Questionnaire for TD Visa Petition Required Documents After completing this questionnaire, send the following documents to Joseph Kallabat & Associates, P.C. Copy of your Passport with all visas and entry/exit stamp(s); Copy of your Form I-94; Copy of ALL Form I-797 Approval Notices for nonimmigrant status including (H-1B/H-4, L-1/L-2, TN/TD, E-1/E-2, E-3, etc); Marriage certificate (spouses); Birth certificate (children) Information About Person Filing TN Name of the Spouse or Parent that is filing the TD Application Name of the Spouse or Parent's New TD Employer Information About You Family Name Given Name Middle Initial Address Apt. # City State Zip Code Daytime Phone # Mobile Phone # Email Address Country of Birth Citizenship Social Security # Date of Birth (MM/DD/YYYY) Date of Last Arrival Into the U.S. I-94 # Current Nonimmigrant Status Expires On (MM/DD/YYYY) Additional Information Passport Country of Issuance Passport Number Valid To (MM/DD/YYYY) Alien Number Foreign Address Apt. # City State Country Zip Code Has an I-140 Immigrant petition ever been filed for you? Yes No Has an I-485 (Adjustment of Status) ever been filed by you or other member of your family? Yes No Have you ever been arrested or convicted of any criminal offense since last entering the US? Yes No Have you ever served in, been a member of, assisted, or participated in any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerrilla group, militia, insurgent organization or any other armed group? Yes No Have you ever held J-1/J-2 status? Yes No Information Regarding Children Please complete the following fields regarding any children you have. If you have no children, leave this section blank. Child #1 First Name Middle Name Last Name Date of Birth (MM/DD/YYYY) Country of Birth Citizenship Social Security # A # Latest Date of Arrival in the USA I-94 # Current Non-Immigrant Status Date of Expiration of Non-Immigrant Status Country Where Passport Was Issued Passport Expiration Date Has an I-140 Immigrant petition ever been filed for you? Yes No Has an I-485 (Adjustment of Status) ever been filed by you or other member of your family? Yes No Have you ever been arrested or convicted of any criminal offense since last entering the US? Yes No Have you ever served in, been a member of, assisted, or participated in any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerrilla group, militia, insurgent organization or any other armed group? Yes No Have you ever held J-1/J-2 status? Yes No Child #2 First Name Middle Name Last Name Date of Birth (MM/DD/YYYY) Country of Birth Citizenship Social Security # A # Latest Date of Arrival in the USA I-94 # Current Non-Immigrant Status Date of Expiration of Non-Immigrant Status Country Where Passport Was Issued Passport Expiration Date Has an I-140 Immigrant petition ever been filed for you? Yes No Has an I-485 (Adjustment of Status) ever been filed by you or other member of your family? Yes No Have you ever been arrested or convicted of any criminal offense since last entering the US? Yes No Have you ever served in, been a member of, assisted, or participated in any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerrilla group, militia, insurgent organization or any other armed group? Yes No Have you ever held J-1/J-2 status? Yes No Child #3 First Name Middle Name Last Name Date of Birth (MM/DD/YYYY) Country of Birth Citizenship Social Security # A # Latest Date of Arrival in the USA I-94 # Current Non-Immigrant Status Date of Expiration of Non-Immigrant Status Country Where Passport Was Issued Passport Expiration Date Has an I-140 Immigrant petition ever been filed for you? Yes No Has an I-485 (Adjustment of Status) ever been filed by you or other member of your family? Yes No Have you ever been arrested or convicted of any criminal offense since last entering the US? Yes No Have you ever served in, been a member of, assisted, or participated in any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerrilla group, militia, insurgent organization or any other armed group? Yes No Have you ever held J-1/J-2 status? Yes No Terms of Engagement – Representation Joseph Kallabat & Associates, PC (hereafter "JK&A") will solely represent your Employer in connection with the requested TD immigration services (the Services). Please review the below information and by submitting the questionnaire you have no objections to JK&A's representation of your Employer in connection with the Services. The I-129 nonimmigrant petition is an Employer sponsored petition. You desire that JK&A provide the Services in a manner most likely to result in the expeditious issuance of the TD nonimmigrant visa on your behalf. Please note JK&A's obligation to represent and respect the wishes of your Employer is our primary responsibility. JK&A does have a duty to your Employer and any information that is material to the representation of either party will be disclosed accordingly. There are several issues which you must be aware of concerning JK&A's representation of your Employer. The first concerns our obligation of confidentiality. Attorneys are under a duty not to disclose to anyone any information disclosed by a client to the attorney in confidence. JK&A will not disclose any information that you provide to us in connection with the Services to any third party. However, JK&A's representation will obligate us to disclose your information that is material information relating to the representation to your Employer without regard to whether such information constitutes a client confidence or secret. Second, at issue in any representation setting is the Attorney's ability to represent its client with zeal and loyalty, should a conflict arise. There always exist potential areas of conflict in representation situations. Should an actual conflict between you and your Employer arise, JK&A will inform both parties of the feasibility of JK&A's continued representation. Should JK&A find our continued representation is in both parties interest, we will, after full disclosure, continue your representation. JK&A's main consideration will be whether we can, in fact, zealously represent both parties without compromising our loyalties to either. Yet, should a dispute be such that the parties decide to litigate, by agreeing to the terms listed here, you allow JK&A to choose to continue representation of your Employer without your prior consent should we so choose. Any information we have obtained during this representation, whether confidential or not, can be disclosed by us. By submitting the TD questionnaire you acknowledge that you understand the potential advantages and disadvantages of this representation, and that you have decided to proceed with this representation. You hereby waive your right to disqualify JK&A from representing your Employer in other immigration matters. I have read and agree to the Terms of Engagement - Representation What is the result of below calculation?
