the file has been opened by the Attorney no refund need be paid and any unpaid costs or outstanding fees shall be due and payable. 6. Client agrees that the fees paid pursuant to this Agreement will be deposited in our general account for our use. Service Agreement Executed by: Bernard P. Wolfsdorf BERNARD P. WOLFSDORF Attorney at Law x (signature) Client

3 (Page 1 of 4 Please type or print neatly.) PAYMENT INFORMATION LEGAL FEE (Check one box): $150 for one adult applicant (for principal applicant only) or $200 for a married couple (for principal applicant & spouse) Payment enclosed (Check one box): U.S. Money Order or Cashier s Check International Money Order Personal or Business Check Drawn on U.S. Bank Applicant s Name Charge to Credit Card: MasterCard or VISA or American Express (Please note: We accept only these credit cards.) Card # Expire date Cardholder sign here X PRINT Cardholder Name Cardholder s Billing Address Cardholder s Home Telephone Work Telephone * * * * * I have read the information provided by Bernard P. Wolfsdorf, a Professional Law Corporation (Attorney) concerning the Diversity Immigrant Visa (DV) Program (pursuant to Section 203(c) of the Immigration and Nationality Act) and agree to provide accurate information. I understand that there is no guarantee that I will be successful in this application and that Attorney will undertake his best efforts on my behalf. I nevertheless wish to apply, and I also understand that the representation provided will be limited to submission of the application only. If additionally retained, further services relating to immigrant visa processing or adjustment of status may be provided. I have read and fully understand the contents of this agreement, and I accept these terms of limited representation. X PRINCIPAL APPLICANT (signature) DATE BERNARD P. WOLFSDORF - LOTTERY

4 (Page 2 of 4 Please type or print neatly.) Feel free to duplicate the Data Sheet and Service Agreement. Return the completed Data Sheet, photographs, signed Service Agreement and payment to: Law Offices of Bernard P. Wolfsdorf, ND STREET, SANTA MONICA, CA USA (310) FAX: (310) lotteryinfo@wolfsdorf.com Web Site: CONTACT INFORMATION - Please inform us of any changes. Your Name Your Address Your Home Telephone Your Work Telephone Your FAX Your Address Address IS REQUIRED!! SECONDARY CONTACT INFORMATION (This should be a relative or friend who will always know where to contact you, preferably someone in the United States. Please let them know that our office may be in contact with them.) Secondary Contact Name Secondary Contact Address Secondary Home Telephone Secondary Work Telephone Secondary FAX Secondary Address Please send all correspondence to: My address My address Secondary Contact address REFERRAL SOURCE (How you heard about our office.) I am currently a client of your law firm. I am a prior client of your law firm. Advertisement in My associate/friend (Name of Publication) (Provide full name) My employer My school (Company Name) (Name of school) Other:

5 BERNARD P. WOLFSDORF - LOTTERY (Page 3 of 4 Please type or print neatly.) The State Department has established processing criteria that can affect the success of your DV application. Please read the following instructions carefully, and provide ALL information as requested. Current DV regulations require complete biographic details of yourself, your spouse (regardless of immigration or marital status), and all natural children, as well as all legally-adopted and stepchildren, who are unmarried and under the age of 21 years, even if you are no longer legally married to the child s parent and even if the child does not currently reside with you and/or will not immigrate with you. Provide full legal names as listed on birth certificates, or current legal names as documented by a marriage certificate or other court document. FAILURE TO PROVIDE COMPLETE INFORMATION WILL DISQUALIFY YOUR APPLICATION. Therefore, it is vital that you include ALL immediate family members on the Data Sheet, and answer all questions completely. Any mistakes may result in disqualification, therefore all information must be clearly readable and accurate. Please note that we request date of birth in order of Month, Day and Year. Should you have any questions, please contact the Lottery Department at (310) PRINCIPAL APPLICANT -- Last Name: First Name: Middle Name(s): 2. Date of Birth: (D) / (M) / (Y) 3. Place of Birth: 4. Education of Principal Applicant: 5. Gender: Male Female a. Highest level of education you have achieved, as of today. Please choose from one of ten options: primary school high school, no degree high school degree vocational school some university courses university degree some graduate level courses master degree some doctorate level course doctorate degree b. I have the equivalent of a high school education. Yes No 6. Marital Status: Single (Never married) Married Widowed Divorced Separated 7. Current Immigration Status (if applicable) 8. Last or current residence outside of the U.S.: (City, Province, Country) 9. Country where you live today: 10. SPOUSE -- Last Name: First Name: Middle Name(s): 11. Date of Birth: (D) / (M) / (Y) 12. Place of Birth: 13. Education of Spouse: 14. Gender: Male Female a. Highest level of education you have achieved, as of today. Please choose from one of ten options: primary school high school, no degree high school degree vocational school some university courses university degree some graduate level courses master degree some doctorate level course doctorate degree b. I have the equivalent of a high school education. Yes No 15. Immigration Status of Spouse: U.S. Citizen Lawful Permanent Resident (has green card) 16. Last or current residence outside of the U.S.: (City, Province, Country) ** Please remember to include two passport style photos (2 inches square, or 50 x 50 mm) ** ** of yourself, two photos of your spouse and two photos of each child when returning these forms.**

6 I/We do not have any children. CHILDREN I/We have listed ALL children who are unmarried and under the age of 21 years. (Page 4 of 4 Please type or print neatly.) CHILDREN (continued) (If you have more than 5 children, please make an extra copy of this page.) ALL children who are unmarried and under the age of 21 years must be included on the Diversity Visa Lottery Application. Should you or your spouse be selected as a winning applicant, please be aware that children over the age of 21 years will not be eligible to immigrant visa process for a derivative green card. Any persons over the age of 21 wishing to enter the Diversity Visa Lottery should submit an individual application where he/she is listed as the Principal Applicant. If your child s 21 st birthday occurs before final green card approval, this child cannot be granted a derivative green card. We strongly recommend submitting an individual application where he/she is listed as the Principal Applicant. If any of your children will complete high school by October of the DV fiscal year, we suggest submitting an individual application as well doubling their chance of selection. Please send me additional DV Lottery packages so my children may also submit individual applications. 15. CHILD -- Male Female Last Name: Middle Name(s): 16. Date of Birth: (D) / (M) / (Y) 3. Place of Birth: 18. CHILD -- Male Female Last Name: Middle Name(s): 19. Date of Birth: (D) / (M) / (Y) 3. Place of Birth: 21. CHILD -- Male Female Last Name: Middle Name(s): 22. Date of Birth: (D) / (M) / (Y) 3. Place of Birth: 24. CHILD -- Male Female Last Name: Middle Name(s): 25. Date of Birth: (D) / (M) / (Y) 3. Place of Birth:

RE: IMMIGRATION VISA PETITION

RE: IMMIGRATION VISA PETITION 95 South Market Street, Suite 530 San Jose, California 95113 Telephone: (408) 993-9577 Facsimile: (408) 881-0456 RE: IMMIGRATION VISA PETITION Please note that despite sponsoring an alien relative under

More information

SEMINARY APPLICATION FORMS 20141003

SEMINARY APPLICATION FORMS 20141003 SEMINARY APPLICATION FORMS 20141003 Checklist All of the following documents must be received by CSBS before an application will be reviewed for admission. Please use the following checklists as a guide:

More information

IPF PENSION APPLICATION

IPF PENSION APPLICATION Bricklayers & Trowel Trades International Pension Fund 620 F Street, Suite 700, NW; Washington, DC 20004 Phone: 202/638-1996 Fax: 202/347-7339 http://www.ipfweb.org IPF PENSION APPLICATION 1. IMPORTANT

More information

Affidavit of Support Under Section 213A of the Act

Affidavit of Support Under Section 213A of the Act Affidavit of Support Under Section 213A of the Act Department of Homeland Security U.S. Citizenship and Immigration Services Form I-864 OMB No. 1615-75 Expires 3/31/215 START HERE - Type or print in black

More information

Questions and Answers Aug. 31, 2009

Questions and Answers Aug. 31, 2009 Office of Communications Questions and Answers Aug. 31, 2009 USCIS Provides Interim Deferred Action Relief For Surviving Spouses Relief for Spouses of Deceased U.S. Citizens Married Less Than Two Years

More information

Place this completed checklist on top of the application you send to Cultural Vistas.

Place this completed checklist on top of the application you send to Cultural Vistas. Place this completed checklist on top of the application you send to Cultural Vistas. Expedited Application Review: 5 business-day review (Additional Cost) participant and host company information Expedited

More information

Cigna Health and Life Insurance Company California Individual and Family Plan Enrollment Application / Change Form

Cigna Health and Life Insurance Company California Individual and Family Plan Enrollment Application / Change Form Section A. Type of Application New Enrollment Application: Applicant Only Applicant and Dependent(s) Child(ren) Only Existing Individual Plan Policy Member requesting a change in coverage: Add Family Member(s)

More information

www.legal-eaze.com Form Preparation and Typing Without a Lawyer Florida Readoption

www.legal-eaze.com Form Preparation and Typing Without a Lawyer Florida Readoption www..com Form Preparation and Typing Without a Lawyer Florida Readoption Dear Parent: Thank you for inquiring about the readoption process in the State of Florida. Enclosed please find an Application for

More information

IMMIGRATION Canada. Warsaw. Sponsorship of parents, grandparents, adopted children and other relatives. Visa Office Specific Instructions

IMMIGRATION Canada. Warsaw. Sponsorship of parents, grandparents, adopted children and other relatives. Visa Office Specific Instructions Citizenship and Immigration Canada Citoyenneté et Immigration Canada IMMIGRATION Canada Table of Contents Appendix A - Document Checklist Appendix B - Photo Specifications Appendix C - Medical Instructions

More information

IMMIGRATION Canada. London. Sponsorship of parents, grandparents, adopted children and other relatives. Visa Office Specific Instructions

IMMIGRATION Canada. London. Sponsorship of parents, grandparents, adopted children and other relatives. Visa Office Specific Instructions Immigration, Refugees and Citizenship Canada Immigration, Réfugiés et Citoyenneté Canada IMMIGRATION Canada Table of Contents Appendix A - Document Checklist Appendix B - Photo Specifications Appendix

More information

Affidavit of Support Under Section 213A of the Act. Department of Homeland Security U.S. Citizenship and Immigration Services

Affidavit of Support Under Section 213A of the Act. Department of Homeland Security U.S. Citizenship and Immigration Services Affidavit of Support Under Section 213A of the Act Department of Homeland Security U.S. Citizenship and Immigration Services Form I-864 OMB No. 1615-75 Expires 3/31/215 START HERE - Type or print in black

More information

Instructions for Fiancé(e) Visa Applicants

Instructions for Fiancé(e) Visa Applicants CONSULATE GENERAL OF THE UNITED STATES OF AMERICA Immigrant Visa Unit Av. Pres. Wilson, 147 Centro Rio de Janeiro RJ 20030-020 Tel: 21-3823-2000 Fax: 21-3823-2083 www.consuladodoseua-rio.org.br www.state.gov

More information

Instruction Guide for Applying for your New Zealand Student Immigration Visa *Read all instructions before beginning your visa application*

Instruction Guide for Applying for your New Zealand Student Immigration Visa *Read all instructions before beginning your visa application* Instruction Guide for Applying for your New Zealand Student Immigration Visa *Read all instructions before beginning your visa application* 1 New Zealand Student Visa: Getting Started NOTE: The following

More information

PLEASE PRINT CLEARLY IN BLUE/BLACK INK

PLEASE PRINT CLEARLY IN BLUE/BLACK INK PLEASE PRINT CLEARLY IN BLUE/BLACK INK APPLICATION FOR NORMAL, EARLY PENSION, OR DISABILITY FORMER 144 HOSPITAL DIVISION Instructions Follow these instructions carefully and completely to avoid delays

More information

HOW TO REGISTER FOR THE BACK ON TRACK PROGRAM. NOT your search engine. Registering online may save you 2 weeks in mailing time

HOW TO REGISTER FOR THE BACK ON TRACK PROGRAM. NOT your search engine. Registering online may save you 2 weeks in mailing time 1 ONLINE Registration package TIPS HOW TO REGISTER FOR THE BACK ON TRACK PROGRAM ` Register ONLINE @ www.remedial.net Type into your address box NOT your search engine Within 72 business hours you will

More information

OPERATING ENGINEERS TRUST FUNDS

OPERATING ENGINEERS TRUST FUNDS OPERATING ENGINEERS TRUST FUNDS 1640 South Loop Road Alameda, CA 94502 P.O. Box 23190 Oakland, CA 94623-0190 Telephone (510) 433-4422 or (510) 271-0222 or Claims Department (800) 251-5013 Pension Department

More information

IMMIGRATION Canada. São Paulo. Sponsorship of parents, grandparents, adopted children and other relatives. Visa Office Specific Instructions

IMMIGRATION Canada. São Paulo. Sponsorship of parents, grandparents, adopted children and other relatives. Visa Office Specific Instructions Immigration and Refugees and Citizenship Canada Immigration, Réfugiés et Citoyenneté Canada IMMIGRATION Canada Table of Contents Appendix A - Document Checklist Appendix B - Photo Specifications Appendix

More information

PERMANENT ADDRESS MAILING ADDRESS FOR I-20 IMMIGRATION INFORMATION

PERMANENT ADDRESS MAILING ADDRESS FOR I-20 IMMIGRATION INFORMATION English Language Institute Texas A&M University Commerce Office: 903-886-5273 or 903-886-5274 Email: ELI@tamuc.edu Application Form for Fall, Summer, and Spring Semester Applicants to the English Language

More information

Advanced College International Language Office

Advanced College International Language Office Advanced College International Language Office Dear Sir or Madam: We are pleased to send you information about the International Language Office (ILO) at Advanced College. The ILO offers a variety of programs

More information

Application form WH1_en_011115 Application for residence and work permit for Working Holiday

Application form WH1_en_011115 Application for residence and work permit for Working Holiday Application form WH1_en_011115 Application for residence and work permit for Working Holiday Uses This form can be used to apply for a residence and work permit in Denmark, if you are an Argentine, Australian,

More information

DISSOLUTION OF MARRIAGE GUIDELINES

DISSOLUTION OF MARRIAGE GUIDELINES DISSOLUTION OF MARRIAGE GUIDELINES THE FOUNDATION FOR A SECURE RETIREMENT Dissolution of Marriage Guidelines Table of Contents Vital Information... 1 Joinder is Mandatory... 1 Authority... 1 Subpoenas...

More information

International Adoption Specialists LLC. www.legal-eaze.com READOPTION/NAME CHANGE -- CONNECTICUT

International Adoption Specialists LLC. www.legal-eaze.com READOPTION/NAME CHANGE -- CONNECTICUT READOPTION/NAME CHANGE -- CONNECTICUT Dear Parent: Thank you for inquiring about the readoption/name change process in the State of Connecticut. Enclosed please find an Application for you to complete

More information

THE SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness --------------- No: 23/2014/TT-NHNN Hanoi, 19 August 2014 CIRCULAR

THE SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness --------------- No: 23/2014/TT-NHNN Hanoi, 19 August 2014 CIRCULAR STATE BANK OF VIETNAM ------- THE SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness --------------- No: 23/2014/TT-NHNN Hanoi, 19 August 2014 CIRCULAR GUIDING THE OPENING AND USE OF PAYMENT

More information

PETITION TO ARBITRATE A FEE DISPUTE (Client Attorney Petition)

PETITION TO ARBITRATE A FEE DISPUTE (Client Attorney Petition) SAN GABRIEL VALLEY LAWYER REFERRAL SERVICE 1175 East Garvey Avenue, Suite 105 Covina, California 91724-3618 (626) 966-5530 (626) 442-6973 (909) 599-3847 Fax (626) 915-4755 PETITION TO ARBITRATE A FEE DISPUTE

More information

APPLICATION FOR IMMIGRANT VISA

APPLICATION FOR IMMIGRANT VISA FOREIGN SERVICE OF THE PHILIPPINES PHILIPPINE CONSULATE GENERAL CHICAGO, IL U.S.A. FA FORM NO. 3 REVISED 23 JANUARY 2008 (USA) APPLICATION FOR IMMIGRANT VISA 122 S. MICHIGAN AVE. SUITE 1600, CHICAGO, IL

More information

Part 1 About your Self-Assessment Appendix Read Guidance notes, Part 1

Part 1 About your Self-Assessment Appendix Read Guidance notes, Part 1 POINTS BASED SYSTEM FORM (VAF9 APRIL 2014) PERSONAL DETAILS This form is for use outside the UK only. This form is provided free of charge. READ THIS FIRST This form must be completed in blue or black

More information

Manitoba Rent Assist - FOR OFFICE USE ONLY: CS # Application # Date Received

Manitoba Rent Assist - FOR OFFICE USE ONLY: CS # Application # Date Received CS # Application # Received Provincial Services Community Service Delivery Division Manitoba Families 102-114 Garry Street, Winnipeg, MB R3C 1G1 Telephone (204) 945-2197 Fax (204) 945-3930 Toll Free 1-877-587-6224

More information

ENTRY VISA TO CAMEROON

ENTRY VISA TO CAMEROON EMBASSY OF THE REPUBLIC OF CAMEROON Telephone: (202) 265-8790 Fax: (202) 387-3826 Email: cs@cameroonembassyusa.org ENTRY VISA TO CAMEROON AMBASSADE DE LA REPUBLIQUE DU CAMEROUN 3400 International Drive,

More information

Toronto International Student Programs STUDENT APPLICATION FORM

Toronto International Student Programs STUDENT APPLICATION FORM Toronto International Student Programs STUDENT APPLICATION FORM Please submit completed application form to: Toronto District School Board International Students and Admissions Office 5050 Yonge Street,

More information

MALAWIAN DIASPORA INVESTMENT ACCOUNT AGREEMENT

MALAWIAN DIASPORA INVESTMENT ACCOUNT AGREEMENT FROM: MALAWIAN DIASPORA INVESTMENT ACCOUNT AGREEMENT NAME OF CUSTOMER: ADDRESS: The undersigned hereby requests you to establish a Malawian Diaspora Investment Account in your b account in chosen currency

More information

Application for Mississippi Medicaid Aged, Blind and Disabled Medicaid Programs

Application for Mississippi Medicaid Aged, Blind and Disabled Medicaid Programs Application for Mississippi Medicaid Aged, Blind and Disabled Medicaid Programs This application is used for an individual, couple or child to apply for Medicaid due to age or disability. Please read each

More information

Secretariat. United Nations ST/AI/2000/19. Administrative instruction

Secretariat. United Nations ST/AI/2000/19. Administrative instruction United Nations ST/AI/2000/19 Secretariat 18 December 2000 Administrative instruction Visa status of non-united States staff members serving in the United States, members of their household and their household

More information

Open Market Option Application Form

Open Market Option Application Form Guaranteed Pension Annuity Open Market Option Application Form 1. QUOTE DETAILS Quote reference Official use only Application Number 2. YOUR PERSONAL DETAILS (THE ANNUITANT) Full name including title (Please

More information

COUNTY OF KERN. HEALTH BENEFITS ELIGIBILITY POLICY for participants without Active Employee Medical Coverage. Rev 6/13

COUNTY OF KERN. HEALTH BENEFITS ELIGIBILITY POLICY for participants without Active Employee Medical Coverage. Rev 6/13 COUNTY OF KERN HEALTH BENEFITS ELIGIBILITY POLICY for participants without Active Employee Medical Coverage Rev 6/13 Date: June 2013 To: From: Kern County Health Benefits Plan Participants Kern County

More information

INDEPENDENT VIRTUAL ASSISTANT AGREEMENT (Company)

INDEPENDENT VIRTUAL ASSISTANT AGREEMENT (Company) INDEPENDENT VIRTUAL ASSISTANT AGREEMENT (Company) This Independent Virtual Assistant Agreement ( Agreement ) is entered into as of,, by and between, with a principal place of business at ( Company ), and,

More information

A Fraternal Benefit Society Corrections must be initialed by Applicant. 1338 Military Street P.O. Box 5020 Port Huron M148061-5020 PART 1

A Fraternal Benefit Society Corrections must be initialed by Applicant. 1338 Military Street P.O. Box 5020 Port Huron M148061-5020 PART 1 Application for Membership and Single Premium Whole Life Insurance or Annuity Print carefully in Black Ink Woman's Life Insurance Society A Fraternal Benefit Society Corrections must be initialed by Applicant.

More information

CITY OF SAN JOSE DEFERRED COMPENSATION PLAN

CITY OF SAN JOSE DEFERRED COMPENSATION PLAN CITY OF SAN JOSE DEFERRED COMPENSATION PLAN Joinder of the Plan in Marital Dissolution Matters and Requirements for Conforming Domestic Relations Orders This document provides information about the Deferred

More information

National Electrical Annuity Plan Lump Sum Benefit Application

National Electrical Annuity Plan Lump Sum Benefit Application National Electrical Annuity Plan Lump Sum Benefit Application To avoid delays in the processing and payment of your benefit, please follow these instructions carefully and completely. 1. Print all information

More information

Final Decree of Divorce

Final Decree of Divorce Print court information exactly as it appears on your Petition for Divorce Cause Number: IN THE MATTER OF THE MARRIAGE OF Petitioner: Print first, middle and last name of the spouse filing for divorce.

More information

DS-2019 Application for J-1 Exchange Visitors

DS-2019 Application for J-1 Exchange Visitors International Affairs MTSU-Box120 Murfreesboro, TN 37132 Email:international@mtsu.edu www.mtsu.edu/international DS-2019 Application for J-1 Exchange Visitors Plans to invite an individual in J-1 status

More information

South Florida Bible College & Theological Seminary 747 S. Federal Highway Deerfield Beach, FL 33441 954-426-8652 toll-free 1-800-432-1926 www.sfbc.

South Florida Bible College & Theological Seminary 747 S. Federal Highway Deerfield Beach, FL 33441 954-426-8652 toll-free 1-800-432-1926 www.sfbc. Page 1 of 8 South Florida Bible College & Theological Seminary 747 S. Federal Highway Deerfield Beach, FL 33441 954-426-8652 toll-free 1-800-432-1926 www.sfbc.edu Expected Entry and Status Application

More information

AIR INDIA ENGINEERING SERVICES LIMITED EASTERN REGION, KOLKATA

AIR INDIA ENGINEERING SERVICES LIMITED EASTERN REGION, KOLKATA AIR INDIA ENGINEERING SERVICES LIMITED EASTERN REGION, KOLKATA Air India Engineering Services Limited wishes to engage Indian Nationals, who meet with the requirements specified hereunder, for the post

More information

KAN_7 1 + + This declaration form is for you if you are a former Finnish citizen and have lost Finnish citizenship.

KAN_7 1 + + This declaration form is for you if you are a former Finnish citizen and have lost Finnish citizenship. KAN_7 1 *1229901* CITIZENSHIP DECLARATION; FORMER FINNISH CITIZEN This declaration form is for you if you are a former Finnish citizen and have lost Finnish citizenship. If you also wish to apply for Finnish

More information

Turkey Tourist visa Application

Turkey Tourist visa Application Turkey Tourist visa Application Please enter your contact information Name: Email: Tel: Mobile: The latest date you need your passport returned in time for your travel: Turkey tourist visa checklist Filled

More information

International Adoption Specialists LLC www.legal-eaze.com

International Adoption Specialists LLC www.legal-eaze.com H E L P I N G P E O P L E H E L P T H E M S E L V E S www.legal-eaze.com Dear Parent: New York State Readoption Thank you for inquiring about readoption in New York State. Enclosed/Attached please find

More information

AdoptLink will provide an unlimited number of profile booklets for presentation to mothers presented by AdoptLink.

AdoptLink will provide an unlimited number of profile booklets for presentation to mothers presented by AdoptLink. AdoptLink Agreement This document will set forth our agreement with respect to fees and adoption facilitation services and other possible related direct costs, as well as mutual commitments to each other.

More information

WHY COMPLETE AN APPLICATION FOR QUÉBEC SELECTION CERTIFICATE?

WHY COMPLETE AN APPLICATION FOR QUÉBEC SELECTION CERTIFICATE? Application for Selection Certificate Individual in particular crisis situation Protected person on-site and family members WHY COMPLETE AN APPLICATION FOR QUÉBEC SELECTION CERTIFICATE? As a Convention

More information

Funeral Aid Insurance: Application for benefit

Funeral Aid Insurance: Application for benefit Funeral Aid Insurance: Application for benefit Employee Benefits Name of scheme Code Important: This form must be completed when: the insurance of an employee commences in terms of the policy or there

More information

Instructions for Freedom of Information/Privacy Act Request

Instructions for Freedom of Information/Privacy Act Request Instructions for Freedom of Information/Privacy Act Request Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form G-639 OMB No. 1615-0102 Expires 03/31/2017 What is the Purpose

More information

THE POCKET LAWYER Document Preparation Service p Workbook y

THE POCKET LAWYER Document Preparation Service p Workbook y THE POCKET LAWYER Document Preparation Service p Workbook y We Help You Help Yourself UNCONTESTED DIVORCE - CALIFORNIA PART A All rights reserved. No part of this workbook may be reproduced by any means

More information

MARRIAGE IN SCOTLAND GUIDANCE NOTES TO HELP YOU COMPLETE THE MARRIAGE NOTICE APPLICATION FORM M10

MARRIAGE IN SCOTLAND GUIDANCE NOTES TO HELP YOU COMPLETE THE MARRIAGE NOTICE APPLICATION FORM M10 MARRIAGE IN SCOTLAND GUIDANCE NOTES TO HELP YOU COMPLETE THE MARRIAGE NOTICE APPLICATION FORM M10 (NOTES) to Form M10 (These notes are not part of the form M10 prescribed under the Marriage (Scotland)

More information

After the application has been completed and before you sign it, re-read it carefully to be certain that all information has been properly recorded.

After the application has been completed and before you sign it, re-read it carefully to be certain that all information has been properly recorded. UTAH INDIVIDUAL HEALTH INSURANCE APPLICATION Only for use outside the Federally Facilitated Marketplace A. APPLICANT INFORMATION Please check one of the following boxes: New Application Dependent Addition

More information

California State University, Los Angeles English Language Program (ELP)

California State University, Los Angeles English Language Program (ELP) (ELP) Application Checklist Students must be at least 18 years of age by the program start date. The (ELP) requires a student (F-1) visa. Your application cannot be processed until all required documents

More information

Financing your renovation

Financing your renovation Financing your renovation Am I eligible? You need to be 21-59 old Singaporeans and PRs Single Application: Minimum income of $24,000 per year Joint Application: At least 1 applicant must earn a minimum

More information

Application for Indefinite Leave to Remain

Application for Indefinite Leave to Remain Home Affairs Department Customs and Immigration Service Maritime House, La Route du Port Elizabeth St Helier, Jersey, JE1 1JD Tel: +44 (0)1534 448000 Fax: +44 (0)1534 448027 PROTECT (when complete) JCE

More information

DIRECT AIRSIDE TRANSIT (VAF6 DEC

DIRECT AIRSIDE TRANSIT (VAF6 DEC DIRECT AIRSIDE TRANSIT (VAF6 DEC 2008) This form is for use outside the UK only. This form is provided free of charge. READ THIS FIRST This form must be completed in English. You may use blue or black

More information

APPLICATION FOR A GRENADIAN PASSPORT

APPLICATION FOR A GRENADIAN PASSPORT APPLICATION FOR A RENADIAN PASSPORT Please read the following instructions carefully before completing the form. HOW TO COMPLETE THE FORM All relevant sections must be completed by all applicants. Answers

More information

ATTORNEY-CLIENT AGREEMENT

ATTORNEY-CLIENT AGREEMENT ATTORNEY-CLIENT AGREEMENT This ATTORNEY-CLIENT RETAINER AGREEMENT ("Agreement") is entered into by and between (Client) and ZHANG & ASSOCIATES, P.C. (Attorney). 1. SCOPE AND DUTIES: Pursuant to this Agreement,

More information

PLEASE SUBMIT ONLY ONE (1) APPLICATION PER HOUSEHOLD EVEN IF YOU ARE INTERESTED IN MORE THAN ONE (1) PROPERTY. THANK YOU.

PLEASE SUBMIT ONLY ONE (1) APPLICATION PER HOUSEHOLD EVEN IF YOU ARE INTERESTED IN MORE THAN ONE (1) PROPERTY. THANK YOU. Dear Applicant: Thank you for your recent inquiry of occupancy at a Carabetta Management Company apartment community. Due to the nature of Federal Assistance provided for these properties, we are required

More information

Asylum Support Application Form (ASF1)

Asylum Support Application Form (ASF1) Destitution Message Asylum Support Application Form (ASF1) Under the terms of the Immigration and Asylum Act 1999, the Secretary of State may provide, or arrange for the provision of support for asylum

More information

Grants State Bank. Requirements for Conventional Commercial Real Estate Loans

Grants State Bank. Requirements for Conventional Commercial Real Estate Loans Grants State Bank Requirements for Conventional Commercial Real Estate Loans The items listed below are required to process your loan with Grants State Bank (GSB). Please complete the applicable forms

More information

INVESTMENT ADVISORY AGREEMENT

INVESTMENT ADVISORY AGREEMENT INVESTMENT ADVISORY AGREEMENT This Agreement is between the undersigned individual or entity ( Client ) and Van Meter Associates, LLC ( Adviser ). The parties agree as follows: 1. Appointment of Manager.

More information

Page 1 of 1. 2 Query on Exchange Program AY2010.pdf application/pdf 38.40 KB 3 Application Form_KIT.pdf application/pdf 521.47 KB

Page 1 of 1. 2 Query on Exchange Program AY2010.pdf application/pdf 38.40 KB 3 Application Form_KIT.pdf application/pdf 521.47 KB file://c:\docume~1\admini~1\locals~1\temp\v6dfcato.htm Page 1 of 1 19/11/2552 Login: (fro) Quota in Mailbox : 358.7MB Limit 1464.8MB (24.5%) 24.5% 100% ว นท : Wed 18 Nov 2009 15:20:06 +0900 จาก: "Akane

More information

APPLICATION FOR PENSION

APPLICATION FOR PENSION Laborers Trust Funds 7130 Columbia Gateway Drive Suite A Columbia, MD 21046 (410) 872-9500 (866) 553-6559 - Toll Free APPLICATION FOR PENSION (PLEASE PRINT ALL INFORMATION CLEARLY) (Please read instructions

More information

SAMPLE VENDOR AGREEMENT VENDOR # 00000. Sample Vendor, Vendor Title Sample Vendor Company. Evelyn V. Martinez, Executive Director

SAMPLE VENDOR AGREEMENT VENDOR # 00000. Sample Vendor, Vendor Title Sample Vendor Company. Evelyn V. Martinez, Executive Director VENDOR AGREEMENT VENDOR # 00000 TO: FROM: Sample Vendor, Vendor Title Sample Vendor Company Evelyn V. Martinez, Executive Director DATE: SUBJECT: Sample Vendor Project This Agreement, by and between the

More information

Part 1 About you Read Guidance notes, Part 1

Part 1 About you Read Guidance notes, Part 1 VISITOR FORM (VAF1 OCT 2007) This form is for use outside the UK only. This form is provided free of charge. For official use only READ THIS FIRST This form must be completed in blue or black ink. s Please

More information

Cigna Health and Life Insurance Company (Cigna) California Individual and Family Plan Enrollment Application / Change Form

Cigna Health and Life Insurance Company (Cigna) California Individual and Family Plan Enrollment Application / Change Form Section A. Type of Application New Enrollment Application: Applicant Only Applicant and Dependent(s) Child(ren) Only Existing Individual Plan Policy Member requesting a change in coverage: Add Family Member(s)

More information

OPEN ENROLLMENT FOR HEALTH BENEFITS 2014 ADJUNCT FACULTY

OPEN ENROLLMENT FOR HEALTH BENEFITS 2014 ADJUNCT FACULTY OPEN ENROLLMENT FOR HEALTH BENEFITS 2014 ADJUNCT FACULTY OPEN ENROLLMENT begins Monday, August 25, 2014 from 11:30AM to 4 PM in the new pavilion. Representatives from Independence Blue Cross, Delta Dental,

More information

APPLICATION FOR CONSULAR REPORT OF BIRTH ABROAD OF A CITIZEN OF THE UNITED STATES OF AMERICA

APPLICATION FOR CONSULAR REPORT OF BIRTH ABROAD OF A CITIZEN OF THE UNITED STATES OF AMERICA STEP 1: Read the instructions before completing and submitting this application. The instructions contain important information about completing the application and list what documents can be submitted

More information

Attestation of Eligibility for an Enrollment Period

Attestation of Eligibility for an Enrollment Period 301 S. Vine St., Urbana, IL 61801 Attestation of Eligibility for an Enrollment Period Typically, you may enroll in a health plan only from November 1 to January 31. There are exceptions that may allow

More information

(Payable to Casto Travel, Inc.)

(Payable to Casto Travel, Inc.) REQUEST FOR VISA/PASSPORT PROCESSING (Transmittal) This form is for Casto s use only, to advise us as to what service you are requesting, when you depart on your trip, and the address to which the documents

More information

(Payable to Casto Travel, Inc.)

(Payable to Casto Travel, Inc.) REQUEST FOR VISA/PASSPORT PROCESSING (Transmittal) This form is for Casto s use only, to advise us as to what service you are requesting, when you depart on your trip, and the address to which the documents

More information

OCI Registration Form FORM XIX (See Rule 25B)

OCI Registration Form FORM XIX (See Rule 25B) LONDON OCI Registration Form FORM XIX (See Rule 25B) Affix your photo of size 200X200pixels Approx Application for registration as an Overseas Citizen of India under section 7A of the Citizenship Act,1955

More information

WRS Version 05/2004. WRS Version 05/2004 Immigration and Nationality Directorate

WRS Version 05/2004. WRS Version 05/2004 Immigration and Nationality Directorate Form WRS Version 05/2004 Immigration and Nationality Directorate Form WRS Version 05/2004 This form is for use for applications made between 1 st May 2004 and 31 st July 2004 Application for a registration

More information

DIVORCE - WITH MINOR CHILDREN For Respondent Only

DIVORCE - WITH MINOR CHILDREN For Respondent Only DIVORCE - WITH MINOR CHILDREN For Respondent Only Response Part 3: Respond to a Divorce Petition (Forms Packet) Superior Court of Arizona in Maricopa County Packet Last Revised December 2008 DRDC3fc -

More information

Street No: Street Name: Apt No: City: Province: Postal Code: Fax Number: ( )

Street No: Street Name: Apt No: City: Province: Postal Code: Fax Number: ( ) The Applicant The person with the disability is referred to as the Applicant. All questions should be answered by the Applicant or on his / her behalf. Please provide information for one Applicant per

More information

Memphis Police Department Police Officer Application Packet

Memphis Police Department Police Officer Application Packet Memphis Police Department Police Officer Application Packet MINIMUM REQUIREMENTS 54 Semester Hours at an Accredited College or University or Two years of continuous Military Service with an honorable discharge

More information

Legal Service. Legal Security Package. Plan 5M, 3/10, I-044

Legal Service. Legal Security Package. Plan 5M, 3/10, I-044 5M, 3/10, I-044 Legal Service Plan Legal Security Package Date Received: For Office Use Only Q. Rev. HCP/POA Mailed Initials Date Initials Date Legal Plan Covered Participant s Name: First Middle Last

More information

LUMP SUM BENEFIT APPLICATION

LUMP SUM BENEFIT APPLICATION NATIONAL ELECTRICAL ANNUITY PLAN NEAP LUMP SUM BENEFIT APPLICATION 2400 Research Boulevard, Suite 500, Rockville, MD 20850-3266 Telephone (301) 556-4300 Rev 01/12 National Electrical Annuity Plan Lump

More information

Healthy Smiles Ontario Program Application Form A

Healthy Smiles Ontario Program Application Form A Ministry of Health and Long-Term Care Healthy Smiles Ontario Program Application Form A Program Information The Healthy Smiles Ontario Program is an Ontario government-funded basic dental program providing

More information

participant application

participant application J-1 WORK/TRAVEL PROGRAM participant application Please attach one passport photo here Alliance Abroad Group Participant ID: (Please get this from your local agency) Name of overseas agency: All sections

More information

SELF-DIRECTED INDIVIDUAL 401K ACCOUNT HOLDER DISCLOSURE AND HOLD HARMLESS

SELF-DIRECTED INDIVIDUAL 401K ACCOUNT HOLDER DISCLOSURE AND HOLD HARMLESS SELF-DIRECTED INDIVIDUAL 401K ACCOUNT HOLDER DISCLOSURE AND HOLD HARMLESS P.O. BO 30007 ALBUQUERQUE, NEW MEICO 87190 P: 888-205-6036 F: 505-288-3905 OPERATIONS@HORIZONTRUST.COM Important! This form contains

More information

A Guide to Completing Your CalPERS. Service Retirement Election Application

A Guide to Completing Your CalPERS. Service Retirement Election Application A Guide to Completing Your CalPERS Service Retirement Election Application TABLE OF CONTENTS Introduction...3 Why Retirement Planning is Important...3 Request a Retirement Benefit Estimate...4 Your Retirement

More information

9 FAM 42.43 SUSPENSION OR TERMINATION OF ACTION IN PETITION CASES

9 FAM 42.43 SUSPENSION OR TERMINATION OF ACTION IN PETITION CASES 9 FAM 42.43 SUSPENSION OR TERMINATION OF ACTION IN PETITION CASES (CT:VISA-1418; 04-09-2010) (Office of Origin: CA/VO/L/R) 9 FAM 42.43 RELATED STATUTORY PROVISIONS (CT:VISA-985; 07-29-2008) See INA 203(g)

More information

OFFICE OF INTERNATIONAL PROGRAMS EXCHANGE STUDENTS 2013-2014 FINANCIAL CERTIFICATION

OFFICE OF INTERNATIONAL PROGRAMS EXCHANGE STUDENTS 2013-2014 FINANCIAL CERTIFICATION PART I: PERSONAL INFORMATION Family/Last Name: First/Given Name: Middle/Other Name: Permanent address in home country: Street: City: Postal Code: Country: U.S. address: Street: City: State: Zip: Date of

More information

Sample Patient Payment Policy

Sample Patient Payment Policy Sample Patient Payment Policy Thank you for choosing our practice! We are committed to the success of your medical treatment and care. Please understand that payment of your bill is part of this treatment

More information

WELCOME TO COASTLINE COMMUNITY COLLEGE!

WELCOME TO COASTLINE COMMUNITY COLLEGE! WELCOME TO COASTLINE COMMUNITY COLLEGE! Dear Prospective Student: Thank you for your inquiry regarding. We are pleased that you are considering our college as you make plans for your education. Enclosed

More information

Voluntary Term Life Program Specifications Prepared For. Gunnison County

Voluntary Term Life Program Specifications Prepared For. Gunnison County Voluntary Term Life Program Specifications Prepared For Gunnison County The Lincoln National Life Insurance Company 8801 Indian Hills Drive, Omaha, NE 68114 VOLUNTARY TERM LIFE INSURANCE Employee Gunnison

More information

EMBASSY OF THE DEMOCRATIC REPUBLIC OF THE CONGO

EMBASSY OF THE DEMOCRATIC REPUBLIC OF THE CONGO EMBASSY OF THE DEMOCRATIC REPUBLIC OF THE CONGO B-3/61, Safdarjung Enclave, New Delhi-110029 Tel: +91-112-618-3354 Fax: +91-114-166-3152 visa@drcembassyinindia.org VISA REQUIREMENTS All applicants for

More information

Tier 4: Application Guide

Tier 4: Application Guide Tier 4: Application Guide Index Page l Contents 1 Introduction. When to make a visa application 2 The CAS document 3 Documents needed to make a visa application 4 Documents needed to make a visa application

More information

PERSONAL SHOPPER SERVICES CONTRACT

PERSONAL SHOPPER SERVICES CONTRACT PERSONAL SHOPPER SERVICES CONTRACT THIS AGREEMENT executed on this the day of, 20 by and between (hereinafter "Employer"), and (Hereinafter "Personal Shopper"). NOW, THEREFORE, FOR AND IN CONSIDERATION

More information

Carroll College Matched Education Savings Account Application

Carroll College Matched Education Savings Account Application PERSONAL INFORMATION Name: Social Sec. No. (last four digits): Gender: Female Male Date of Birth: / / Ethnicity: African American Caucasian Latino or Hispanic Asian, Pacific Islander Native American Other

More information

Blessings to you from Charis Bible College,

Blessings to you from Charis Bible College, Blessings to you from Charis Bible College, Thank you for your interest in our school. We are pleased that your desire is to study the Word and the good news of the gospel with us. The first step in the

More information

Child Benefit claim form

Child Benefit claim form Child Benefit claim form Claim now or you may lose money Child Benefit cannot be backdated more than 3 months Completing this form also helps to protect your State Pension more information go to www.gov.uk/child-benefit/what-youll-get

More information

16.24% This APR will vary with the market based on the prime rate.

16.24% This APR will vary with the market based on the prime rate. PNC PREMIER TRAVELER SM VISA SIGNATURE IMPORTANT INFORMATION ABOUT RATES AND FEES Interest Rates and Interest Charges Annual Percentage Rate (APR) for Purchases 16.24% This APR will vary with the market

More information

B/G Club in its sole discretion. Subject to availability, Entrants may purchase as many Tickets as they wish. Tickets are non-transferable and can onl

B/G Club in its sole discretion. Subject to availability, Entrants may purchase as many Tickets as they wish. Tickets are non-transferable and can onl OFFICIAL EMW BMW RAFFLE RULES The Boys & Girls Club of Elma Marilla & Wales ("EMW") BMW Raffle ("Raffle") begins on February 10, 2016 and ends on August 10, 2016 ("Raffle Period"). The New York License

More information

LAWFUL PERMANENT RESIDENCY

LAWFUL PERMANENT RESIDENCY Office of International Students and Scholars Wayne State University LAWFUL PERMANENT RESIDENCY A Lawful Permanent Resident (LPR) is a person who has been lawfully accorded the privilege of residing in

More information

SEVP Frequently Asked Questions

SEVP Frequently Asked Questions SEVP Frequently Asked Questions Who is classified as an International Student? Any prospective student whose country of residence and citizenship is not the United States and is considered a non-immigrant.

More information

Admissions Checklist For Questions, Contact Admissions 800.255.7529 or 323.462.1384

Admissions Checklist For Questions, Contact Admissions 800.255.7529 or 323.462.1384 Admissions Checklist For Questions, Contact Admissions 800.255.7529 or 323.462.1384 Bachelor Degree Performance Bass Drums Guitar Keyboard Technology Vocal Composition For your application to be considered,

More information

Health Professions Student Loan Application

Health Professions Student Loan Application Health Professions Student Loan Application Directions: Complete all pages of the enclosed Health Professions Student Loan Application. Do not leave any answers blank use N/A if not applicable. Please

More information