s072902019
(http:www.state.gov)
Electronic Diversity Visa Entry Form
(OMB Control Number: 1405-0163
Form: DS-5501
Expires: 08/31/2020
Estimated Burden: 30 minutes
Electronic Diversity Visa Lotiery
U.S. Department of State
Bureau of Consular Affairs
eDV AES: 12.6
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Part One - Entrant Information
1. Name
a. LasFamily Name
ABDELRAHMAN
b. First Name
MAHMOUD
. Middle Name
ALI SULIMAN
2. Gender
Male
3. Birth Date
March 06, 1989
4. City Where You Were Born
ALGENAINA
5. Country Where You Were Born
Sudan
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6, Country of Eligibility for the DV Program
Sudan
7. Passport
In order to submit an entry for the Diversity Visa program, you must currently possess
a valid, unexpired passport from your country of nationality, unless exempt (see
below). Please answer A or B.
A) Passport Information:
Name On Passport:
a, Last/Family Name
ABDELRAHMAN
b. First Name
MAHMOUD
idle Name
‘ALI SULIMAN
Passport Number:
03355074
Passport Expiration Date:
August 09, 2021
Country/Authority of Issuance:
Sudan
8. Entrant Photograph
{Photograph received)
9. Malling Address
a. In Care Of (optional)
b, Address Line 1
ALGENAINA,
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Electronic Diversity Visa Lotiery
218s072972019 Electronic Diversity Visa Lotiery
c. Address Line 2 (optional)
4. City/Town
ALGENAINA
. District/County/Province/State
ALMADARESS/ALGENAINAWEST DAR FUR
Postal CodelZip Code
9. Country
Sudan
10. Country Where You Live Today
Sudan
11. Phone Number
oozag9zesa9892
12. E-mail Address
hootaali@gmail.com
(NOTE: This e-mail address will be used to provide you with adeitional information if you are selected.)
13. 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://www.onetonline.org/
{http://www.onetonline.org/) to see if your occupation qualifies) for a Diversity Visa
14, What is your current marital status?
Married and my spouse is NOT a U.S.citizen or U.S. Lawful Permanent Resident (LPR)
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Legal separation is an arrangement when a couple remain married but live apart, following a court order.
Ifyou and your spouse are legally separated, your spouse will not be able to immigrate with you through
the Diversity Visa program. You will not be penalized if you choose to enter the name of a spouse from
whom you are legally separated.
If you are not legally separated by a court order, you must include your spouse even if you plan to be
divorced before you apply for the Diversity Visa. Failure to list your eligible spouse is grounds for
disqualification.
If your spouse is a U.S. citizen or Lawful Permanent Resident, do not list him/her in your entry.
15. Number of Children
Children include all biological children, legally adopted children, and stepchildren who are unmarried and
under the age of 21 on the date you submit your entry. You must include all eligible children, even if they
do not live with you or if they do not intend to apply for a Diversity Visa as your derivative. Failure to list
all eligible children is grounds for disqualification. if your child is a U.S. citizen or Lawful Permanent
Resident, do not list him/her in your entry.
Part Two - Derivatives
14. Spouse Name
a. Last/Family Name
Azaldeen
b. First Name
Manal
. Middle Name
‘Adam Ahmed
14d, Birth Date
October 23, 1996
140, Gender
Female
14f. City Where Spouse Was Born
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46s072972019 Electronic Diversity Visa Lotiery
ELGENEINA,
414g. Country Where Spouse Was Born
Sudan
14h. Spouse Photograph
(Photograph received)
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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 documentation, providing the
information andlor documents required, and reviewing the final collection. You do not have to supply this information unless this,
collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or
recommendations for reducing it, please send tham to: PRA_BurdenComments@state.gov.
CONFIDENTIALITY STATEMENT: The information asked for on this form is requested pursuant to Section 222 of the Immigration and
Nationality Act. INA Section 222(* provides that visa issuance and refusal records shall be considered confidential and shall be used
only forthe formulation, amendment, administration, or enforcement of the immigration, nationality, and other laws of the United
States, Certified copies of visa records may be made available toa court which certifies that the information contained in such records
is needed in a case pending before the cour.
PRIVACY POLICY: For information on the Department of State's privacy policy, regarding the nature, purpose, use, and sharing of any
Personally Identifiable Information (Pll) collected via this website please click here (htps:/iwww.state.goviprivacy-policy).
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