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Part B. Information About Your Application

(NOTE: Use Form 1-589 Supplement B, or attach additional sheets of paper as

needed to complete your responses to the questions contained in PartB.)

When answering the following questions about your asylum or other

protection claim (withholding of removal under 241(b)(3) of the INA or

withholding of removal under the Convention Against Torture), you must

provide a detailed and specific account of the basis of your claim to

asylum or other protection. To the best of your ability, provide specific

dates, places, and descriptions about each event or action described.

You must attach documents evidencing the general conditions in the

country from which you are seeking asylum or other protection and the

specific facts on which you are relying to support your claim. If this

documentation is unavailable or you are not providing this documentation

with your application, explain why in your responses to the following questions.

Refer to Instructions, Part 1. Filing Instructions, Section II., Basis of Eligibility,

Parts A. - D., Section V., Completing the Form, Part B.; and Section VII. Additional

Evidence That You Should Submit, for more information on completing this section of the form.

1. Why are you applying for asylum or withholding of removal under section 241(b)(3)

of the INA, or for withholding of removal under the Convention Against Torture?

Check the appropriate box(es) below and then provide detailed answers to questions

A and B below.

I am seeking asylum or withholding of removal based on:

Race

Political opinion

Religion

Membership in a particular social group

Nationality

Torture Convention

A. Have you, your family, or close friends or colleagues ever experienced harm or mistreatment

or threats in the past by anyone?

No

Yes

If "Yes," explain in detail:

1. What happened,

2. When the harm or mistreatment or threats occurred,

3. Who caused the harm or mistreatment or threats, and

4. Why you believe the harm or mistreatment or threats occurred.

B. Do you fear harm or mistreatment if you return to your home country?

No

Yes

If "Yes," explain in detail:

1. What harm or mistreatment you fear,

2. Who you believe would harm or mistreat you; and

3. Why you believe you would or could be harmed or mistreated.

2. Have you or your family members ever been accused, charged, arrested, detained,

interrogated, convicted and sentenced, or imprisoned in any country other than the

United States (including for an immigration law violation)?

No

Yes

If "Yes," explain the circumstances and reasons for the action.

3.A. Have you or your family members ever belonged to or been associated with any

organizations or groups in your home country, such as, but not limited to,

a political party, student group, labor union, religious organization, military or

paramilitary group, civil patrol, guerrilla organization, ethnic group, human

rights group, or the press or media?

No

Yes

If "Yes," describe for each person the level of participation, any leadership or

other positions held, and the length of time you or your family members were involved

in each organization or activity.

3.B. Do you or your family members continue to participate in any way in these organizations

or groups?

No

Yes

If "Yes," describe for each person your or your family members's current level of participation,

any leadership or other positions currently held, and the length of time you or your family

members have been involved in each organization or group.

4. Are you afraid of being subjected to torture in your home country or any other country to

which you may be returned?

No

Yes

If "Yes," explain why you are afraid and describe the nature of torture you fear, by whom,

and why it would be inflicted.

Assistant