1. Family name:  

2. Given name:  

3. Middle name: 

4. Full address:  

5. Date of birth:  

6. Country of birth:  

7. social security number (if any):  

8. A# (if any):  

9. If you are in the U.S.:

·   Date of arrival:

·   I-94 card #:

·   Current nonimmigrant status:

·   Date status expires:

·   Daytime Phone # with area code:

10.  Upon approval of EB-5 petition

·    Will you adjust status to permanent residence in the U.S.

Or

·     Will you apply for an immigrant visa at a U.S. consular post

*Please contact us if you have any questions about this choice. We need to choose before filing the EB-5 petition.

11.  Provide foreign address:

12.  Are you in deportation proceedings:

13.  Have you ever worked in the U.S. without permission?

14.  Prior immigration history:

·     Obtained U.S. Visa before?

·     If yes, what type?

·     Ever stayed in U.S. beyond authorization?

·     If yes, circumstances:

·     Denied visa application?

·     If yes, circumstances

15.  Family information:

·     Marital status:

·     Spouse with separate possibilities:

·     Children:

16.  Education history

Please return completed Questionnaire with:

·      Copies of bank statements, clearly showing your ownership of the account (your name on the statement), and showing funds out of the account and into Regional Center

·       Foreign business registration records (if funds derive from business abroad)

·       Personal Tax returns filed within the last 5 years in or outside the U.S.

·       Business Tax returns filed within the last 5 years (if your investment funds derive from a business you own)

·       Other sources of capital – please inform us whether your source of investment funds derives from one or more of:

1.      earned income from employment

2.      proceeds of securities accounts

3.      inheritance

4.      trust account in which you are a beneficiary

5.      gift letter

**Source of income must be discussed with us before you proceed with your investment. If your investment funds derive from sources other than your own earned income, documentation of those sources will be required.

·       Certified copies of any judgment against the investor from any court within the past 15 years, if applicable

·       Full copy of passport for yourself and all non-U.S. dependents (each page, including blanks)

·       If in the U.S. – for yourself and all non-U.S. dependents:

·       I-94 card

·       visa

·       social security card, U.S. driver’s license

·       Birth certificates for yourself and all non-U.S. dependents (long form, naming both parents)

·       Marriage certificate if married (especially important if investment funds are from joint accounts)