Application for Asylum and for Withholding of RemovalFile Online

• Legal Form Number: I-589
• Section: Citizenship and Immigration Services (United States of America)
• Issuer: Citizenship and Immigration Services (United States of America)

9. Mailing Address in the U.S. (if different than the address in Item Number 8)

8. Residence in the U.S. (where you physically reside)

Telephone Number

Telephone Number

(

Department of Homeland Security

U.S. Citizenship and Immigration Services

18. Check the box, a through c, that applies:

START HERE - Type or print in black ink. See the instructions for information about eligibility and how to complete and file this

application. There is no filing fee for this application.

Part A.I. Information About You

1. Alien Registration Number(s) (A-Number) (if any) 2. U.S. Social Security Number (if any)

4. Complete Last Name

7. What other names have you used (include maiden name and aliases)?

Street Number and Name

City

12. Date of Birth (mm/dd/yyyy)

14. Present Nationality (Citizenship)

5. First Name6. Middle Name

)

Apt. Number

StateZip Code

Apt. Number

Street Number and Name

Zip Code

CityState

10. Gender:MaleFemale11. Marital Status:SingleMarriedDivorcedWidowed

13. City and Country of Birth

15. Nationality at Birth16. Race, Ethnic, or Tribal Group17. Religion

I have never been in Immigration Court proceedings.

I am not now in Immigration Court proceedings, but I have been in the past.

I am now in Immigration Court proceedings.

a.

c.b.

19. Complete 19 a through c.

a. When did you last leave your country? (mm/dd/yyyy)b. What is your current I-94 Number, if any?

c. List each entry into the U.S. beginning with your most recent entry. List date (mm/dd/yyyy), place, and your status for each entry.

(Attach additional sheets as needed.)

DatePlaceStatus

DatePlaceStatus

DatePlaceStatus

20. What country issued your last passport or travel

document?21. Passport Number

Travel Document Number

Page 1

NOTE: Check this box if you also want to apply for withholding of removal under the Convention Against Torture.

()

Date Status Expires

22. Expiration Date

(mm/dd/yyyy)

In Care Of (if applicable):

U.S. Department of Justice

Executive Office for Immigration Review

OMB No. 1615-0067; Expires 01/31/2023

I-589, Application for Asylum

and for Withholding of Removal

23. What is your native language (include dialect, if applicable)?24. Are you fluent in English?

YesNo

25. What other languages do you speak fluently?

3. USCIS Online Account Number (if any)

For EOIR use only.For

USCIS

use only.

Action:Decision:

Asylum Officer ID No.:

Approval Date:

Denial Date:

Referral Date:

Interview Date:

Form I-589 Edition 10/12/22

(NOTE: You must be residing in the United States to submit this form.)