USGC Services - DV2005 Application Form

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USGC Services - DV2005 Application Form

USGC Services – Diversity Visa Checklist DV2008

This form is the property of USGC Services. It is the official USGC Services paper Diversity Visa Application form and only valid for the DV2008 (calendar year 2006) green card lottery program. No other paper applications will be accepted by USGC Services.

The application must be completed 100% accurately and returned together with photographs and payment to the address supplied. The closing date for paper applications is currently the end of November 2006 and might change. The reason for this is to allow enough time to scan, process and fix any errors on your application.

Also take note that the fee structure for paper applications differ from online applications. It is highly recommended that you rather complete an online application over the Internet at the USGC Services website (www.usaza.com), that completing a paper application. A paper application should only be completed if it impossible for you to complete an online application over the Internet.

The following is a checklist to help ensure you complete all part of the application correctly. Check off the items as you go along:

CHECKLIST  1. Read the Diversity Visa Program Information to ensure you do qualify.  2. Read the Terms and Conditions page if you agree to the terms and conditions.

3. Complete the Application Forms with pen and write clearly in English to prevent  errors and delays. If you have more that 3 kids, add additional children on the Additional Children form.  4. Complete the Payment Information section:  a. Select the applicable application and payment amount,  b. Select the payment method, c. Complete the credit card payment information if this is your preferred  payment method.

5. Sign the Terms and Conditions form to indicate that you have read, understood and  accept the conditions within.

6. Have a passport photograph taken for each person on your application form.  Carefully follow the instructions as explained under # 7 on the DV Program Information page.  7. Mail your application to USGC Services and include the following:  a. The Application Form (page 4 & 4a) b. A passport photograph for each person on your application form (as per  section F on page 4 & section H on page 4a) c. Additional Child information page if you included more than 3 children (page  4a)  d. Payment Information page (page 3) e. Signed Terms and Conditions acceptance form (page 5)  f. Payment (if other than credit card) Page 1 USGC Services – Diversity Visa Program Information (Valid until Nov 30, 2006) DV2008

1. WHAT IS THE GREEN CARD LOTTERY  There’s a required Processing Fee The GREEN CARD LOTTERY, also known as the DIVERSITY VISA  Photograph's: PROGRAM, allocates 50,000 – 55,000 visas, to applicants from certain Applicants may also upload digital eligible countries around the world. The qualifying applications will be o chosen in a random drawing or "LOTTERY" conducted by the U.S. photographs after completing an online application at STATE DEPARTMENT. The selected applicants will qualify for a so- www.usaza.com. called "Green Card" after submitting a successful immigration petition. o If you cannot submit a digital photograph, The United States Congress first enacted the program in 1965. attach a passport photograph of size 50mm x 50mm (2 inches X 2 inches) for each person on the application to 2. HOW DOES THE LOTTERY WORK? USGC Services address below. Note that it must be a Approximately 100 000 "WINNERS" will be selected by a computer recent photograph of the applicant, the applicant’s drawing and be notified via mail or email. All winners will receive the spouse, and all children on the application. official immigration forms to be completed immediately. Interviews will o Write the name of each person on the be granted to the first 50 000 returned immigration applicants. An back of his or her photograph. Failure to submit interview at the nearest US Consulate will be scheduled and if photographs for all family members will result in successful, the DV Visas will be issued. You will then have 6 months disqualification. from the date of issuance to enter the US to complete the green card o The person on the picture must be directly issuing process. facing the camera; the head of the person being photographed should not be tilted up, down or to the 3. WHAT DOES A GREEN CARD ALLOW ME TO DO? side, and should cover about 50% of the area of the A Green Card gives a person the LEGAL RIGHT to: photograph.  LIVE, WORK AND STUDY permanently in the United States. o The photograph should be taken with the  Enter and leave the country freely. person being photographed in front of a neutral, light- colored background. Photos taken with very dark or  Work at any government institution, public or private jobs. patterned, busy backgrounds will NOT be accepted.  Receive health, education and other benefits. o Photos in which the face of the person  Sponsor certain relatives for Green Cards. being photographed is not in focus will not be  Keep your present citizenship. (The Green Card DOES NOT accepted. affects your present citizenship. A Green Card holder may, after 5 o Photos in which the person being years residency in the US, apply for US citizenship, if desired) photographed is wearing a hat or glasses with dark lens or in which the face is obscured in any way will 4. WHO QUALIFIES TO PARTICIPATE? NOT be accepted. You will qualify if the following is true: o Photos may be either color or black and  You or your spouse was born in a qualifying country. See the white. list of countries that DON’T qualify in section 5 below.  You have at least the equivalent to a U.S. high school 8. ANY OTHER IMPORTANT INFORMATION? diploma (12 years of successful schooling) or two years work The State Department released new rules in August 2003 experience in the past five years that requires two years of training. allowing submissions of online applications and digital  You must be able to work and/or support yourself photographs.

You don't have a criminal record.  The U.S. State Department doesn’t charge a fee for entering the  You meet the needed medical requirements. Diversity Visa Program. You may choose to submit your entry on your own during the brief submission period from the State 5. WHICH COUNTRIES DON’T QUALIFY? Departments website. However past statistics indicate that many The selected lottery countries include most of the countries in the applications received were disqualified for various possible world. The following countries DON’T qualify: CANADA, CHINA reasons: (mainland-born), COLOMBIA, DOMINICAN REPUBLIC, EL  Insufficient information SALVADOR, HAITI, INDIA, JAMAICA, MEXICO, PAKISTAN, PHILIPPINES, RUSSIA, SOUTH KOREA, UNITED KINGDOM  Incorrect information (names, addresses) (except Northern Ireland) and its dependent territories, VIETNAM.  Incorrect photographs (size, orientation & picture quality) 6. ANY OTHER REQUIREMENTS?  Applications arriving before or after the submission  You don't need to be able to speak English. period (no longer possible)  You don't need to have relatives living in the United States. The State Department has very specific requirements for  You don't need a certain amount of money or a job waiting. applicants and any deviation might result in a disqualification.  You cannot have a criminal record. USGC Services will help minimize this possibility and assist  You cannot be mentally disturbed. applicants in the following ways:  You cannot be a threat to the United States national interest.  Year round acceptance of submissions. We will submit your application during the brief submission period.  You can enter the Green Card Lottery even if you have other The receipt received from the State Department confirming petitions pending. Entering does not affect current or past petitions. success submission will be sent to you via email where provided. 7. HOW DO I ENTER THE LOTTERY?  We accept and validate non-digital photographs and You can capture your information on the State Departments website will contact you should your pictures not comply with all the during the allowed entry period, or complete all the information on the State Department's requirements as listed above. application form below. Important things to remember are:  We will turn passport photographs into digital  Write on the application form the First Name, Middle photographs. Names, Last Name, Gender and the date and place of birth of  We will downscale digital photographs to required the applicant, his/her spouse if married, and all unmarried size. children, as well as all legally-adopted and stepchildren under the age of 21 years. Applicants must also indicate their marital  We will contact you if your application is incomplete status. e.g. missing photographs etc.  Provide the applicant's native country  If you are selected as a winner, your information will first be sent to our office in the US. We will make copies of all the documentation and contact you via email, telephone or mail, and inform you of your winning status. The winning package will then be couriered to your preferred address.  As we have firsthand experience with the immigration process, we will guide you through any of the procedures and questions you might have regarding the process.

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9. CAN BOTH HUSBAND AND WIFE APPLY? 12. WHAT DOES IT COST? (Also refer to section 14) YES, a person can only enter a single application per year, but by The fees vary between $35 - $70, depending on the following: having both husband and wife entering you will double your chances.  The application type (married or single, multiple years)  The mailing date (last minute entries cost more) 10. WHEN SHOULD I SUBMIT MY APPLICATION? The payment method (paying with a MoneyGram will The State Department’s brief application submission period varies every  year and is currently unknown (for DV2007 it was 5 Oct 2005 – 4 Dec result in a discounted rate) 2005). However, USGC Services accepts applications throughout the Note that the fee is a service fee only charged by USGC Services. year with a discounted rate of up to 40% for early entries. So we strongly advice you enter immediately to avoid disappointment. Always 13. HOW TO REGISTER: first use the online application submission before completing this form.  Please use only the English language and alphabet. To complete an online application, connect to the internet and go to  Complete areas 14, 15 on this page. www.usaza.com and select Register an Online Application.  Complete areas A, B, C, D, E, F on the application form 11. WHEN WILL I BE NOTIFIED THAT I HAVE BEEN and G & H if you have more than 3 children. SELECTED?  Read and sign the Terms & Conditions page (5). Successful applicant will be notified by our office during the months of  Mail this application + photographs to the address May through July of the following year. Note that the DV program of the provided. previous year officially closes in October of the following year.

14. SELECT AND MARK THE APPLICABLE PAYMENT OPTION (dates below refers to postmarked dates on mail / emails) INDIVIDUAL APPLICATION – A single application for and individual or family  Individual Application for one year - $50 (Oct 1 – Nov 30)  Individual Application for one year - $45 (Oct 1 – Nov 30 only if paying with a MoneyGram. See page 4 for more details)  Individual Application for one year - $40 (July 1 – Sep 30)  Individual Application for one year - $35 (July 1 – Sep 30 only if paying with a MoneyGram. See page 4 for more details)

MARRIED / DOUBLE APPLICATION – Two separate applications will be submitted, one for applicant and one for spouse. See #9 above.  Married Application for one year - $70 (Oct 1 – Nov 30)  Married Application for one year - $65 (Oct 1 – Nov 30 only if paying with a MoneyGram. See page 4 for more details)  Married Application for one year - $60 (July 1 – Sep 30)  Married Application for one year - $55 (July 1 – Sep 30 only if paying with a MoneyGram. See page 4 for more details)

15. METHOD OF PAYMENT

Please select and mark an option below. Make all payments payable to USGC Services  US issues Money Order (e.g. Western Union, US Postal, MoneyGram)  International issued Money Order  US or Canadian Bank Check  Credit Card (currently only accepting VISA and MasterCard)  MoneyGram International Money Transfer

 If you are paying with a electronic MoneyGram, please enter the reference number here on the printout: ______(do not include the answer to the qualifying question here)

If you choose to pay with a credit card, please fill out the following information:  VISA  MasterCard  American Express Amount:

US$ ______

    __|__|__|______Credit Card Number MM YY Cardholder’s signature Expiration Date

______Cardholders Name Address as known by issuing bank

______@______Issuing Bank’s Name Card Holder’s Phone number Card Holder’s email address (very important)

By signing this form you authorize USGC Services, operated by Chris Scholtz, to charge the amount entered to the above card number.

PLEASE MAIL ALL APPLICATIONS WITH A FAST MAIL SERVICE TO: USGC Services P.O.Box 774 Hanover, NH 03755, USA

By completing this form you agree to all the terms and conditions as stipulated at www.usaza.com and as listed under the Terms and Conditions section. US Green Card Services cannot guarantee that you will be selected as a winner. The required filing fee covers all handling and expenses that includes preparation, processing and filing your DV application with the US State Department. The Diversity Visa program is a lottery program and USGC Services cannot guarantee your chance to be selected. USGC Services has no responsibility or liability for damages or claims relating to any use of the Services on a professional or personal basis. USGC Services will process your application as correct as possible, but are not liable for any typographical errors that might occur during the submission period. This form is not an entity on its own and forms part of the online material at www.usaza.com and all the same terms and conditions apply as listed on the website. Page 3 USGC Services - DV2008 Application Form (Valid until November 30, 2006) DV2008

Only complete this form if you cannot capture the requested data on the Internet at www.usaza.com. If you have any questions regarding the DV program, please email [email protected]. Follow all of these instructions: MAIL THIS FORM AND  Complete all the applicable areas on this form.  Write clearly with a pen and in the English language only.  Ensure PAGE 2 TO: that you do qualify to enter the DV program as listed under section four and stated by the State Department.  You must also include a passport photograph for each person listed on this form.  You MUST read and accept the Terms and Conditions as listed on page 5 of this application.  You must read the minimum requirements as listed on page 2 & 3. USGC Services P.O. Box 774 WARNING: USGC Services has not appointed any outside INDIVIDUALS or ORGANIZATIONS claiming to represent Hanover, NH 03755 USGC Services. Only applications that include payments made to USGC Services, as described under “Payment Methods” at section 15 on page 3, will be accepted and processed. See also the last paragraph on page 3. USA

For Office Use Only Ver 4.1  MoneyGram #  $45  $35   Photographs Included?  Money Order # DV2K8- $50  $65  $59   Photographs correct?  Credit Card $44  Scanned  Captured  Submitted  Single  Double  Check # Date Received: A. Applicant’s Details F. Photographs

Full Name: ______LAST / FAMILY NAME FIRST GIVEN NAME MIDDLE NAME Applicant Photo - Size must be: Unmarried  Married  Date Of Birth: ______/ ______/ ______50mm x Separated Divorced DAY / MONTH / YEAR   50mm Legally Separated Widowed   - No Photo Copies Place Of Birth: ______- Write name on TOWN COUNTRY OF BIRTH back mm/yy Due Date: - Colour or B&W Native Country: ______Male  Female  Pregnant  B. Spouse’s Details

______Spouse’s Photo Spouse Full Name: LAST / FAMILY NAME FIRST GIVEN NAME MIDDLE NAME - Size must be: 50mm x ______/ ______/ ______mm/yy 50mm Spouse Date Of Birth: DAY / MONTH / YEAR Male  Female  Pregnant  Due Date: - No Photo Copies - Write name on Spouse Place Of Birth: ______CITY/TOWN, STATE/PROVINCE ______back COUNTRY OF BIRTH - Colour or B&W Native Country: ______C. Children’s Details 1 st Child’s Photo First Child Full Name: ______- Size must be: LAST / FAMILY NAME FIRST GIVEN NAME MIDDLE NAME 50mm x 50mm First Child Date Of Birth: ______/ ______/ ______Male  Female  - No Photo Copies DAY / MONTH / YEAR - Write name on back First Child Place Of Birth: ______- Colour or B&W CITY/TOWN, STATE/PROVINCE COUNTRY OF BIRTH

nd Second Child Full Name: ______2 Child’s Photo LAST / FAMILY NAME FIRST GIVEN NAME MIDDLE NAME - Size must be: 50mm x Second Child Date Of Birth: ______/ ______/ ______Male  Female  50mm DAY / MONTH / YEAR - No Photo Copies - Write name on Second Child Place Of Birth: ______back CITY/TOWN, STATE/PROVINCE COUNTRY OF BIRTH - Colour or B&W

rd Third Child Full Name: ______3 Child’s Photo LAST / FAMILY NAME FIRST GIVEN NAME MIDDLE NAME - Size must be: 50mm x Third Child Date Of Birth: ______/ ______/ ______Male  Female  50mm DAY / MONTH / YEAR - No Photo Copies - Write name on Third Child Place Of Birth: ______back CITY/TOWN, STATE/PROVINCE COUNTRY OF BIRTH - Colour or B&W

D. Contact Details

Telephone Number: ______DAY PHONE NUMBER NIGHT PHONE NUMBER MOBILE / CELL PHONE NUMBER

Email Address ______(USE A FRIEND’S IF YOU DON’T HAVE ONE)

Address: ______STREET or PO BOX ADDRESS, CITY/TOWN STATE / PROVINCE COUNTRY

E. Signature – I, the principal applicant, read, understood and agrees to all the terms, conditions and requirements ______Please note that USGC Services is not associated with the US State Department. USGC Services is a separate entity focusing only on assisting potential DV applicants to enter the DV program. Page 4 Complete this form only if you have more than 3 kids that should be added on the application.

Applicant Name: ______(same as in section A)

Applicant Last Name (Family Name): ______(same as in section A)

G. Additional Children H. Photographs

4 st Child’s Photo Fourth Child Full Name: ______- Size must be: LAST / FAMILY NAME FIRST GIVEN NAME MIDDLE NAME 50mm x 50mm Fourth Child Date Of Birth: ______/ ______/ ______Male  Female  - No Photo Copies DAY / MONTH / YEAR - Write name on back Fourth Child Place Of Birth: ______- Colour or B&W CITY/TOWN, STATE/PROVINCE COUNTRY OF BIRTH

nd Fifth Child Full Name: ______5 Child’s Photo LAST / FAMILY NAME FIRST GIVEN NAME MIDDLE NAME - Size must be: 50mm x Fifth Child Date Of Birth: ______/ ______/ ______Male  Female  50mm DAY / MONTH / YEAR - No Photo Copies - Write name on Fifth Child Place Of Birth: ______back CITY/TOWN, STATE/PROVINCE COUNTRY OF BIRTH - Colour or B&W

rd Sixth Child Full Name: ______6 Child’s Photo LAST / FAMILY NAME FIRST GIVEN NAME MIDDLE NAME - Size must be: 50mm x Sixth Child Date Of Birth: ______/ ______/ ______Male  Female  50mm DAY / MONTH / YEAR - No Photo Copies - Write name on Sixth Child Place Of Birth: ______back CITY/TOWN, STATE/PROVINCE COUNTRY OF BIRTH - Colour or B&W

rd Seventh Child Full Name: ______7 Child’s Photo LAST / FAMILY NAME FIRST GIVEN NAME MIDDLE NAME - Size must be: 50mm x Seventh Child Date Of Birth: ______/ ______/ ______Male  Female  50mm DAY / MONTH / YEAR - No Photo Copies ______- Write name on Seventh Child Place Of Birth: ______COUNTRY OF BIRTH back CITY/TOWN, STATE/PROVINCE - Colour or B&W

rd Eighth Child Full Name: ______8 Child’s Photo LAST / FAMILY NAME FIRST GIVEN NAME MIDDLE NAME - Size must be: 50mm x Eighth Child Date Of Birth: ______/ ______/ ______Male  Female  50mm DAY / MONTH / YEAR - No Photo Copies ______- Write name on Eighth Child Place Of Birth: ______COUNTRY OF BIRTH back CITY/TOWN, STATE/PROVINCE - Colour or B&W Page 4a USGC Services – Terms and Conditions DV2008

You may not use the USGC Services website or any paper application forms until you have read this Agreement. Selecting to proceed with the application indicates your unconditional acceptance of the terms specified below. If you do not accept or agree to this Agreement, you should not proceed with the application forms. If you have any questions, please feel free to contact USGC Services at: [email protected]

USAGE AGREEMENT AND LIMITED WARRANTY As used in this Agreement, the terms you, your, applicant or user are synonymous, and refer to the person using the Services in any way. A registered user is a user from whom USGC Services has received the information necessary to permit such person to print prepared immigration forms by using the Services and who complies with the terms and conditions of this Agreement.

USGC Services provides assistance only with filling out Diversity Visa applications. Discretion on the contents of the whole form relies solely and completely on the user. An Internet interface to any supported form does not extend the corresponding Government instructions with additional advice, personal or general. Government instructions are truthfully and completely integrated in provided the Internet interface to any supported form. In addition, original Government instructions for any supported form are made available together with the filled out form as an end product.

Notwithstanding anything in this Agreement, USGC Services has no responsibility or liability for damages or claims relating to any use of the Services on a professional or personal basis. USGC Services assumes no responsibility for errors or omissions of personal information from paper or online applications. You shall not attempt to access any other USGC Services systems, programs or data that are not made available for public use. Additionally, no material from this form may be copied, reproduced, republished, uploaded, posted, transmitted, or distributed in any way without USGC Services written permission. Modification or use of materials on the site for any purpose other than those permitted in this Agreement is a violation of USGC Services rights.

Pricing and Fees Pricing on this form represent application preparation fees payable to USGC Services. Any Additional processing and filing fees (if any) are payable to the US Citizenship and Immigration Services (USCIS) or US Embassy during the interview process. These additional fees are not included in the USGC Services service fee, and must be paid separately at the time of application submission and interview as and when required by the USCIS or their representatives.

Security and Data Storage During the processing of your paper application, your information will be captured on the USGC Services database. During this time you will be given a username and password. You are the only person authorized to use your user identification (username) and password, and shall not permit or allow other persons to have access to or use the same. You are responsible for the use of the Services under your user identification number, and for maintaining the confidentiality of your user identification (User Name) and password. Although it has taken significant measures to ensure the security of information submitted by you in using the Services, USGC Services cannot guarantee the security of information collected during your use of the Services and shall not be liable in any way for a compromise of your data. You agree to print or save a copy of your application for you records. Credit card information will not be stored on any USGC Services database and will only be used through the Authorize.net network during the credit card processing procedure.

Credit Card Payment USGC Services use the Authorize.net secure credit card payment system. Authorize.Net is a secure online payment-processor that allows for businesses to authorize, process and manage credit card transactions directly via the Web. (www.authorize.net) Paper applications are also processed through Authorize.net using a merchant secure web payment method. USGC Services do not store any credit card information on any of it’s databases.

Operation USGC Services has the right at any time and for any reason to modify or discontinue any aspect or feature of the Services, including but not limited to its content, functionality or hours of availability, the equipment needed for its access or use, or its pricing. You should confirm that the pricing for your use of the Services has not changed, particularly if some time has passed between the date you start your immigration application and the date you finish and are ready to file it. USGC Services is not responsible for any late filing or rejection of your immigration application due to any reason.

In addition, USGC Services reserves the right, at any time, to change the terms of this Agreement by publishing notice of such changes on its Internet site. Any use of the Services by you after USGC Services publication of any such changes shall constitute your acceptance of this Agreement as modified. You agree that USGC Services is permitted to access and use any other information provided by you to perform the Services and, if necessary, to access such information to obtain contact information in order to provide notifications relating to the Services to you.

Refund Policy If a user is dissatisfied with the USGC Services service, he/she can discontinue the use of the service at any point BEFORE THE PAYMENT STAGE, with no consequences and no fees. Demonstrations and examples of the service are available before this point, allowing the user to make an informed decision about using the service. If paid users are unable to use the purchased service due to any technical problems that they encounter at our site, they are entitled to discontinue the service and request a full refund, within 30 days from the date of payment (TECHNICAL PROBLEMS MUST BE SUBMITTED ALONG WITH ANY REFUND REQUESTS). By providing payment information, the user agrees to these terms, and receives permission to access and use the USGC Services system at his/her convenience to learn about the Diversity Visa application process and prepare the application.

The completed application is merely a part of the USGC Services service. One of the primary advantages of the service is educating the user about the process and requirements of the U.S. Immigration and Naturalization Service applications. USGC Services provides a highly user friendly and interactive "do it yourself" service on the web that guides the user through the application preparation process. The user also has an option to make use of a paper application process. The payment is received in exchange for the use of this service.

If technical issues arise, USGC Services provides technical support via e-mail for all paid users. Paid users may contact us with any technical issues at [email protected]. Please note that this support is only to address technical related problems that a user may encounter at the site or when using the service. USGC Services will refrain from answering any questions that we feel is legal in nature. We do not intend to or claim to provide legal advice or solutions to individual's specific problems through this support.

Copyright, Disclaimer of Warranty and Restricted Rights USGC Services assumes no responsibility for errors or omissions in these materials or during the application process. THESE MATERIALS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NON-INFRINGEMENT. USGC Services does not warrant the accuracy or completeness of the information, text, graphics, links or other items contained within these materials. USGC Services shall not be liable for any special, indirect, incidental, or consequential damages, including without limitation lost revenues or lost profits, that may result from the use of these materials or its services. USGC Services may make changes to these materials, or to the products described therein, at any time without notice. USGC Services makes no commitment to update the information contained herein. Copyright © 1996-2006, USGC Services All rights reserved.

Miscellaneous USGC Services shall have the right to immediately terminate your access to or use of the Services in the event of any activities which are in breach of this Agreement or conduct which, in USGC Services judgment, interferes with the operation or use of the Services (e.g., excessive usage of the Services which disrupts the use of the Services by other users). Termination of this Agreement automatically terminates your license and authorization to use and/or access Services and any content or other material contained therein. This Agreement (including any related content on the Services, such as the introductory and welcome pages, which by this reference are incorporated herein) set forth by USGC Services and its Participating Parties entire liability and your exclusive remedy with respect to the Services, and is a complete statement of the agreement between you and USGC Services. This Agreement does not limit any rights that USGC Services may have under trade secret, copyright, patent or other laws. The employees of USGC Services and its Participating Parties are not authorized to make modifications to this Agreement, or to make any additional representations, commitments, or warranties binding on USGC Services, except in a writing signed by an authorized officer of USGC Services If any provision of this Agreement is invalid or unenforceable under applicable law, then it shall be, to that extent, deemed omitted and the remaining provisions will continue in full force and effect. The validity and performance of this Agreement shall be governed by Massachusetts law (without reference to choice of law principles), and applicable federal law. All questions to USGC Services regarding these terms and conditions must be directed to [email protected].

I, ______have read, understand and agree to the above mentioned terms and conditions.

Applicant Signature: ______Date: ______Spouse or Witness Signature: ______Date: ______Page 5 Transferring money using the MoneyGram® International Money Transfer Network (Visit Money Gram on the Internet at www.moneygram.com for more information and to find an agent near you.)

The MoneyGram® International Money Transfer network is a quick, convenient and guaranteed way to send and receive money 24 hours a day, 7 days a week. MoneyGram transactions can be exchanged with an individual, or sent to a U.S. business, within minutes through any one of MoneyGram’s 60,000 agent locations in 160 countries worldwide. Not only is MoneyGram's money transfer service easy to use, it's a great value!

IMPORTANT STEPS TO FOLLOW: 1. Qualifying Question - When visiting your MoneyGram agent, make sure to add a qualifying question and answer. We suggest use your application ID. This acts like a password and will prevent unauthorized receipt of the payment. 2. Email the following information to [email protected] a. Answer to the qualifying question b. The MoneyGram reference number c. Your name as it appears on the application d. The application type (single or married) e. The amount paid. f. Enter the email subject as DV-MG and your surname (last name/family name on application). 3. Write the MoneyGram reference number in the area provided on page 2 of this document marked with a  and mail the application to the address provided on page 2. 4. If you don’t have an email address or access to email, send a separate envelope with the information above to our address on page 2, but don’t include the MoneyGram reference number.

GREAT BENEFITS - By selecting to pay the service fee with a MoneyGram, you will receive the following benefits:  A discounted rate of US$6 to cover the MoneyGram fee,  A secure payment method with minimum chance of losing your money in the mail,  It provides payment protecting for both you, the client and USGC Services against fraud,  It provides you with a way to trace the payment and ensure it was received by USGC Services.  Economical - costs less than similar services and USGC Services pays for it by providing you with a discount.  Reliable - service is 100% guaranteed.  Fast - funds sent are usually available for receipt within 10 minutes.  Free Call - gives consumers a 3-minute phone call for qualifying transactions.  Free Message - gives consumers a 10-word message. Page 6

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