[[[["field2","equal_to","Yes"]],[["show_fields","field17"],["show_fields","field28"]],"and"],[[["field3","equal_to","Yes"]],[["show_fields","field18"]],"and"],[[["field4","equal_to","Yes"]],[["show_fields","field19"]],"and"],[[["field5","equal_to","Yes"]],[["show_fields","field20"]],"and"],[[["field14","equal_to","Yes"]],[["show_fields","field16"]],"and"],[[["field9","equal_to","Yes"]],[["show_fields","field21,field12"]],"and"],[[["field14","equal_to","Yes"]],[["show_fields","field16"]],"and"]]
1 Step 1
IMBRA-covered situations require fee-based International Marriage Brokers to collect the following background information from United States clients before they may have direct contact with foreign national clients.
First Name
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Last Name
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(i) Any temporary or permanent civil protection order or restraining order issued against the United States client.
Explain the details of all temporary or permanent civil protection order(s) and/or restraining order(s) issued against the United States client.
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Explain your relationship to the person(s) who were issued a temporary or permanent civil protection order or restraining order against you. Example: wife, girlfriend, sister, daughter, etc.
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(ii) Any Federal, State, or local arrest or conviction of the United States client for homicide, murder, manslaughter, assault, battery, domestic violence, rape, sexual assault, abusive sexual contact, sexual exploitation, incest, child abuse or neglect, torture, trafficking, peonage, holding hostage, involuntary servitude, slave trade, kidnapping, abduction, unlawful criminal restraint, false imprisonment, or stalking.
Provide detailed information about your arrest or conviction, and describe your relationship to the victim(s).
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(iii) Any Federal, State, or local arrest or conviction of the United States client for— (I) solely, principally, or incidentally engaging in prostitution; (II) a direct or indirect attempt to procure prostitutes or persons for the purpose of prostitution; or (III) receiving, in whole or in part, of the proceeds of prostitution.
Provide detailed information about your arrest or conviction and describe your relationship to the victim(s).
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(iv) Any Federal, State, or local arrest or conviction of the United States client for offenses related to controlled substances or alcohol.
Provide detailed information about your arrest or conviction and describe your relationship to the victim(s).
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Marital history of the United States client

Is the United States client currently married?
Has the United States client previously been married?
How many times has the United States client previously been married?
How were previous marriages of the client terminated and the date of termination
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Has the United States client previously sponsored an alien to whom the client was engaged or married.
Does the United States client have any children who are under the age of 18?
(vi) The ages of any of the United States client’s children who are under the age of 18.
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(vii) List all States and countries in which the United States client has resided since the client was 18 years of age.
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I certify and attest that my above client background information is true and complete. I also give my permission to Love From Abroad to release and provide this information in any format to any or all interested foreign ladies. I have provided all necessary additional truthful information to all questions answered 'Yes' above. I hereby waive any privacy rights in regards to release of this information. I also hereby release and hold harmless and forever discharge Love From Abroad from any and all liabilities arising from my release of this information and any use of it.
Signature
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Date
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