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Bureau of Population, Refugees and Migration ESTIMATED ...

5. Sex1. Case Size (Yourself plus family members traveling with you)2. Name as it Appears on your Passport (Last, First, Middle)3. Passport Ethnicity11. ReligionB. PRINCIPAL APPLICANTA. CASE INFORMATION (To be completed by NVC)NVC Case NumberAssigned PostPost POC Information13. E-mail12. Phone Number(s)DS-234 12-2020 Page 1 of 44. Sex2. Passport Ethnicity10. Religion12. E-mail11. Phone Number(s)MaleFemale3. IV Case Marital Status6. Date of Birth(mm-dd-yyyy)7. Place of Birth(City, Country)8. Nationality15. Native Language(Good, Some, None)16. Other Language(s)(Good, Some, None)LanguageReadingLanguage 2 Language 1 Language 4 Language 3 WritingSpeaking13.

Speaking 13. Occupation/Skill 14. Education Level/Field of Study 17. English Speaking Ability (Good, Some, None) 18. Pregnant Yes No 19. Estimated Delivery Date (mm-dd-yyyy) 20. Health Issues (If yes, please explain) 1. Name as it Appears on Passport (Last, First, Middle) Child 2 2. Passport No. 4. Sex 9. Ethnicity 10. Religion 11. Phone Number ...

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