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05/31/09
Gupta None
Family Name Father Gupta Mother (Maiden Name) Gupta
Rahul
All Other Names Used (Including names by previous marriages) First Name
Mumbai, India
Date, City and Country of Birth (If known)
123-45-6789
City and Country of Residence
Ram Sita
First Name
12/13/1944 08/01/1950
Husband or Wife (If none, Family Name so state.) (For wife, give maiden name)
Agrawal
Former Husbands or Wives (If none, so state) First Name Family Name (For wife, give maiden name)
Manisha
Birth Date (mm/dd/yyyy)
11/20/1975
Pune, India
12/14/2004
Mumbai, India
None
From Year
Edison Billerica
Reseton
NJ MA VA
USA USA
08
09 11
2004 2001
USA
1998
07 08
2004
2001
Applicant's last address outside the United States of more than one year.
Street and Number City Province or State Country
To Month Year
Maharashtra Mumbai India Applicant's employment last five years. (If none, so state.) List present employment first.
Full Name and Address of Employer Occupation (Specify)
11
Month
1997
From Year
10
To Month
1998
Year
AT&T
Software Engineer
08 09 11
2004
Present Time
2001 1998
07 08
2004 2001
Show below last occupation abroad if not shown above. (Include all information requested above.)
Citicorp
This form is submitted in connection with an application for: Naturalization Other (Specify): Status as Permanent Resident Signature of Applicant
Software Engineer
11
1997
10
Date
1998
11/14/2005
If your native alphabet is in other than Roman letters, write your name in your native alphabet below:
Penalties: Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact.
Applicant:
Gupta
Be sure to put your name and Alien Registration Number in the box outlined by heavy border below.
(Given Name) (Middle Name) (Alien Registration Number)
Rahul
Ram
A12345678
(1) Ident.
Gupta None
Family Name Father Gupta Mother (Maiden Name) Gupta
Rahul
All Other Names Used (Including names by previous marriages) First Name
Mumbai, India
Date, City and Country of Birth (If known)
123-45-6789
City and Country of Residence
Ram Sita
First Name
12/13/1944 08/01/1950
Husband or Wife (If none, Family Name so state.) (For wife, give maiden name)
Agrawal
Former Husbands or Wives (If none, so state) First Name Family Name (For wife, give maiden name)
Manisha
Birth Date (mm/dd/yyyy)
11/20/1975
Pune, India
12/14/2004
Mumbai, India
None
From Year
Edison Billerica
Reseton
NJ MA VA
USA USA
USA
08
09 11
2004 2001
1998
07 08
2004
2001
Applicant's last address outside the United States of more than one year.
Street and Number City Province or State Country
To Month Year
Mumbai India Applicant's employment last five years. (If none, so state.) List present employment first.
Full Name and Address of Employer Occupation (Specify)
Maharashtra
11
1997
10
To Month
1998
Year
AT&T
Bull Technologies Fannie Mae
Software Engineer
Software Engineer Software Engineer
08 09 11
Present Time
2004 2001
Show below last occupation abroad if not shown above. (Include all information requested above.)
Citicorp
This form is submitted in connection with an application for: Naturalization Other (Specify): Status as Permanent Resident Signature of Applicant
Software Engineer
11
1997
10
Date
1998
11/14/2005
If your native alphabet is in other than Roman letters, write your name in your native alphabet below:
Penalties: Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact.
Applicant:
Gupta
Be sure to put your name and Alien Registration Number in the box outlined by heavy border below.
(Given Name) (Middle Name) (Alien Registration Number)
Rahul
Ram
A12345678
Gupta None
Family Name Father Gupta Mother (Maiden Name) Gupta
Rahul
All Other Names Used (Including names by previous marriages) First Name
Mumbai, India
Date, City and Country of Birth (If known)
123-45-6789
City and Country of Residence
Ram Sita
First Name
12/13/1944 08/01/1950
Husband or Wife (If none, Family Name so state.) (For wife, give maiden name)
Pune, India
12/14/2004
Agrawal
Former Husbands or Wives (If none, so state) First Name Family Name (For wife, give maiden name)
Manisha
Birth Date (mm/dd/yyyy)
11/20/1975
Date and Place of Marriage
Mumbai, India
None
From Year
Edison Billerica
Reseton
NJ MA VA
USA USA
USA
08
09 11
2004 2001
1998
07 08
2004
2001
Applicant's last address outside the United States of more than one year.
Street and Number City Province or State Country
To Month Year
Mumbai India Applicant's employment last five years. (If none, so state.) List present employment first.
Full Name and Address of Employer Occupation (Specify)
Maharashtra
11
1997
10
To Month
1998
Year
AT&T
Bull Technologies Fannie Mae
Software Engineer
Software Engineer Software Engineer
08 09 11
Present Time
2004 2001
Show below last occupation abroad if not shown above. (Include all information requested above.)
Citicorp
This form is submitted in connection with an application for: Naturalization Other (Specify): Status as Permanent Resident Signature of Applicant
Software Engineer
11
1997
10
Date
1998
11/14/2005
If your native alphabet is in other than Roman letters, write your name in your native alphabet below:
Penalties: Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact.
Applicant:
Gupta
Be sure to put your name and Alien Registration Number in the box outlined by heavy border below.
(Given Name) (Middle Name) (Alien Registration Number)
Rahul
Ram
A12345678
(3) C.
Gupta None
Family Name Father Gupta Mother (Maiden Name) Gupta
Rahul
All Other Names Used (Including names by previous marriages) First Name
Mumbai, India
Date, City and Country of Birth (If known)
123-45-6789
City and Country of Residence
Ram Sita
First Name
12/13/1944 08/01/1950
Husband or Wife (If none, Family Name so state.) (For wife, give maiden name)
Agrawal
Former Husbands or Wives (If none, so state) First Name Family Name (For wife, give maiden name)
Manisha
Birth Date (mm/dd/yyyy)
11/20/1975
Pune, India
12/14/2004
Mumbai, India
None
From Year
Edison Billerica
Reseton
NJ MA VA
USA USA
USA
08
09 11
2004 2001
1998
07 08
2004
2001
Applicant's last address outside the United States of more than one year.
Street and Number City Province or State Country
To Month Year
Mumbai India Applicant's employment last five years. (If none, so state.) List present employment first.
Full Name and Address of Employer Occupation (Specify)
Maharashtra
11
1997
10
To Month
1998
Year
AT&T
Bull Technologies Fannie Mae
Software Engineer
Software Engineer Software Engineer
08 09 11
Present Time
2004 2001
Show below last occupation abroad if not shown above. (Include all information requested above.)
Citicorp
This form is submitted in connection with an application for: Naturalization Other (Specify): Status as Permanent Resident Signature of Applicant
Software Engineer
11
1997
10
Date
1998
11/14/2005
If your native alphabet is in other than Roman letters, write your name in your native alphabet below:
Penalties: Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact.
Applicant:
Gupta
Be sure to put your name and Alien Registration Number in the box outlined by heavy border below.
(Given Name) (Middle Name) (Alien Registration Number)
Rahul
Ram
A12345678
(4) Consulate
Instructions
What Is the Purpose of This Form?
Complete this biographical information form and include it with the application or petition you are submitting to U.S. Citizenship and Immigration Services (USCIS). USCIS will use the information you provide on this form to process your application or petition. Complete and submit all copies of this form with your petition or application. If you have any questions on how to complete the form, call our National Customer Service Center at 1-800-375-5283.