Professional Documents
Culture Documents
LOCAL AFFILIATE:
RA :
DATE:
DATE OF BIRTH :
Please be aware that this application constitutes a request to participate in the U.S. Refugee Admissions Program. It should be noted that completion and submission of this form does not
guarantee the issuance of a D Visa nor does it guarantee admission to the United States as a refugee. Processing times can vary widely and can range from months to years depending on timely
submission of documents/information, security clearances, and payments of Care & Maintenance funds. If the individuals on this application need to leave Iran urgently, please tick the expedite
box on the Application Checklist and submit an explanation. Cases can be expedited at any point in the process. Should the applicants situation change, please provide an explanation to your local
resettlement agency regarding why the case now needs to be expedited.
D .
. C&M . .
. .( expedite box)
.
INSTRUCTIONS: A Refugee Information Form (RIF) can be filed by anyone legally residing in the U.S. The person for whom the RIF is filed must be personally known by the U.S. tie. The principal
applicant (PA) must be a member of an eligible religious minority group in Iran (for this particular program) and reside in Iran at the time of this application.
All sections of the RIF must be filled out in English with the assistance of a local resettlement agency. All dates given should be as specific as possible in the format 05/JAN/1965 or, at a minimum,
month and year. All required documentation (as indicated on the Application Checklist) must be included in the application packet. Failure to submit a complete RIF and all required documentation
will result in serious delays or could result in the application not being accepted for further processing.
It is required that the applicant(s) have a current passport(s) at the time of submission of this application.
All application packets (RIF and all required documents) must be mailed to RSC/Austria by the local resettlement agency. Electronic submissions will not be accepted.
A case number will be issued and sent to the resettlement agency once RSC/Austria receives the application. All applicants must check HIAS RSC/Austrias website (www.hias-vienna.at) regularly for
updates regarding the case.
. U.S. tie .( RIF) :
(RIF) .
05/Jan/1965 .
) .
. RIF .(
. )(
. . RSC/Austria RIF
. RSC/Austria
. www.hias-vienna.at RSC/Austria
DATE OF BIRTH :
GENDER
DATE OF BIRTH
CITY/COUNTRY
OF BIRTH
LEGAL STATUS
IN USA
MARITAL
STATUS
ALIEN NUMBER
NUMBER OF
MARRIAGES
RELATION TO PA
WORK PHONE:
CITY:
STATE:
MOBILE PHONE:
EMAIL:
Yes:
No:
List all family members applying to this program, including the principal applicant (PA), spouse, and any children under the age of 21. Children over 21 years of age or turning 21 within nine months of
filing this form must file a separate RIF, if applying to the program. Children under 18 years of age will only be processed when together with their parent(s). If you need more space, continue on the
RIF Supplemental Page for Section 2.
NAME: LAST, FIRST, MIDDLE
RELATION TO
PRINCIPAL
APPLICANT (PA)
PA
1.
GENDER
MARITAL
STATUS
DATE OF BIRTH
CITY/COUNTRY
OF BIRTH
NATIONALITY
CURRENT
RELIGION
DATE OF
CONVERSION
(IF APPLICABLE)
DOES THE
APPLICANT
SPEAK FARSI?
Y/N
Iran
2.
If spouse is not traveling with #1, see Section 3
3.
4.
5.
6.
DATE OF BIRTH :
PROVINCE:
CITY:
EMAIL ADDRESS:
POSTAL CODE:
COUNTRY:
WHEN DID THE PA START USING THIS EMAIL ADDRESS? (PROVIDE MONTH AND YEAR)
Is the principal applicants spouse traveling with the principal applicant and listed in Section 2?
Yes:
No:
If NO, please provide details below, including the reason why the spouse is not traveling:
GENDER
DATE OF BIRTH
CITY/COUNTRY
OF BIRTH
NATIONALITY
CURRENT
RELIGION
DATE OF
CONVERSION
(IF APPLICABLE)
RELATION TO PA
Spouse
RELATION
NO. OF
MARITAL
STATUS MARRIAGES
DATE
OF BIRTH
COUNTRY
NATIONALITY RELIGION
OF BIRTH
IMMIGRATION
PREVIOUS
YEAR OF
CITY/COUNTRY STATUS IN DECEASED
RELIGION
CONVERSION OF RESIDENCE COUNTRY OF
Y/N
(IF APPLICABLE)
RESIDENCE
DATE OF BIRTH :
GENDER
NO. OF
MARITAL
STATUS MARRIAGES
DATE
OF BIRTH
COUNTRY
OF BIRTH
NATIONALITY RELIGION
CITY/COUNTRY
OF RESIDENCE
RELATION
IMMIGRATION
(CHILD,
DECEASED
STATUS IN
STEP-CHILD,
Y/N
COUNTRY
ADOPTED,
OF RESIDENCE
ETC.)
GENDER
NO. OF
MARITAL
STATUS MARRIAGES
DATE
OF BIRTH
COUNTRY
OF BIRTH
NATIONALITY RELIGION
CITY/COUNTRY
OF RESIDENCE
IMMIGRATION
DECEASED
STATUS IN
Y/N
COUNTRY
OF RESIDENCE
RELATION
DATE OF BIRTH :
SECTION 7: EMPLOYMENT
List a complete employment history for all applicants in Section 2 who are age 18 or older. Employment histories should start with the first job held after the age of 17. If you need more space,
continue on the RIF Supplemental Page for Section 7.
NAME: LAST, FIRST, MIDDLE
NAME OF COMPANY/
ORGANIZATION
TITLE
COMPANY/ORG.
CITY, STATE, COUNTRY
START DATE
END DATE
START DATE
END DATE
BRANCH/UNIT
COUNTRY
RANK ATTAINED
ATTENDING UNIVERSITY
OR EXEMPTED
If the applicant has been exempted from the military, please provide the applicants name and the reason for the exemption:
DATE OF BIRTH :
SECTION 9: TRAVEL
Have any of the applicants listed in Section 2 ever traveled outside of Iran for any length of time during their entire life?
Yes:
No:
If YES, please provide details below regarding all travel for all family members on this application. A complete copy of the travel documents or visas used for the travel must be included with this
application. If you need more space, continue on the RIF Supplemental Page for Section 9.
COUNTRY VISITED
OR RESIDED
DATE OF
DEPARTURE
FROM IRAN
DATE OF
RETURN
TO IRAN
DURATION OF
TRIP OR STAY
REASONS
FOR TRAVEL
REASONS FOR
RETURN TO IRAN
COPY OF TRAVEL
DOCUMENT
INCLUDED WITH
APPLICATION? Y/N*
IF NO, SEE BELOW.
If you are submitting an update to this section, please provide the date updated: ______________
DATE OF BIRTH :
Yes:
No:
WHERE
APPLIED
TYPE OF
APPLICATION
VISA/
RESIDENCY
DATE
APPLIED
Denied
Visas
Only
OUTCOME
(IN
PROGRESS/
GRANTED/
DENIED)
ISSUE
DATE
EXPIRATION
DATE
TRAVEL/RESIDE
IN THE U.S.?
Y/N
DATE
ENTERED
U.S.
DATE
DEPARTED
U.S.
COPY OF TRAVEL
DOCUMENT
INCLUDED WITH
APPLICATION? Y/N*
IF NO, SEE BELOW.
*If copies of the travel documents are not included in this application, please explain why:
Yes:
No:
DATE OF BIRTH :
SECTION 10: VISAS AND LEGAL PERMANENT RESIDENCE OUTSIDE OF IRAN (CONT)
If YES, please provide details below:
TYPE OF
APPLICATION
VISA/
RESIDENCY
COUNTRY
ISSUING
VISA/
RESIDENCY
DATE
APPLIED
Denied
Visas
Only
OUTCOME
(GRANTED/
DENIED)
ISSUE
DATE
EXPIRATION
DATE
DID YOU
TRAVEL/RESIDE
IN THE
COUNTRY? Y/N
DATE
ENTERED
COUNTRY
DATE
DEPARTED
COUNTRY
COPY OF TRAVEL
DOCUMENT
INCLUDED WITH
APPLICATION?
Y/N*
IF NO, SEE BELOW.
*If copies of the travel documents are not included in this application, please explain why:
No:
If YES, please list the applicants name and the name of the country or countries (other than Iran) where the applicant has/had citizenship.
DATE OF BIRTH :
List ALL current passports held by all applicants listed in Section 2. If you need more space, continue on the RIF Supplemental Page for Section 12, Current Passports.
NAME: LAST, FIRST, MIDDLE
RELATION TO
PRINCIPAL
APPLICANT
PASSPORT NUMBER
ISSUING COUNTRY
ISSUE
DATE
EXPIRATION
DATE
SPOUSE/CHILDREN
LISTED IN PASSPORT?
IF YES, PLEASE INDICATE WHO
COPY OF PASSPORT
IN APPLICATION? Y/N
IF NO, PLEASE
EXPLAIN BELOW
PA
If copies of current passports are not included in this application, please explain why:
EXPIRED PASSPORTS
List ALL expired passports ever held by all applicants listed in Section 2. If you need more space, continue on the RIF Supplemental Page for Section 12, Expired Passports.
NAME: LAST, FIRST, MIDDLE
RELATION TO
PRINCIPAL
APPLICANT
PASSPORT NUMBER
ISSUING COUNTRY
ISSUE
DATE
EXPIRATION
DATE
SPOUSE/CHILDREN
LISTED IN PASSPORT?
IF YES, PLEASE INDICATE WHO
COPY OF PASSPORT
IN APPLICATION? Y/N
IF NO, PLEASE
EXPLAIN BELOW
PA
If copies of expired passports are not included in this application, please explain why:
DATE OF BIRTH :
Yes:
No:
Yes:
No:
Yes:
No:
SECTION 14: CONVICTIONS (THIS DOES NOT INCLUDE VIOLATIONS OF SHARIA LAW)
Have any of the applicants listed in Section 2 on this form ever been convicted of a crime in a court of law in Iran or any other country?
Yes:
No:
If YES, please provide details of the conviction and sentence, including the nature, date, and location of the violation, as well as the date of conviction.
Yes:
No:
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DATE OF BIRTH :
MEDICAL CONDITION
DATE OF
CONDITION
______________________________________________________________________________________________________________________________________________________________
I hereby confirm that all information on this form and all documentation submitted in connection with this application is true and complete to the best of my knowledge. I further affirm that:
I have a genuine personal relationship to the applicants on whose behalf I submit this application.
Neither I nor any of my family or associates will profit from the submission of this application through any monetary or material compensation, reward, or gift.
This application is submitted with the sole and genuine intent of assisting the applicants to flee persecution and being reunited with them in the U.S.
I will convey to the applicant all information regarding processing, including, but not limited to: processing procedures, appointment times, acceptance into the program, and the
necessary documents.
I understand that it is my responsibility to ensure that the applicants listed in this application have adequate financial resources, food, clothing, shelter, and access to medical care during
their stay in Vienna for a period of no less than six months.
I further understand that providing false information on this form may have negative consequences on other immigration benefits for which I or the applicants may be eligible.
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Date:
Date:
Date:
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