Electronic Diversity Visa Entry For(kabir)

OMB Control Number: 1405-0153 Form: DS-5501 Expires: 05/31/2010 Estimated Burden: 30 minutes

ELECTRONIC DIVERSITY VISA ENTRY FORM If you need to go back and make a correction, DO NOT use the back button on your browser. Instead use the appropriate button here or below:

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Part One - Entrant Information 1. Name a. Last/Family Name KHAN

b. First Name MD.

2. Birth Date Tuesday, January 01, 1985

3. Gender Male

4. City Where You Were Born COMILLA

5. Country Where You Were Born Bangladesh

6. Country of Eligibility for the DV Program Bangladesh

7. Entrant Photograph (Photograph received)

8. Mailing Address 8a. In Care Of MD. ASALAT KHAN 8b. Address Line 1 VILLAGE-PURNAMATI 8c. Address Line 2 POST OFFICE-PURNAMATI 8d. City/Town P.S: BURICHONG 8e. District/County/Province/State DISTRICT-COMILLA

c. Middle Name KABIR

8f. Postal Code/Zip Code 3520 8g. Country Bangladesh (NOTE: This is the address that will be used to notify you if you are selected.)

9. Country Where You Live Today Bangladesh

10. Phone Number 01913160334, 01714397705

11. E-mail Address Electronic delivery of DV correspondence may be offered in the near future. Please enter an email address in the box below if you would prefer to receive correspondence electronically. [email protected]

12. What is the highest level of education you have achieved, as of today? University Degree You must have a minimum of a high school diploma reflecting the completion of a full course of study (vocation schools or equivalency degrees are not acceptable) or be a skilled worker in an occupation that requires at least two years of training or experience to qualify (visit http://online.onetcenter.org/ {this link will open in a new window} to see if your occupation qualifies) for a Diversity Visa.

13. What is your current marital status? Unmarried Legal separation means that a court has formally declared that you and your spouse are legally separated. Legal separation means that your spouse would not be eligible to immigrate as your derivative.

14. Number of Children 0 Children include all biological children, legally adopted children, and stepchildren who are unmarried and under the age of 21 on the date that you submit your entry. Failure to include all children or inclusion of children who are not your biological children, legally adopted children, and stepchildren (regardless of whether they live with you and/or intend to apply for a visa as your derivative) is grounds for disqualification of the entire entry. Legal Permanent Residents (LPR) and American Citizens should not be included. Cancel Entry

Submit Entry

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Please print this page for your personal records. You will need to use your browser's print button for this. PAPERWORK REDUCTION ACT

*Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/ISS/DIR) Washington, D.C. 20520.

ELECTRONIC DIVERSITY VISA ENTRY FORM

OMB Control Number: 1405-0153 Form: DS-5501 Expires: 05/31/2010 Estimated Burden: 30 minutes

Submission Confirmation: Entry Received Success! Your entry for the 2010 Diversity Visa Lottery Program Lottery Entry Form was received on Thursday, October 30, 2008 at 2:52:27 PM EDT. Please do not close this window until you have printed this confirmation page or made a record of your Confirmation Number. Entrant Name: KHAN, MD. KABIR Confirmation Number: 20101AZEWXP6O2JR Thank you for your entry for the 2010 Diversity Visa Lottery. Please either print this page or make a record of the confirmation number before closing this window. You will not be able to retrieve this number after you close this window. You must retain your confirmation number in order to check your entry status using the internet. You may check back on this site at anytime between July 1, 2009 and June 30, 2010 to determine whether your entry was selected for further processing in the 2010 DV Lottery. You will be required to enter your confirmation number in combination with other personal information in order to check on your entry status. Selectees will also receive a letter through their country's postal service notifying them of their selection. Entrants who are not selected for further processing will not receive any type of notification through mail. Do not submit additional Entry Forms with this person as the Primary Entrant! Multiple entries will disqualify the entrant from participation in the Lottery. PAPERWORK REDUCTION ACT *Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320 5(b), persons are not required to respond to the collection of this information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: U.S. Department of State (A/ISS/DIR) Washington, D.C. 20520.