■ 난민법 시행규칙 [별지 제2호서식]
Application for Recognition of Refugee Status
※ Do not mark in the shaded area and check the appropriate box.
Application No.	Date of Application		Processing Period	6 month (extensible within 6 month)
1. Personal Background
1-1) Family Name(s)	1-2) Given Name(s)
1-3) Other names you have been known by (including maiden names, religious names and nicknames)
1-4) Date of Birth (mm/dd/yy)	1-5) Gender [ ] Male [ ] Female
1-6) Nationality	1-7) Occupation
1-8) Place of Birth (Village, Town, City, County, District, Province, Country)
1-9) Registered Address in Home Country (Village, Town, City, County, District, Province, Country)
1-10) Religion and Sect	1-11) Race, Ethnic or Tribal Group
1-12) Language(s) you can speak most fluently [ ] Mother language: [ ] Korean [ ] English [ ] French [ ] Other languages:
2. Entry to the Republic of Korea
2-1) Date of last entry in Korea (mm/dd/yy)	2-2) Place of last entry in Korea
2-3) Did you get an entry permit to Korea? [ ] Yes [ ] No If yes, complete 2-4) ~ 2-6)
2-4) Identity Document No. [ ] Passport No.: [ ] Identification No.:	2-5) Type of Visa	2-6) Period of Stay
2-7) Did you present your identity as listed above(2-4) when entering Korea? [ ] Yes [ ] No (If not, complete 2-8) ~ 2-11)
2-8) Family name(s) on Passport	2-9) Given name(s) on Passport
2-10) Date of Birth on Passport (mm/dd/yy)	2-11) Nationality on Passport
3. Status in the Republic of Korea
3-1) Type of Current Visa	3-2) Expiration Date
3-3) Violation of law committed (If applicable) [ ] Illegal Stay [ ] Illegal Entry [ ] Falsified or Forged Passport [ ] Criminal Offence [ ] Others

3-4) Explain in detail the reason(s) for above.
3-5) Address in Korea
3-6) Contact Number					3-7) E-Mail Address
3-8) If you have any of the following in Korea, check the box(es) and complete below. [ ] Family [ ] Relatives [ ] Representative [ ] Lawyer [ ] Interpreter [ ] Friends [ ] Others
Full Name				Relationship		Telephone Number
4. Nationality (Citizenship) and Permanent Resident Status
List all countries where you have held citizenship or permanent resident status.
Country		From(mm/dd/yy)			To(mm/dd/yy)		Status
5. Marital Status
Check the appropriate box and indicate your marital history in chronological order. [ ] single [ ] married [ ] divorced [ ] widowed [ ] separated [ ] common-law marriage [ ] same-sex marriage [ ] etc.
Date (mm/dd/yy)	Name of spouse						Current Status
	Family name(s)		Given name(s)

6. Family Information
List your family members, living or deceased, in the order given below. i) Father, mother, brother(s), sister(s) ii) Spouse and children(including children born outside of marriage or adopted).
Relationship	Full name			Date of birth (mm/dd/yy)	Citizenship(s)	Current Location (If dead, provide date of death)
7. Education
List in chronological order all the schools and training institutions you have attended, beginning with primary education.
Educational background			Name of School or Institution	Location(Address)		Degrees or Qualifications Obtained
From(yy)		To(yy)

8. Work Experience
List all the jobs you have had in chronological order (including full-time, part-time, self-employment and internships)
From (mm/dd/yy)	To (mm/dd/yy)		Name of Workplace			Location(Address)			Type of Work
9. Military Service
9-1) Is military service compulsory or voluntary in your country or countries of citizenship? [ ] Compulsory [ ] Voluntary
9-2) Did you serve in the military? [ ] Yes [ ] No
9-3) If yes, when did you serve?							9-4) Where did you serve?
9-5) In which military branch did you serve? [ ] Army [ ] Navy [ ] Air Force [ ] Marine Corps [ ] Others ( )
9-6) Name of regiment(unit)				9-7) Rank at the conclusion of service				9-8) Reason for discharge
9-9) Did you have experiences of combat? (If yes, give details.) [ ] Yes [ ] No
10. Residence Records
List all the places of residence in your home country and in foreign countries in chronological order.
From (mm/dd/yy)	To (mm/dd/yy)	Country			Address (Village, town, city, country, district, province)				Type of Visa

11. Travel Documents
11-1) Do you currently possess your passport or travel document? [ ] Yes [ ] No
11-2) If yes, by whom was it issued?	11-3) Date of Issuance			11-4) Purpose of Obtaining
11-5) Was the passport or travel document genuine and legally obtained? [ ] Yes [ ] No (e.g forged or falsified)
11-6) Explain in detail where and how you obtained your passport or travel document.
11-7) If passport is not genuine or illegally obtained, explain in detail.
11-8) If you do not have a passport or travel document, explain the reasons in detail.
11-9) If you do not currently have a passport or travel document, can you have it issued? [ ] Yes [ ] No
11-10) If yes, check the box(es). [ ] Passport [ ] Travel document [ ] I.D card [ ] Other
11-11) If not, explain the reason in detail.
12. Korean Visa
12-1) Do you have a Korean visa? [ ] Yes [ ] No
12-2) If yes, which Consulate/Embassy did you apply at?		12-3) Visa Type		12-4) Validity of Visa (Date of issuance and expiry)
12-5) Document(s) you submitted to apply for a Korean visa
12-6) Did anyone help you to obtain a Korean visa or enter Korea? If yes, give details.
13. Record of Entry Into and Departure From Home Country
13-1) When did you last leave your home country? (mm/dd/yy)
13-2) Place of Departure			13-3) Means of Transportation
13-4) Reason(s) for Departure
13-5) Were you required to obtain an exit permit or exit visa from the authorities of your country? [ ] Yes [ ] No

13-6) If yes, did you obtain it legally? [ ] Yes [ ] No
13-7) If yes, when was it issued? (mm/dd/yy)
13-8) If not, explain why and how you left your country.
13-9) Have you travelled through any other countries before coming to the Republic of Korea? [ ] Yes [ ] No
If yes, list all the countries in chronological order.
From (mm/dd/yy)	To (mm/dd/yy)		Country	Location			Status	Purpose of visit
13-10) Have you ever been deported from, denied visa, or refused entry to any country including the Republic of Korea? [ ] Yes [ ] No
If yes, complete below in chronological order.
Date (mm/dd/yy)		Action (Deportation, Visa Denial, Entry Refusal)			Country	Reason

14. Information on Application for Refugee Status

Definition of a Refugee

A refugee is a person who owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.

14-1) Why are you applying for refugee status? Check the appropriate box(es) and answer in detail the questions below:

I am claiming for protection as a refugee based on

[ ] Race:

[ ] Religion:

[ ] Nationality:

[ ] Political Opinion:

[ ] Membership in a particular social group:

14-2) Have you, your family, friends or colleagues ever experienced harm,  mistreatment or threats in the past by anyone?

[ ] Yes	[ ] No

If Yes, explain in detail.

□ What happened?

□ Who experienced the harm, mistreatment or threats?

□ When the harm, mistreatment or threats occurred;

□ Who caused the harm, mistreatment or threats;

□ Why you believe the harm, mistreatment or threats occurred;

□ Where did the the harm, mistreatment, or threats occur?

14-3) Do you fear harm or mistreatment if you return to your country ?

[ ] Yes	[ ] No

If Yes, give details.

□ What kind of harm or mistreatment you fear;

□ Who you believe would harm or mistreat you; and

□ Why you believe you would or could be harmed or mistreated.

14-4) Have you or your family members ever been interrogated or questioned in your country ?

[ ] Yes	[ ] No

If Yes, describe what happened in detail.

□ Who experienced the action?

□ When the action occurred?

□ Who interrogated or questioned you/your family members?

□ Why you/your family members were interrogated or questioned.

□ Where did the action occur?

14-5) Have you or your family members ever been arrested, detained, arrested or imprisoned in your country?

[ ] Yes	[ ] No

If yes, describe what happened in detail.

□ When the action occurred;

□ Who detained or arrested or imprisoned you?

□ Why you were detained or arrested or imprisoned; and

□ How/Why you were released.

□ Where did the action occur?

14-6) Have you or any of your family members ever joined or been associated with any organizations or groups in your home country?

[ ] Yes	[ ] No

If yes, complete for each person the level of participation, any leadership or other positions held, and the length of time you or your family members were involved in each organization or activity.

Relationship	Participant's Name	Name of Organization	Level of Participation /Position	Period of Activity (from-to mm/dd/yy)

14-7) Have you ever been in hostile activity against  your government or any group ?

[ ] Yes	[ ] No

If yes, write in detail including information on date, location, and activities.

14-8) Have you or any of your family members ever applied for refugee status in any other country?

[ ] Yes	[ ] No

(1) If yes, explain the decision and any status you or your family received as a result.

Name (Relationship to you)	Country of Asylum	Date of Application	Result	Cancellation or Cessation

(2) If you or any of your family members were already recognized as a refugee in another country, explain in detail why you or your family member left the country.

14-9) Do you have any contact with, or information concerning your family members remaining in your country of origin?

[ ] Yes	[ ] No

(1) If yes, with whom and how often:

(2) If not, please explain:

14-10) Can you provide any documentation or evidence in support of your application?

[ ] Yes	[ ] No

If yes, give details.

14-11) How did you get the information on refugee status application procedures in Korea? (When, where, and from whom did you get the information?)

14-12) If you have not applied for refugee status within one year after you arrived in Korea, please explain.

15. Personal Statement

If you have additional statement of your reasons for applying for refugee status besides above, please write in detail. Your statement may be completed on a separate sheet of paper.

16. Declaration

□ Declaration by the applicant

I understand all the information and questions in this form and I declare the information I have supplied is complete, correct and current in every detail. I understand that if I have given false or misleading information, my application for refugee status may be refused, or, if I have been recognized as a refugee, the recognition may be cancelled.

	<Declaration>
※ Please confirm and handwrite the statement above.

□ Declaration by a representative, interpreter, legal guardian of minor etc.

I have helped the applicant complete this form in the capacity of:

[ ] Representative     [ ] Interpreter     [ ] Legal Guardian of Minor

[ ] Other(give details of relationship):

Name / Date of Birth

Current Address in Korea

Contact Number

I certify that I have completed this form and additional documents at the request of the applicant(

), and that he/she has fully understood the contents of this form and the answers given, and approved them before signing the declaration above.

Name

Signature

Date(mm/dd/yy)

Pursuant to Article 5(1) and 6(1) of the Refugee Act, I apply for recognition of refugee status as above.

Date(mm/dd/yy)      .      .      .

Name

(Signature)

Chief of ○○○ Immigration Office/ Branch/ Immigration Detention Center

Attachments

1. Passport or Alien Registration Card(However, if an applicant is without his/her passport or alien registration card, he/she is required to submit a statement to explain the reason.)

2. Additional documents related to your refugee claim(If you have)

3. Photo(35mm×45mm) taken within the last 6 months

No fee

Procedure

Application

□

Interview and Investigation

□

Decision

□

Notice

Applicant

Refugee Officer

Chief of Immigration office/ branch/ immigration Detention Center

210mm×297mm[일반용지 60g/㎡(재활용품)]