This application is NOT FREE. Applications with Non-Payment will not be processed
1
COMPLETE
& SUBMIT the form below. If you are filing a dual application, complete 2 applications,
one for each spouse.
2
PRINT
& SIGN the resulting application (2 pages). If you are
unable to print the application, provide the required
information on a sheet of paper.
3
MAIL your application,
photograph, and
processing fee to Sudan Gate.Or proceed to pay online by credit card.
DV-2003
APPLICATION
APPLICANT
Name
First Name
Middle Name
Last Name
Birth
Date
Day
Month
Year
Birth
Place
City/Town
Province/State
Country
Country
Claimed
SPOUSE
Name
First Name
Middle Name
Last Name
Birth
Date
Day
Month
Year
Birth
Place
City/Town
Province/State
Country
CHILD #1
Name
First Name
Middle Name
Last Name
Birth
Date
Day
Month
Year
Birth
Place
City/Town
Province/State
Country
CHILD #2
Name
First Name
Middle Name
Last Name
Birth
Date
Day
Month
Year
Birth
Place
City/Town
Province/State
Country
ADDITIONAL INFORMATION
List
additional children and/or provide an explanation for
claiming nativity in a country other than your country of
birth:
CONTACT
INFORMATION
Address
Address
Line 1
Address Line 2
City/Town
Province/State
Postal
Code
Country
Telephone
Email
IMPORTANT NOTICE
THIS PAYMENT IS
UNREFUNDABLE
By submitting this form, you
agree to pay Sudan Gate for services related
to the preparation and submission of your Diversity Immigrant Visa
("Green Card") Lottery application. You further
acknowledge that Sudan Gate does not guarantee
that you will receive a permanent US residence/work visa, but only
provides you with an opportunity to participate in the Green Card
Lottery. Because this is a lottery, you cannot claim a
refund for fees paid to process your application. If you
accept these terms, please proceed by clicking Submit,
below.
