Form I-131 - Application For Travel Document Page 2
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1
2
3Part 3. Processing Information
1. Date of Intended Departure (mm/dd/yyyy)
2. Expected Length of Trip
3. Are you, or any person included in this application, now in
No
Yes
(Name of DHS office):
exclusion, deportation, removal, or rescission proceedings?
If you are applying for an Advance Parole Document, skip to Part 7.
4. Have you ever before been issued a reentry permit or Refugee Travel Document?
No
Yes
(If "Yes," give the following information for the last document issued to you):
Date Issued (mm/dd/yyyy):
Disposition (attached, lost, etc.):
5. Where do you want this travel document sent? (Check one)
a.
To the U.S. address shown in Part 1 on the first page of this form.
b.
City:
Country:
To a U.S. Embassy or consulate at:
c.
To a DHS office overseas at:
City:
Country:
d. If you checked "b" or "c," where should the notice to pick up the travel document be sent?
To the address shown in Part 2 on the first page of this form.
To the address shown below:
Address (Number and Street)
Apt. #
Daytime Telephone #
(area/country code)
City
State or Province
Zip/Postal Code
Country
Part 4. Information About Your Proposed Travel
Purpose of trip. (
List the countries you intend to visit.
If you need more room, continue on a separate sheet of paper.)
Part 5. Complete Only If Applying for a Reentry Permit
Since becoming a permanent resident of the United States (or during the
less than six months
two to three years
past five years, whichever is less) how much total time have you spent
six months to one year
three to four years
outside the United States?
one to two years
more than four years
Since you became a permanent resident of the United States, have you ever filed a Federal income tax
return as a nonresident or failed to file a Federal income tax return because you considered yourself to be a
Yes
No
nonresident? (If "Yes," give details on a separate sheet of paper.)
Part 6. Complete Only If Applying for a Refugee Travel Document
1. Country from which you are a refugee or asylee:
If you answer "Yes" to any of the following questions, you must explain on a separate sheet of paper.
2. Do you plan to travel to the country named above?
No
Yes
3. Since you were accorded refugee/asylee status, have you ever:
Yes
No
a. Returned to the country named above?
Yes
No
b. Applied for and/or obtained a national passport, passport renewal, or entry permit of that country?
No
c. Applied for and/or received any benefit from such country (for example, health insurance benefits).
Yes
4. Since you were accorded refugee/asylee status, have you, by any legal procedure or voluntary act:
Yes
No
a. Reacquired the nationality of the country named above?
Yes
No
b. Acquired a new nationality?
c. Been granted refugee or asylee status in any other country?
Yes
No
Form I-131 (Rev. 11/23/10)Y Page 2
American LegalNet, Inc.
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