EB-5客户调查问卷

步骤 1 字，最多 9

FORM INSTRUCTIONS

1. Please complete this questionnaire completely.

Enter “N/A” if any question is not applicable. Please do not leave blanks.
a. Complete this questionnaire for the primary applicant and any spouse or dependents who you anticipate will be included in the final EB-5 petition to US Citizenship and Immigration Services.

2. Passport copies

a. Attach a legible copy of the photo page of the primary applicant’s passport.
b. If this questionnaire includes the primary applicant’s spouse and/or children, also attach a legible copy of the photo page of each dependent’s passport.
c. If the signature page is separate from the photo page on any applicant’s passport, also attach a legible copy of the signature page.
PRIMARY APPLICANT INFORMATION
Name*
First/Given Middle Name Last/Family
OTHER NAMES USED OR ALIASES (including maiden name)*
FULL NAME IN NATIVE ALPHABET*
NATIONAL ID NUMBER (HOME COUNTRY)
DATE OF BIRTH*
MM slash DD slash YYYY
GENDER*
- Male
- Female
PASSPORT NUMBER*
COUNTRY OF PASSPORT ISSUANCE*
COUNTRY OF BIRTH*
COUNTRY OF CURRENT LEGAL RESIDENCE*
CURENT PERMANENT ADDRESS*
街道地址地址2 (街道) 市州/省/地区邮编/邮政编码国家
CURRENT MARITAL STATUS*
- Single/Never Married
- Married
- Divorced
- Widowed
NUMBER OF DEPENDENTS (excluding spouse)*
CURRENT TELEPHONE NUMBER: ( ) - (Country Code) (Area Code) (Number)*
CURRENT FAX NUMBER (Country Code) (Area Code) (Number)*
ENGLISH PROFICIENCY*
- Need Translator
- Conversational
- Fluent
OTHER LANGUAGES SPOKEN (if any)*
EMAIL ADDRESS*
FULL NAME OF CURRENT EMPLOYER (if any)*

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FOR PRIMARY APPLICANTS RESIDING IN THE UNITED STATES
PRIMARY APPLICANTS
- Please fill out the information below if the primary applicant resides in the United States. If you do not reside in the United States, please check this box to indicate this section is not applicable:
Address
街道地址地址2 (街道) 市州/省/地区邮编/邮政编码国家
DATE OF ARRIVAL
MM slash DD slash YYYY
CURRENT VISA TYPE (if any)
I-94 NUMBER
I-94 EXPIRATION DATE
MM slash DD slash YYYY
CURRENT NON-IMMIGRANT STATUS (if any)

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CHILDREN’S INFORMATION (IF APPLICABLE)
CHILDREN’S INFORMATION
- please check this box to indicate this section is not applicable:
Please provide the following information about each of your applicant children under the age of 21. Please list children in order from oldest to youngest.
1. Name
Last/Family First/Given Middle Name
DATE OF BIRTH
MM slash DD slash YYYY
GENDER
- Male
- Female
COUNTRY OF CITIZENSHIP
2. Name
Last/Family First/Given Middle Name
DATE OF BIRTH
MM slash DD slash YYYY
GENDER
- Male
- Female
COUNTRY OF CITIZENSHIP
3. Name
Last/Family First/Given Middle Name
DATE OF BIRTH
MM slash DD slash YYYY
GENDER
- Male
- Female
COUNTRY OF CITIZENSHIP
4. Name
Last/Family First/Given Middle Name
DATE OF BIRTH
MM slash DD slash YYYY
GENDER
- Male
- Female
COUNTRY OF CITIZENSHIP

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EB-5客户调查问卷

步骤 1 字，最多 9

FORM INSTRUCTIONS

PRIMARY APPLICANT INFORMATION

FOR PRIMARY APPLICANTS RESIDING IN THE UNITED STATES

APPLICANT SPOUSE INFORMATION (IF APPLICABLE)

CHILDREN’S INFORMATION (IF APPLICABLE)

PRIMARY APPLICANT AND SPOUSE’S FINANCIAL RESOURCES

PRIMARY APPLICANT ONLY

PRIMARY APPLICANT PLUS SPOUSE

PRIMARY APPLICANT’S NET WORTH (IN $US)

SOURCE OF FUNDS FOR EB-5 INVESTMENT

SOURCE OF FUNDS

AMOUNT ($US)

DESCRIPTION OF SOURCE OF FUNDS

FURTHER INFORMATION REGARDING GIFT FUNDS FOR EB-5 INVESTMENT

SOURCE OF FUNDS

GIFT #1

GIFT #2 (if any)

GIFT #3 (if any)

ADDITIONAL QUESTIONS - IMMIGRATION ATTORNEY

ADDITIONAL QUESTIONS - GENERAL

APPLICANT CERTIFICATION AND SIGNATURE