Part D. Your Signature

I certify, under penalty of perjury under the laws of the United States of America, that this application and the

evidence submitted with it are all true and correct. Title 18, United States Code, Section 1546(a), provides in part:

Whoever knowingly makes under oath, or as permitted under penalty of perjury under Section 1746 of Title 28,

United States Code, knowingly subscribes as true, any false statement with respect to a material fact in any

application, affidavit, or other document required by the immigration laws or regulations prescribed thereunder, or

knowingly presents any such application, affidavit, or other document containing any such false statement or

which fails to contain any reasonable basis in law or fact - shall be fined in accordance with this title or

imprisoned for up to 25 years. 1 authorize the release of any information from my immigration record that U.S.

Citizenship and Immigration Services (USCIS) needs to determine eligibility for the benefit I am seeking.

WARNING: Applicants who are in the United States unlawfully are subject to removal if their asylum or withholding claims are not

granted by an asylum officer or an immigration judge. Any information provided in completing this application may be used as a basis for

the institution of, or as evidence in, removal proceedings even if the application is later withdrawn. Applicants determined to have

knowingly made a frivolous application for asylum will be permanently ineligible for any benefits under the Immigration and Nationality

Act. You may not avoid a frivolous finding simply because someone advised you to provide false information in your asylum application. If

filing with USCIS, unexcused failure to appear for an appointment to provide biometrics (such as fingerprints) and your biographical

information within the time allowed may result in an asylum officer dismissing your asylum application or referring it to an immigration

judge. Failure without good cause to provide DHS with biometrics or other biographical information while in removal proceedings may

result in your application being found abandoned by the immigration judge. See sections 208(d)(5)(A) and 208(d)(6) of the INA and 8 CFR

sections 208.10, 1208.10, 208.20, 1003.47(d) and 1208.20.

Print your complete name.

Write your name in your native alphabet.

Did your spouse, parent, or child(ren) assist you in completing this application?

Yes

(If "Yes," list the name and relationship.)

Name

Relationship

Name

Relationship

Did someone other than your spouse, parent, or child(ren) prepare this application?

Yes

Asylum applicants may be represented by counsel. Have you been provided with a list of

persons who may be available to assist you, at little or no cost, with your asylum claim?

Yes

Signature of Applicant (The person in Part. A.I )

Sign your name so it all appears within the brackets

Date of signature (mm/dd/yyyy)

Assistant