I-130A Spouse Beneficiary Information
Part 1: Information About Spouse Beneficiary
A-Number
USCIS Online Account Number
Last Name
*
First Name
*
Middle Name
Street Number and Name
*
Apt / Ste / Flr
City
*
State
*
ZIP Code
*
Province
Postal Code
Country
*
From
*
-
Month
-
Day
Year
Date
To
-
Month
-
Day
Year
Date
Street Number and Name
Apt / Ste / Flr
City
State
ZIP Code
Province
Postal Code
Country
Street
Apt
City
Province
Postal Code
Country
Parent 1 Full Name
First Name
Middle Name
Last Name
Parent 1 Date of Birth
-
Month
-
Day
Year
Date
Parent 1 City of Birth
Parent 1 Country of Birth
Parent 1 City of Residence
Parent 1 Country of Residence
Beneficiary Date of Birth
*
-
Month
-
Day
Year
Date
Sex
*
Please Select
Male
Female
Other
Part 2: Employment History (Last 5 Years)
Employer 1 - Company Name
*
Employer 1 - Street Address
*
Employer 1 - City
*
Employer 1 - State
*
Employer 1 - ZIP Code
*
Employer 1 - Province
*
Employer 1 - Postal Code
*
Employer 1 - Country
*
Employer 1 - Occupation
*
Employer 1 - Date From
*
-
Month
-
Day
Year
Date
Employer 1 - Date To
*
-
Month
-
Day
Year
Date
Employer 2 - Company Name
*
Employer 2 - Street Address
*
Employer 2 - City
*
Employer 2 - State
*
Employer 2 - ZIP Code
*
Employer 2 - Province
*
Employer 2 - Postal Code
*
Employer 2 - Country
*
Employer 2 - Occupation
*
Employer 2 - Date From
*
-
Month
-
Day
Year
Date
Employer 2 - Date To
*
-
Month
-
Day
Year
Date
Part 3: Employment Outside the United States
Employer Name
*
Occupation
*
Date From
*
-
Month
-
Day
Year
Date
Date To
*
-
Month
-
Day
Year
Date
Signature Section
Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: