EB-5 Investor Questionnaire for Permanent Residence Based on Investment

EB-5 Investor Questionnaire for Permanent Residence Based on Investment

Please complete all sections. Please do not leave any questions blank. If the question does not apply to you, please write in “N/A” or “none” as appropriate.

Part I: Investor Information

Name of Investor
LAST / First / Middle / Maiden
Current U.S. residential address
Street / City / State / Postal code / Country
Permanent address abroad, in care of a relative is acceptable
Street / City / State / Postal code / Country
Social Security # / Alien Registration Number (A#), if applicable
Email Address(es) / Home Telephone #
Work Telephone # / Cell Telephone #
Country of Citizenship / Place of Birth (city, state/province, country) / , ,
Date of birth (mm/dd/yy) / / / / Current U.S. Immigration Status
Date of first admissionto U.S. (mm/dd/yy) / / / / Date of most recent entry to U.S. (mm/dd/yy) / / /
Form I-94 Admission # / Port of Entry (city, state) / ,
Education: highest level achieved relevant to the requested occupation / None High School Associate’s Bachelor’s Master’s
Doctorate Other
Major field(s) of study / Year relevant education completed
Name of Institution where education specified above was completed
Address of Institution where relevant education completed
Street / City / State / Postal code / Country

Part II: Employment Information

Current Employer Name
Current Work Address
Street / City / State / Postal code / Country
Job title / Salary / $ per hour week month year
Base hours per week / Name of Supervisor
Years of experience do you have in this type of work with other employers / Years of experience related to this type of work with this employer

Describe any prior employment experience in the U.S. and abroad (in the alternative, you can provide a resume that includes all of the detailed information as requested below):

Job 1

Employer Name / Type of Business
Worksite Address
Street / City / State / Postal code / Country
Name of Supervisor / Contact Number
Job Title / Hours per week
Dates of Employment / / / / / /
Start (mm/dd/yy) / End(mm/dd/yy)
Type of Work Authorization (if in U.S.) / Document(s) Validity Period (mm/dd/yy) / / /
to
/ / / / /
to
/ /
USCIS Document(s) providing work authorization (name and document number, ie: I-797, EAD, etc.)
Document name and number / Document name) and number
Detailed Description of Job Duties

Job 2

Job 3

*For additional employment history (including overseas experience not listed above), please attach additional sheets to the questionnaire providing the same information requested for each position.

Part III: Immigration Status History

Have you ever been in the U.S. before? yes no
If yes, please list:

Date of Entry (mm/dd/yy) / Date of Departure (mm/dd/yy) / Visa Type (B, H, L, TN, etc)
/ / / / /
/ / / / /
/ / / / /
/ / / / /

If you are or have ever been in the U.S., did you always maintain legal status?

yes no

If no, please explain:

List all U.S. employment and type of USCIS work authorization not listed in Part II:

Employer Name / Position / Start date of employment (mm/dd/yy) /

End date of employment (mm/dd/yy)

/ USCIS employment authorization (name and document number, ie: I-797, EAD, etc.)
/ / / / /
/ / / / /
/ / / / /
/ / / / /

List chronologically the countries where you have lived for more than 6 months during the last five years.

Country / Dates of Residence – From/To (mm/yy)
/
/
/
/

Please answer “yes” or “no” to the following questions. If any answer is “yes,” please provide an explanation within this document or in a separate sheet of paper. All information provided will remain confidential from third parties and is being requested to ensure that we provide complete accurate legal advice and address all of your immigration issues and matters without jeopardizing your immigration options in the U.S.

Have you or has anyone acting for you ever filed an immigration petition or requested labor certification for you?

yes no

If yes, please explain, giving as much detail as possible, including dates:

Do you have a valid passport?

yes no

If yes, please provide the country of issuance and expiration date:

Within the past seven years, have you ever been given the visa classification or permanent residency?

yes no

Within the past seven years, have you ever been denied the classification you now seek?

yes no

If yes, please explain, giving as much detail as possible, including dates:

Have you or your family members ever been refused a visa?

yes no

If yes, where and when did you apply?

Has your or your family members visa ever been canceled?

yes no

If yes, where and when did you apply?

Are you or your family members now or have you ever been in deportation or removal proceedings or refused admission to the U.S.?

yes no

If yes, have you ever been deported or removed?

yes no If yes Please provide date:

Have you been refused admission to the U.S. or have you ever been deported from the U.S.?

yes no

If yes, please explain, giving as much detail as possible, including dates:

Have you or your family members ever been arrested, fined, or convicted for any offense?

yes no

If yes, please explain, giving as much detail as possible, including dates:

Have you or your family members ever violated the terms of a U.S. visa or been unlawfully present in the United States or overstay your visa?

yes no

If yes, please explain, giving as much detail as possible, including dates:

Have you or your family members ever worked without authorization in the U.S. including any time spent as an unpaid volunteer?

yes no

If yes, please explain, giving as much detail as possible, including dates:

Are you aware of any issue in your history that might make you inadmissible to the United States and/or ineligible for a visa? ( e.g., prior misrepresentation in securing entry to the U.S., in obtaining a visa, in connection with any prior applications with USCIS; use of fraudulent work authorization documents; receipt of public assistance; induced or assisted any alien to try to enter the U.S. illegally; subject to 2-year foreign residency requirement for J-1s)

yes no

If yes, please explain, giving as much detail as possible, including dates:

IV Family Information

If you have family members you intend to bring with you to the United States, please list them below and provide the following information:

Name

LAST, First / Relationship to you
e.g. wife, daughter, son / Date of Birth (mm/dd/yy) /

Country of Birth

/ Date of most recent entry to U.S. and status (H, L, TN, B, etc.)
, / / / / / /
Date (mm/dd/yy) / Status
, / / / / / /
Date (mm/dd/yy) / Status
, / / / / / /
Date (mm/dd/yy) / Status
, / / / / / /
Date (mm/dd/yy) / Status

V Funding Sources

Source of Investment Capital (Attach evidence of possession and control of funds in the U.S.) / Personal funds / Corporate funds / Loans
Stock debentures / bonds / other
Location of Assets

If outside of the United States, please list all countries where assets are located:
Assets / Will Serve as Source of Investment Funds
Checking Account / $
Savings / $
Investments (stocks, bonds, mutual funds) / $
Business income / $
Real estate / $
Inheritance / $
Gift / $
Other
Explain: / $
Liabilities
Mortgage / $
Other
Explain: / $
Total Net Worth: / $

Supporting Documentation

Please provide the following supporting documents with translation:

1. Passport biographic page of the investor and family members, marriage certificate and birth certificates for investor, spouse and dependent children;

2. Narrative of the investor’s past earnings history, current occupation/business, history of how he or she has made the investment funds;

3. Documentation to show that the investor has a level of income or has accumulated sufficient wealth to make the EB-5 investment and reside in the U.S. Financial statements for the investor or their business.

4. Investor’s Curriculum Vitae or Resume;

5. Investor’s academic degrees, if any;

6. Professional licenses from appropriate foreign or domesticauthority;

7. Recent bank account statements showing personal savings;

8. 5 years of tax returns for every country where the individual has earned money and/ or filed tax returns. If income was earned in years prior to this, tax returns showing highest income levels. In cases where a company pays taxes on behalf of its employees, records from the company showing that such filings have been made on behalf of the investor.;

9. If the money comes from a business the investor owns, they will need to submit:

a. 5 years of the business’ tax returns

b. Audited financial statements or accountant’s evaluation

c. website print outs

d. marketing/ promotional materials

e. business licenses/registration documents

f. media coverage of the business

g. bank statements for the business

h. Documentation providing ownership or position within the company

i. Stock certificates showing ownership percentage

j. Documentation relating to acquisition of business and funds spent for acquisition

k. Documentation relating to sale of business and proceeds from same

10. If the money comes from earnings from an employer:

a. Paystubs

b. Employment confirmation letter from the employer confirming the individual’s title, rate of pay, and length of employment

c. Employment contracts or offer letters

d. Letters providing a bonus or stock options

e. Letters describing any promotions

11. If the funds are from the sale of real estate:

a. Documentation of purchase and sale of real estate

b. Appraisals of real estate

c. Lease documents demonstrating lease income

d. Deeds and mortgages

12. If the funds are from sales of stocks of bonds:

a. Securities account statements if the money comes from stocks/bonds/trading

b. Documentation of purchase and sale

13. If the funds are from an inheritance all documents relating to the estate settlement;

14. If the funds are from a lawsuit or divorce proceeding:

a. All documents related to alimony

b. Property settlements

c. Awards or settlements related to civil lawsuits

15. If the funds are from lottery or gambling winnings documentation related to same;

16. If the money is a gift from a family member:

a. The above documents as they relate to the giftor, as well as the investor

b. A gift affidavit explaining the reason for the gift, and how the giftor has earned his or her money;

c. Documentation of the relationship between the giftor and investors, such as birth certificates, marriage certificates, etc.

d. Tax returns evidencing payment of applicable gift taxes

Please be sure that all the documents above are clean, clear copies showing as much detailed information as possible. Please note that all documents must be in English. Please provide a professional translation to English for those documents in any other language. If you do not have translations and wish us to arrange for translations by a vendor, please provide us with these documents as soon as possible in order to allow sufficient time.

I have completed this questionnaire based on all information available to me. I have read and understand the terms of the dual nature of this representation.

Printed Name

SignatureDate

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