1. Name *
1. Name
Full name (including all middle name(s) and initial(s))
Provide details of any disabilities you have.
Can you prove that you or your family are in a distress situation in terms of potential loss of liberty, fear of danger due to persecution or impending financial devastation? Prove details.
8A. Have you been convicted or have a felony record? *
9A. Have you applied for and/or been denied a second citizenship? *
10. Do you require a driver's licence? *
11A. Are you able to travel outside of your current country?
12. Do you require a legal name change? *
14. Will it be possible for you to provide a complete set of fingerprints? *

Please note that we base the assessment on the information provided by you.  If it is incomplete or inaccurate, this will affect the opinion rendered.

By answering and submitting this assessment form, you agree not to share it or its contents with other parties, including the answers, be they implied or explicit.

Reproduction of this form in any way, in whole or in part, is strictly prohibited without the explicit written permission of Amicus International Consulting.

 

Information provided will be kept in the strictest confidence and will be completely deleted from our servers once the assessment has been completed.