Application for Post-adoption Services Applicant Information Method of Application □X E-mail □ Fax □X Visitation □ Others: Current Legal Name Fill in full adoptive name Name Korean (if known) Fill in Korean name Country of Gender □ Male □ Female List country of citizenship Citizenship Adoption Date Fill date you departed Korea. Birth Date Fill birth date (Departure Date) Placing Agency Case No. This number is often in your adoption file, and may begin with the year of your birth (if known) (if known) (e.g. K-75-1234) Adoptive Parents' Name Write your adoptive parents full names Current Fill in your address. Your current and permanent address may be the same. address Permanent Contact Home Fill in your phone number. Your home and cell number may be the same. Information Phone no. C.P. This refers to your cell phone number. e-mail Name: Emergency Contact Fill in emergency contact info. Relationship: Contact info: Marital Status Fill in marital status Education Fill in highest level of education Occupation Fill in your occupation Duration of stay in Korea ( . .~ . ) Accommodation You can leave this blank. (if you have planned) (if you have planned) ^ You can leave this blank if you Service Request have not made travel plans. Check off all items you are interested in pursuing. Most tour members do not need to check "Adoption Certificate" ∙ file review ( X ) — this is usually requested when applying for a specific ∙ foster mother: contact ( ) meeting ( ) visa to stay in Korea long term. For "Others," list any other X X details or goals you have related to your search. An ∙ birth search: birth mother ( x ) birth father ( x ) example could be finding siblings or extended family. ∙ adoption certificate ( ) for what: ______________________________________________ ∙ others: Remarks Date(yy/mm/dd) : Name : Sign and date here. Signature : Eastern Social Welfare Society, Inc. ■ Enforcement Rule of the Special Adoption Act [Attached Form No.16] Petition for Adoption Information Disclosure ※ Please mark (√) the check box [ ] as appropriate (Front) Receipt No. Date Received Processing Duration 15 days (Korean) (Telephone) PH. NUMBER, INCL. COUNTRY CODE WRITE KOREAN NAME E.G. +1 444-444-4444 Contact (Fax) Name (English) Number (E-mail) Petitioner WRITE ADOPTIVE NAME PRIMARY EMAIL ADDRESS Resident Registration Number (Passport Number/Foreign Registration Number) US Passport No.: WRITE PASSPORT NUMBER Address (Domicile) WRITE YOUR CURRENT ADDRESS. DON'T FORGET TO INCLUDE COUNTRY (e.g. 1234 MAIN STREET, ANYTOWN, CA 94123, UNITED STATES OF AMERICA) THE "PETITION DETAILS" Personal Information on Birth SECTION PERTAINS TO Parents (at the time of [X ] Name [X ] Date of Birth [X ] Address [ ] Contact Number INFO YOU HOPE TO FIND. X CHECK OFF ANY ITEMS adoption) YOU ARE HOPING TO LEARN ABOUT. IT IS Age of birth parents at the time of adoption, adoption date and COMMON TO CHECK ALL OPTIONS, AS YOU SEE [X ] Adoption Background adoption reasons, name of the domicile area of birth parents HERE. (name of a si/gun/gu) Petition Details [X ] Name, resident registration number, date of birth, and place of birth of the petitioner before the adoption [X ] Name, address, and contact number of the protective facility or adoption agency where the petitioner was taken into care before adoption FILL IN ANY OTHER DETAILS YOU ARE HOPING TO LEARN. EXAMPLES COULD INCLUDE DETAILS ON YOUR SIBLINGS, [X ] Others: OTHER EXTENDED FAMILY, FOSTER FAMILY, OR ANY OTHER DETAILS YOU BELIEVE MAY BE IN YOUR FILE. Disclosure [ ] Perusal [X ] Copy/Printout [ ] Storage Device (electronic file) [X ] E-mail (electronic file) Method FOLLOW THESE CHECK Receipt [X] Visit [ ] Mail [ ] Fax [ ] Information Communication Network MARKS FOR DISCLOSURE & Method RECEIPT. I hereby request that my adoption information be disclosed as indicated above pursuant to Article 36.1 of the Special Adoption Act, Article 14.1 of the Enforcement Decree of the same Act, and Article 29 of the Enforcement Rule of the same Act. FILL IN DATE HERE ____Month __Day, _______Year Petitioner Be sure to sign here! (signature or seal) Attention : President of Korea Adoption Services Head of Adoption Agency 1. A copy of a document certifying that the petitioner is an adoptee. This document need not be submitted if the petitioner has been confirmed as an adoptee by presenting his/her identification card (ie, resident registration Attached card, passport, foreign registration card, or other certificate(s) confirming the petitioner's identity) to an employee Fee Document of the Korea Adoption Services or an adoption agency. 2. A copy of a document certifying that there is a compelling reason for disclosure, such as a medical need, as per Article 36.3 of the Special Adoption Act 1. A copy of a document certifying that the petitioner is an adoptee. This document need not be submitted if the petitioner has been confirmed as an adoptee by presenting his/her identification card (ie, resident registration Attached card, passport, foreign registration card, or other certificate(s) confirming the petitioner's identity) to an employee None Document of the Korea Adoption Services or an adoption agency. 2. A copy of a document certifying that there is a compelling reason for disclosure, such as a medical need, as per Article 36.3 of the Special Adoption Act .