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[ارکیده]

این نمونه فرممون هست....مثلا خط پایین نوشته فول نام رو بنوسیید ولی نه جایی براش مشخص کرده نه گفته اسم کی باید نوشته بشه...
Print or type your full name
Check one box only to the left of the statement that is your choice.
[ ] I appoint _________________________________________________ ______________________
Telephone Number
as my agent or attorney to receive mail about my application. Mail from the U.S. Department of State concerning my
immigrant visa application should be sent to:
____________________________________________________ ___________________
Name of the person who will act as your agent or attorney for receipt of mail Telephone Number
____________________________________________________ ___________________
Street address (where my agent or attorney will receive mail about my application) *Email Address
________________ ___________________________ _____________ ______________
City State/Province Postal Code Country
[ ] I do not appoint an agent or an attorney to receive mail about my application. Mail from the U.S.
Department of State concerning my immigrant visa application should be sent to me at:
_____________________________________________________ ___________________
Street address (include "in care of" if needed) *Email Address
_________________ ___________________________ _____________ ______________
City State/Province Postal Code Country
[ ] I have already legally immigrated to the U.S. and do not need to apply for an immigrant visa. I received my
Green Card through the ________________________________(city) USCIS office. My A# is
____________________
[ ] I no longer wish to apply for an immigrant visa.
As proof of your choice, sign and date this document:
___________________________________________________ ________________
Signature of Applicant Date of Signature (mm-dd-yyyy)
PAPERWORK REDUCTION ACT
Public reporting burden for this collection of information is estimated to average 10 minutes per response. Persons are not required to provide this
information in the absence of a valid OMB approval number. Send comments on the accuracy of this estimate of the burden and recommendations for
reducing it to: U.S. Department of State (A/ISS/DIR) Washington, DC 20520-1849.
*The Department is currently testing an electronic application system for nonimmigrant visa application that will allow electronic submission and eliminate
paper forms. Once testing on this application is completed the Department is examining whether or not the system can be used for the immigrant visa
system.