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INFORMATION ON ASYLUM PROCEDURES IN UKRAINE
State Border Guard Service of Ukraine
State Migration Service of Ukraine
Kyiv 2018
1
Information on asylum procedures in Ukraine
CONTENTS
I. De�nition of refugee status and complementary protection .................................................. 2
II. How do I apply for refugee status or complementary protection in Ukraine? .................. 3
III. How will my application be processed? ........................................................................................... 5
IV. What happens after I get a decision from the SMS? ................................................................. 15
ATTACHMENTS
Annex 1 An application - questionnaire form that you may �ll immediately in case you wish to apply for international protection in Ukraine. (You can use the application located in this booklet) ............................................................................ 7
Annex 2 A list of State Migration Service o�ces that receive applications for international protection ......................................................................................................................17
Annex 3 A list of non-governmental organizations that provide free legal assistance on the asylum procedure in Ukraine ............................................................................... 19
2
Information on asylum procedures in Ukraine
This lea�et provides basic information about how to apply for refugee status or comple-mentary protection in Ukraine. As the lea�et is short, it cannot provide complete informa-tion about every aspect of the procedure; the procedure has some complicated aspects. You are advised to contact the Migration Services or non-governmental organisations list-ed in this lea�et for more comprehensive information.
This lea�et introduces you to the status determination procedures of Ukraine step-by-step. For this purpose it is structured in four sections, covering
De�nition of refugee status and status of person in need of complementary protection
Procedures for applying for refugee status and complementary protection
How your application is processed by the authorities
What happens after you get a decision
I. De�nition of refugee status and complementary protection
There are two legal statuses providing international protection in Ukraine: refugee status and status of person in need of complementary protection.
Who is a Refugee?
In line with international law, Ukrainian legislation, de�nes a refugee as a person, who (a)
is not a citizen of Ukraine, and
owing to a well-founded fear of being persecuted for reasons of race, religion, nationality/citizenship, membership of a particular social group or political opin-ion, is outside the country of his nationality/citizenship and
is unable or, owing to such fear, is unwilling to avail himself of the protection of that country;
Who is eligible for complementary protection status?
The Ukrainian legislation, de�nes a person in need of complementary protection as a person, who
is not a refugee, but is in need of protection because of a threat to his/her life, safety or freedom in the country of origin owing to a fear of the death penalty, torture or inhu-man or degrading treatment or punishment or generalized violence in the situations of international or internal armed con�icts or to systematic human rights abuses.
Important!
You are a refugee or a person in need of complementary protection only when and if you �t these de�nitions.
If you left your country only for economic or personal reasons, then there are not su�cient grounds for you to be recognized as a refugee or person in need of complementary protection.
3
II. How do you apply for refugee status or complementary protection in Ukraine?
If you believe that you �t the de�nition of refugee or person in need of complementary protection, you should apply to the State Migration Service of Ukraine. This is the only institution that can recognize your status and grant you legal rights to stay in Ukraine. If the State Migration Service recognizes you as a refugee or person needing complementary protection, you will receive a legal status and protection in Ukraine. If the State Migration Service does not recognize you (including at the appeals stage) and you have no other legal permission to stay in Ukraine, you may be treated as an irregular migrant, and may be deported from Ukraine.
Can I get legal assistance in applying for refugee status or complementary protection?
Yes, UNHCR provides free legal aid to persons applying for refugee status or complementary protection through a network of NGO partners. They are listed in Annex 3 to this lea�et. Since the asylum procedure can be long and complex, it is advisable to obtain legal advice. However, please note that not all asylum-seekers are eligible for free legal assistance provided by UNHCR through a network of NGO partners. Due to limited capacity, UNHCR’s legal aid partners conduct an initial screening to assess whether there are su�cient legal grounds to support your application. You have a right to receive free legal aid (a consultation and assistance in �ling your application from the State Border Guard Service and/or the State Migration Service). Thus if you are at a border crossing point or in a region (or oblast) where UNHCR’s NGO partners are not present, you should request such free legal aid from the authorities. You can request them to provide you the asylum application-questionnaire form in a language which you understand.
When and where should I apply for refugee status or complementary protection?
If you entered Ukraine illegally, you should approach the border guards immediately. You should explain to them the reasons why you entered Ukraine illegally. If you enter the country illegally because you need to apply for refugee status or complementary protection, you will not be punished as long as you explain yourself at the earliest opportunity. Thus, if you enter Ukraine and do not have an identity document, or if your document is forged, you should immediately inform the State Border Guard Service in writing, and also explain this fact in your application to the State Migration Service. The border guards should provide you with an interpreter if you do not speak Ukrainian or Russian for drafting such explanations to State Border Guard Service. After providing the above explanations, you and your asylum application should be forwarded to the State Migration Service within 24 hours. If this did not happen you may call the State Border Guard Service on their hotline at: +38(044) 527-6363. You may send them a complaint by email at E-mail: [email protected] and E-mail: [email protected].
If you are legally entering Ukraine with an intention to seek asylum, you should indicate this intention to the State Border Guard Service as the purpose of your travel to Ukraine. The o�cial will explain to you where and how you should apply for asylum in Ukraine.
If you entered Ukraine legally, you (or your authorized representative) must submit your application within �ve working days to the State Migration Service. The State Migration Service has o�ces that can process your application for international protection in 12 regions of Ukraine. A list of the addresses is available in Annex 2 of this lea�et.
If you are staying legally in Ukraine and conditions in your home country change while you are here, such that you are afraid to return home, you should �le your application for asylum before your visa or residence permit expires.
4
The State Migration Service may refuse your application if you �le it late. However, you can also explain the reasons why you are applying late, such as if you were seeking legal advice or were ill. Keep in mind that it is in your interest to make your application as soon as it is reasonably possible.
Every family-member of eighteen years of age or older should submit a separate application. Information on children below the age of eighteen should be included in the application of a parent or another legal representative of the child.
What documents do I need to apply for refugee status or complementary protection?
To apply for refugee status or complementary protection in Ukraine you must �ll a written application form and questionnaire. These forms are available in Annex 1. They are also available in di�erent languages (Arabic, English, Farsi, French, Somali, Russian,) on the UNHCR web-site (see http://www.unhcr.org/ua/en/refugees-asylum-seekers). In this application you should explain why you are afraid to return to your home country. You will see that paragraph 5 of the Questionnaire asks if you give permission for UNHCR and its partner organizations to have access to your �le. If you would like the assistance of UNHCR and its a�liated legal services, then you should respond “yes” to this question.
In your application, you should explain your situation truthfully and as completely as possible. Bring your identity document (passport) to the State Migration Service when you �le your application.
If you have any documents that give evidence of why you cannot return to your home country, be sure to bring these documents with you to the State Migration Service. If you do not have these documents with you, you should consider requesting your friends or family to send them to you, if that is possible.
When you go to the State Migration Service, you should be sure to go with all the members of your family (including children), and bring along 4 passport photos (40x60 mm) of each member of the family. In case you are detained and do not have photos, the State Migration Service shall make them.
In addition, it is important that you make a photocopy of your Asylum Application Form and the Questionnaire for future reference.
Note: If you cannot submit your application because you are illiterate or su�er from physical defects, you can ask another person to �ll your application on your behalf.
What happens when I go to the State Migration Service?
The State Migration Service will register your application, determine your identity, ask you some basic questions, and issue you with an asylum-seeker certi�cate. It is called a “certi�cate on application for protection in Ukraine”. Usually the certi�cate is issued on the same day; sometimes it is issued in a few days.
They may request that you attend a meeting with other state authorities.
The State Migration Service will appoint a date for your personal interview.
Do I have to pay for services at the State Migration Service?
No. It is free to apply for refugee status or complementary protection. You should not pay bribes to receive asylum-seeker certi�cates, refugee status or complementary protection in Ukraine; that is corruption.
5
What do I do if I am under 18 and I am not with my parent or guardian?
Special procedures apply if you are younger than eighteen years of age and separated from your parents, grandparents, adult siblings or other guardians. The border guards or police should immediately inform the State Migration Service and a special child protection authority (called the body of trusteeship and guardianship) about your situation and your intention to apply for international protection. These government authorities are responsible for providing you accommodation. They can also help you to search for your parents and/or other legal representatives. The authorities will appoint for you a “legal representative” who will help you to apply for international protection in Ukraine.
III. How will my application be processed?
The SMS considers your application in three stages.
The �rst stage is regarding the acceptance of the asylum application. The State Migration Service takes a decision on whether to accept your application for international protection (refugee status or complementary protection). Starting from the �rst stage of your application processing you will be provided with an interpreter. If the SMS accepts your application, then they issue a certi�cate on application for protection in Ukraine valid for 1 month, and appoint a date for your personal interview. If the SMS decides not to accept your application, they have to issue you a written notice, specifying reasons for rejection within one working day. If you are rejected, you have the right to appeal against this rejection within �ve working days. If you wish to seek legal assistance in �ling an appeal, you should do that immediately. The Ukrainian legislation stipulates that you have a right for government-run free legal aid (on drafting appeals and representation at court) that is provided by advocates of the Centres for Free Secondary Legal Aid which operate all over Ukraine. You can reach these Centres through common telephone number of government-run free secondary legal aid system at: 0-800-213103.
The second stage is admissibility consideration. If you are accepted into the procedure, you will be invited for a personal interview. For the interview, you will be provided with an interpreter. You also have the right to invite your own interpreter and to be accompanied or represented throughout the interview by a representative of your choice. This representative may be working for an NGO (list attached), be a lawyer or any other person you choose.
Guidance regarding your asylum interview
As the interview is the most important part of refugee status determination procedure, you should prepare yourself in advance, thinking over the reasons why you are afraid to return to your home country. The information should be without contradictions and truthful, supported, where possible, with additional documents or other evidence.Answer questions only if you fully understand them. If you do not understand them, you can ask the interviewer or interpreter to clarify the meaning, as every question of the interview is important and can in�uence the result of your application.Do not give false information, documents and names during your application. The Ukrainian authorities are aware of the situation in your country and may use experts in verifying your documents. If you are found to be misleading the authorities, your application is more likely to be rejected.
After this interview, the State Migration Service body takes a decision whether to take your case into a full, substantive review, or to reject your case as inadmissible. The State Migration Service generally takes this decision in about 15 working days.
6
If the SMS decides that your case is inadmissible, they will issue you a written notice of this fact. If you are rejected, you have the right to appeal against this rejection within �ve working days. If you wish to seek legal assistance in �ling an appeal, you should do that immediately.
If your case is taken into the full procedure, then the SMS will renew your certi�cate on application for protection in Ukraine for a further period of 6 months. The SMS will ask you to hand over your national passport and/or other identity documents. The SMS will refer you for medical screening. The SMS will conduct with you personal interviews which shall reveal additional information necessary for assessment of your case. For the interview, you will be provided with an interpreter. The SMS also conducts routine checks with the Security Service of Ukraine to verify whether there are any reasons to consider that you are not deserving international protection. Within 2-3 months, the regional o�ce of the SMS will send your �le with its recommendation on your case to the central o�ce of the SMS in Kyiv.
The third stage is substantive assessment of your application. The central o�ce of the SMS will take a �nal decision on your case within 1-3 months. The central o�ce may request the regional o�ce of the SMS to provide them additional information on your case. The Central o�ce may also cross check the credibility of provided information with the Ministry of Foreign A�airs and the Security Service of Ukraine. The central o�ce of the SMS in Kyiv makes a decision about whether you receive refugee status or complementary protection. If you are recognized as having one of these statuses, you will be issued an identity document showing that you have refugee status or complementary protection in Ukraine. This document gives you extensive civil, social and economic rights in Ukraine. You can consult separate materials to �nd out more about these rights.
If the SMS decides to reject your application for refugee status/complementary protection, they will issue you a written notice of this fact. If you are rejected, you have the right to appeal against this rejection within �ve working days. If you wish to seek legal assistance in �ling an appeal, you should do that immediately.
How long does the asylum procedure take?
In most cases, you will receive a decision from the SMS within seven months of your application. In case you receive a negative decision, the appeal procedure can be lengthy.
What are my rights as an asylum-seeker in Ukraine?
Asylum-seekers have the right to be documented with a certi�cate on application for protection in Ukraine, which gives a legal basis for stay in Ukraine. Asylum-seekers can apply for accommodation to the State Migration Service, which has three temporary accommodation centres (in Zakarpattia and Kyiv region and in Odesa city). Current Ukrainian law does not provide for free social or medical assistance to asylum-seekers; asylum-seekers have the right to apply for a work permit after the application was considered as admissible and the certi�cate was issued for 6 months. Asylum seeker has a right to con�dential correspondence with UNHCR and the right to be visited by UNHCR o�cers.
What are my duties as an asylum seeker in Ukraine?
You have to demonstrate your cooperation throughout the asylum procedure. You should provide all relevant information and documentation to the SMS. You have to provide the address where you reside in Ukraine, as this is re�ected on your certi�cate on application for protection in Ukraine. If you do not have any address of stay you should be registered at the Centre for homeless persons. If the SMS provides you with a place in the temporary
Annex 1
APPRO
VED by O
rder of the Ministry
of Internal A�airs of U
kraine N
o. 649, dd. 07.09.2011
APPLICATIO
N FO
RMfor recognition as a refugee or a person w
ho needs complem
entary protection
D/M
/Y «_____» _____________________ 20____
No. ______________
I, ________________________________________________________________________________________________________________(Last N
ame, First N
ame, Patronym
ic)
_________________________________________________________________________________________________________________
________________________________________________________________________________________________________________ , hereby request recognition as refugee or person w
ho needs complem
entary protection because_________________________________________________________________________________________________________________
(state the reason(s) of granting the refugee status)
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Family M
embers: H
usband/Wife ______________________________________________________________________________________
Children under 18 ___________________________________________________________________________________________________________________________________________________________________________________________________________________
7
Annex 1
APPRO
VED by O
rder of the Ministry
of Internal A�airs of U
kraine N
o. 649, dd. 07.09.2011
APPLICATIO
N FO
RMfor recognition as a refugee or a person w
ho needs complem
entary protection
D/M
/Y «_____» _____________________ 20____
No. ______________
I, ________________________________________________________________________________________________________________(Last N
ame, First N
ame, Patronym
ic)
_________________________________________________________________________________________________________________
________________________________________________________________________________________________________________ , hereby request recognition as refugee or person w
ho needs complem
entary protection because_________________________________________________________________________________________________________________
(state the reason(s) of granting the refugee status)
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Family M
embers: H
usband/Wife ______________________________________________________________________________________
Children under 18 ___________________________________________________________________________________________________________________________________________________________________________________________________________________
8
QU
ESTI
ON
NA
IRE
for a
per
son
appl
ying
for r
ecog
nitio
n as
refu
gee
or p
erso
n w
ho n
eeds
com
plem
enta
ry p
rote
ctio
n
Case
No.
___
____
____
____
Phot
oA
pplic
atio
n’s
Regi
stra
tion
No.
40 х
60
mm
siz
eRe
gist
ratio
n D
ate
1. A
PPLI
CAN
T’S
DAT
A
1.1.
Las
t N
ame_
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1.1.
1. If
app
licab
le, i
ndic
ate
the
appl
ican
t’s p
revi
ous
last
nam
e (if
a fe
mal
e, in
dica
te m
aide
n na
me)
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1.2.
Firs
t Nam
e (o
ther
nam
es)_
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1.2.
1. In
dica
te th
e ap
plic
ant’s
pre
viou
s �r
st n
ame
(if a
pplic
able
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1.3.
Patr
onym
ic__
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1.4.
Sex
: Mal
e/Fe
mal
e___
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1.4.
1. In
cas
e of
the
appl
ican
t’s s
ex c
hang
e, in
dica
te th
e tim
e an
d pl
ace_
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1.5.
Dat
e of
Birt
h (D
ay, M
onth
, Yea
r) _
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1.6.
Pla
ce o
f Birt
h (C
ount
ry, P
rovi
nce/
Regi
on, D
istr
ict,
City
, Vill
age,
Set
tlem
ent)
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1.7.
Citi
zens
hip/
Nat
iona
lity
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1.7.
1 Co
untr
y of
Per
man
ent R
esid
ence
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1.8.
Pla
ce o
f Res
iden
ce in
Ukr
aine
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1.9.
Las
t Cou
ntry
bef
ore
ente
ring
Ukr
aine
(ind
icat
e ac
tual
add
ress
ther
e at
the
time
of e
xit)
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1.10
. Nat
iona
lity_
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_
1.11
. Rel
igio
n___
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_
1.12
. Ide
nti�
catio
n do
cum
ents
you
can
pre
sent
(Birt
h Ce
rti�
cate
, Pas
spor
t: na
tiona
l, fo
r tra
velin
g ab
road
, ser
vice
, dip
lom
atic
, ide
ntity
car
d, ID
-car
d, o
ther
):
No.
Doc
umen
t Titl
eSe
ries,
Num
ber
Issu
ing
Auth
ority
Dat
e of
Issu
eEx
pire
s on
Not
es
1.13
. Mar
ital S
tatu
s __
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_
1.14
. Fam
ily M
embe
rs A
ccom
pany
ing
App
lican
t:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
icD
egre
e of
Kin
ship
/ Rel
atio
nshi
pD
ay, M
onth
, Yea
r, an
d Pl
ace
of B
irth
1.14
.1. U
nder
age
Pers
ons
unde
r 18,
who
se L
egal
Rep
rese
ntat
ive
is A
pplic
ant:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
icD
egre
e of
Kin
ship
/ Re
latio
nshi
pD
ay, M
onth
, Yea
r, an
d Pl
ace
of B
irth
Doc
umen
t (Se
ries,
No.
, Dat
e of
Issu
e)
that
con
�rm
s th
is fa
ct
1.14
.2. L
egal
ly In
capa
ble
Pers
ons
unde
r App
lican
t’s C
usto
dy/C
are:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
ic
Deg
ree
of K
insh
ip/
Rela
tions
hip
Day
, Mon
th, Y
ear,
and
Plac
e of
Birt
hD
ocum
ent (
Serie
s, N
o., D
ate
of Is
sue)
th
at c
on�r
ms
this
fact
1.15
. Fam
ily M
embe
rs N
ot A
ccom
pany
ing
App
lican
t:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
ic
Deg
ree
of K
insh
ip/
Rela
tions
hip
Day
, Mon
th, Y
ear,
and
Plac
e of
Birt
hAd
dres
s of
Per
man
ent R
esid
ence
1.16
. Edu
catio
n:
Nam
e of
Edu
catio
nal
Inst
itutio
n (s
tart
ing
from
m
iddl
e/hi
gh sc
hool
yea
rs)
Loca
tion
Year
s of
Stu
dyD
iplo
ma
(Num
ber,
Qua
li�ca
tion,
Sp
ecia
lty/P
rofe
ssio
n - i
f app
licab
le)
1.17
. You
r Nat
ive L
angu
age?
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_
1.17
.1. W
hat L
angu
ages
do
You
know
(com
man
d: �
uent
, rea
ding
and
spea
king
, rea
ding
and
tran
slat
ing
usin
g di
ctio
narie
s)?_
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1.18
. Wor
k H
isto
ry fo
r the
last
10
year
s?
Nam
e of
Org
aniz
atio
n (In
stitu
tion)
Loca
tion/
Addr
ess
Posi
tion
Year
s/Pe
riods
of W
ork
1.18
.1. I
f une
mpl
oyed
dur
ing
that
per
iod,
indi
cate
the
reas
on(s
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1.18
.2. A
re y
ou c
urre
ntly
em
ploy
ed?
If ye
s, in
dica
te th
e lo
catio
n, p
ositi
on, a
nd ti
me
you
star
ted
wor
king
at y
our c
urre
nt p
lace
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1.19
. Hav
e yo
u su
�ere
d fr
om th
e fo
llow
ing
dise
ases
: pul
mon
ary
tube
rcul
osis
, oss
eous
tube
rcul
osis
, inf
ectio
us d
isea
ses?
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1.20
. Wha
t dis
ease
(s) a
re y
ou c
urre
ntly
su�
erin
g fr
om?_
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1.21
. AID
S te
stin
g re
sults
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2. E
XIT
FRO
M T
HE
LAST
CO
UN
TRY
OF
PERM
AN
ENT
RESI
DEN
CE
2.1.
Whe
n di
d yo
u le
ave
your
last
cou
ntry
of p
erm
anen
t res
iden
ce?_
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2.2.
Did
you
hav
e a
perm
it to
leav
e y
our l
ast c
ount
ry?_
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2.3.
Wha
t typ
e of
tran
spor
tatio
n di
d yo
u us
e fo
r exi
ting
the
last
cou
ntry
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_
2.4.
Indi
cate
the
coun
trie
s and
citi
es y
ou c
ross
ed in
tran
sit_
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2.5.
How
long
did
you
sta
y at
tran
sit c
ente
rs?
Indi
cate
the
loca
tion
Dur
atio
n of
Sta
y
2.6.
Hav
e yo
u ev
er a
pplie
d fo
r asy
lum
or f
or th
e re
fuge
e st
atus
in o
ther
cou
ntrie
s? If
yes
, ind
icat
e th
e tim
e an
d pl
ace
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2.7.
If n
o, in
dica
te th
e re
ason
(s)_
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3. E
NTR
Y IN
TO U
KRA
INE
3.1.
Dat
e an
d Pl
ace
of C
ross
ing
the
Ukr
aini
an B
orde
r___
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3.2.
Wha
t tra
nspo
rtat
ion
was
use
d du
ring
entr
y in
to U
krai
ne?_
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3.3.
In w
hat m
anne
r did
you
cro
ss th
e bo
rder
? (s
ecre
tly, o
r bas
ed o
n o�
cial
per
mit,
vis
a, in
vita
tion,
wor
k co
ntra
ct, o
ther
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3.4.
Wha
t doc
umen
t did
you
use
/pre
sent
for e
nter
ing
Ukr
aine
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3.5.
Wha
t are
the
lega
l gro
unds
for y
our s
tay
in U
krai
ne?
(vis
a, re
fuge
e st
atus
, no
grou
nds/
illeg
ally
, oth
er)_
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3.6.
Hav
e yo
u ev
er a
pplie
d fo
r acq
uisi
tion
of th
e re
fuge
e st
atus
in o
ther
regi
ons
o f U
krai
ne?
Mig
ratio
n Se
rvic
e Bo
dy
App
licat
ion
Dat
eAd
opte
d D
ecis
ion
4. R
EASO
NS
FOR
LEAV
ING
TH
E CO
UN
TRY
OF
PERM
AN
ENT
RESI
DEN
CE4.
1. S
peci
fy th
e re
ason
s fo
r lea
ving
you
r las
t cou
ntry
of p
erm
anen
t re
side
nce
(indi
cate
fact
s of
vio
lenc
e or
per
secu
tion
of y
ou o
r you
r fam
ily m
embe
rs, o
r re
al th
reat
s of
per
secu
tion
unde
r the
circ
umst
ance
s de
scrib
ed in
Art
icle
1 o
f the
Law
of U
krai
ne “O
n Re
fuge
es a
nd P
erso
ns W
ho N
eed
Com
plem
enta
ry o
r Te
mpo
rary
Pro
tect
ion
in U
krai
ne”.
Att
ach
any
docu
men
tary
pro
of.)
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4.2.
Spe
cify
pol
itica
l, m
ilita
ry, r
elig
ious
, or p
ublic
org
aniz
atio
ns in
you
r cou
ntry
of p
erm
anen
t res
iden
ce y
ou o
r you
r fam
ily m
embe
rs h
ave
mem
bers
hip
in
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4.3.
Des
crib
e yo
ur a
ctiv
ity in
the
abov
e or
gani
zatio
ns__
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_
4.4.
Hav
e yo
u ev
er b
een
invo
lved
in in
cide
nts,
with
the
use
of p
hysi
cal f
orce
, in
conn
ectio
n w
ith y
our r
acia
l and
nat
iona
l orig
in, r
elig
ious
con
vict
ions
, pol
itica
l vi
ews,
etc?
If y
es, d
escr
ibe
the
char
acte
r of t
hose
inci
dent
s an
d yo
ur in
volv
emen
t in
deta
il.
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4.5.
Hav
e yo
u ev
er b
een
subj
ecte
d to
adm
inis
trat
ive
mea
sure
s (d
eten
tion,
arr
est)
? If
yes,
indi
cate
the
reas
ons.
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4.6.
Hav
e yo
u ev
er b
een
held
crim
inal
ly li
able
? If
yes,
spec
ify:_
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4.6.
1. N
atur
e of
Vio
latio
n of
Law
, its
Leg
al C
lass
i�ca
tion_
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4.6.
2. Im
pose
d Se
nten
ce, T
ype
of P
unis
hmen
t___
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4.6.
3. Te
rm o
f Im
pris
onm
ent (
as st
ated
in th
e co
urt v
erdi
ct, a
ctua
lly se
rved
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4.6.
4. P
lace
of S
ervi
ng th
e Pu
nish
men
t___
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_
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4.7.
Hav
e yo
u se
rved
in th
e A
rmed
For
ces?
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_
a) L
iabl
e fo
r M
ilita
ry S
ervi
ce _
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b) E
xem
pt fr
om M
ilita
ry S
ervi
ce__
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4.7.
1. M
ilita
ry R
ank_
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__
4.7.
2. If
you
hav
e no
t ser
ved,
exp
lain
the
reas
ons_
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4.7.
3. A
t the
tim
e of
exi
t, di
d yo
u se
rve
in th
e ar
my
of y
our c
ount
ry o
f las
t cou
ntry
of p
erm
anen
t res
iden
ce: t
o co
mpl
ete
com
puls
ory
mili
tary
ser
vice
/dra
ft,
or p
erfo
rm d
utie
s un
der a
mili
tary
ser
vice
con
trac
t?
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___
Mili
tary
Ran
k___
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_
4.7.
4. D
id th
e ar
med
forc
es y
ou s
erve
d in
par
ticip
ate
in a
ctiv
e m
ilita
ry o
pera
tions
at t
he ti
me
of y
our e
xit f
rom
the
last
cou
ntry
of p
erm
anen
t res
iden
ce?
If ye
s, sp
ecify
.
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5. A
DD
ITIO
NA
L D
ATA
If yo
u ha
ve s
ome
rele
vant
info
rmat
ion
that
is n
ot in
clud
ed in
the
mai
n te
xt, p
leas
e sp
ecify
all
data
tha
t yo
u co
nsid
er im
port
ant
for
deci
sion
-mak
ing
on
reco
gniti
on a
s re
fuge
e or
per
son
who
nee
ds c
ompl
emen
tary
pro
tect
ion
____
____
____
____
____
____
____
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____
____
____
____
____
____
____
____
____
____
____
____
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____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
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____
____
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____
____
____
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____
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____
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____
____
____
___
Plea
se n
otify
if y
ou a
gree
to g
rant
acc
ess
to th
e m
ater
ials
in y
our p
erso
nal �
le to
you
r law
yer,
lega
l rep
rese
ntat
ive,
Uni
ted
Nat
ions
Hig
h Co
mm
issi
oner
for
Refu
gees
(her
eina
fter
, UN
HCR
), or
to a
repr
esen
tativ
e of
non
-gov
ernm
ent o
rgan
izat
ions
of U
NH
CR a
t any
sta
ge o
f con
side
ratio
n of
you
r app
licat
ion
for
reco
gniti
on a
s re
fuge
e or
per
son
who
nee
ds c
ompl
emen
tary
pro
tect
ion.
On
"__"
___
____
____
____
_ 20
_(S
igna
ture
of A
pplic
ant)
On
"__"
___
____
____
____
_ 20
_ (L
ast N
ame,
Sig
natu
re o
f Leg
al R
epre
sent
ativ
e)
9
QU
ESTION
NA
IREfor a person applying for recognition as refugee or person w
ho needs complem
entary protection
Case No. _______________
PhotoA
pplication’s Registration No.
40 х 60 mm
sizeRegistration D
ate
1. APPLICA
NT’S D
ATA
1.1. Last Nam
e___________________________________________________________________________________________________________________
1.1.1. If applicable, indicate the applicant’s previous last name (if a fem
ale, indicate maiden nam
e) ______________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
1.2. First Nam
e (other names)________________________________________________________________________________________________________
1.2.1. Indicate the applicant’s previous �rst name (if applicable)___________________________________________________________________________
_______________________________________________________________________________________________________________________________
1.3. Patronymic____________________________________________________________________________________________________________________
1.4. Sex: Male/Fem
ale______________________________________________________________________________________________________________
1.4.1. In case of the applicant’s sex change, indicate the time and place_____________________________________________________________________
1.5. Date of Birth (D
ay, Month, Year) _________________________________________________________________________________________________
1.6. Place of Birth (Country, Province/Region, District, City, Village, Settlem
ent)_______________________________________________________________
_______________________________________________________________________________________________________________________________
1.7. Citizenship/Nationality ________________________________________________________________________________________________________
1.7.1 Country of Permanent Residence________________________________________________________________________________________________
1.8. Place of Residence in Ukraine____________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
1.9. Last Country before entering Ukraine (indicate actual address there at the tim
e of exit)____________________________________________________
_______________________________________________________________________________________________________________________________
1.10. Nationality__________________________________________________________________________________________________________________
1.11. Religion____________________________________________________________________________________________________________________
1.12. Identi�cation documents you can present (Birth Certi�cate, Passport:
national, for traveling abroad, service, diplomatic, identity card, ID
-card, other):
No.
Docum
ent TitleSeries, N
umber
Issuing AuthorityD
ate of IssueExpires on
Notes
1.13. Marital Status _______________________________________________________________________________________________________________
1.14. Family M
embers Accom
panying Applicant:
Last Nam
e, First Nam
e (Nam
es), Patronymic
Degree of Kinship/ Relationship
Day, M
onth, Year, and Place of Birth
1.14.1. Underage Persons under 18, w
hose Legal Representative is Applicant:
Last Nam
e, First Nam
e (N
ames), Patronym
icD
egree of Kinship/ Relationship
Day, M
onth, Year, and Place of BirthD
ocument (Series, N
o., Date of Issue)
that con�rms this fact
1.14.2. Legally Incapable Persons under Applicant’s Custody/Care:
Last Nam
e, First Nam
e (N
ames), Patronym
ic D
egree of Kinship/ Relationship
Day, M
onth, Year, and Place of BirthD
ocument (Series, N
o., Date of Issue)
that con�rms this fact
1.15. Family M
embers N
ot Accompanying A
pplicant:
Last Nam
e, First Nam
e (N
ames), Patronym
ic D
egree of Kinship/ Relationship
Day, M
onth, Year, and Place of BirthAddress of Perm
anent Residence
1.16. Education:
Nam
e of Educational Institution (starting from
m
iddle/high school years)
LocationYears of Study
Diplom
a (Num
ber, Quali�cation,
Specialty/Profession - if applicable)
1.17. Your Native Language?_________________________________________________________________________________________________________
1.17.1. What Languages do You know
(comm
and: �uent, reading and speaking, reading and translating using dictionaries)?__________________________
_______________________________________________________________________________________________________________________________1.18. W
ork History for the last 10 years?
Nam
e of Organization (Institution)
Location/AddressPosition
Years/Periods of Work
1.18.1. If unemployed during that period, indicate the reason(s)___________________________________________________________________________
_______________________________________________________________________________________________________________________________
1.18.2. Are you currently em
ployed? If yes, indicate the location, position, and time you started w
orking at your current place________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
1.19. Have you su�ered from
the following diseases: pulm
onary tuberculosis, osseous tuberculosis, infectious diseases?_____________________________
_______________________________________________________________________________________________________________________________
1.20. What disease(s) are you currently su�ering from
?__________________________________________________________________________________
_______________________________________________________________________________________________________________________________
1.21. AID
S testing results___________________________________________________________________________________________________________
2. EXIT FROM
THE LA
ST COU
NTRY O
F PERMA
NEN
T RESIDEN
CE
2.1. When did you leave your last country of perm
anent residence?________________________________________________________________________
_______________________________________________________________________________________________________________________________
2.2. Did you have a perm
it to leave your last country?___________________________________________________________________________________
2.3. What type of transportation did you use for exiting the last country?____________________________________________________________________
2.4. Indicate the countries and cities you crossed in transit________________________________________________________________________________
_______________________________________________________________________________________________________________________________
2.5. How
long did you stay at transit centers?
Indicate the locationD
uration of Stay
2.6. Have you ever applied for asylum
or for the refugee status in other countries? If yes, indicate the time and place _______________________________
_______________________________________________________________________________________________________________________________
2.7. If no, indicate the reason(s)______________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
3. ENTRY IN
TO U
KRAIN
E
3.1. Date and Place of Crossing the U
krainian Border_____________________________________________________________________________________
_______________________________________________________________________________________________________________________________
3.2. What transportation w
as used during entry into Ukraine?_____________________________________________________________________________
3.3. In what m
anner did you cross the border? (secretly, or based on o�cial perm
it, visa, invitation, work contract, other)____________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
3.4. What docum
ent did you use/present for entering Ukraine?____________________________________________________________________________
_______________________________________________________________________________________________________________________________
3.5. What are the legal grounds for your stay in U
kraine? (visa, refugee status, no grounds/illegally, other)_________________________________________
_______________________________________________________________________________________________________________________________
3.6. Have you ever applied for acquisition of the refugee status in other regions o f U
kraine?
Migration Service Body
Application D
ateAdopted D
ecision
4. REASO
NS FO
R LEAVING
THE CO
UN
TRY OF PERM
AN
ENT RESID
ENCE
4.1. Specify the reasons for leaving your last country of permanent residence (indicate facts of violence or persecution of you or your fam
ily mem
bers, or real threats of persecution under the circum
stances described in Article 1 of the Law
of Ukraine “O
n Refugees and Persons Who N
eed Complem
entary or Tem
porary Protection in Ukraine”. A
ttach any documentary proof.)
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.2. Specify political, military, religious, or public organizations in your country of perm
anent residence you or your family m
embers have m
embership in
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.3. Describe your activity in the above organizations___________________________________________________________________________________
4.4. Have you ever been involved in incidents, w
ith the use of physical force, in connection with your racial and national origin, religious convictions, political
views, etc? If yes, describe the character of those incidents and your involvem
ent in detail.
_______________________________________________________________________________________________________________________________
4.5. Have you ever been subjected to adm
inistrative measures (detention, arrest)? If yes, indicate the reasons.
_______________________________________________________________________________________________________________________________
4.6. Have you ever been held crim
inally liable? If yes, specify:_____________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.6.1. Nature of Violation of Law
, its Legal Classi�cation__________________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.6.2. Imposed Sentence, Type of Punishm
ent_________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.6.3. Term of Im
prisonment (as stated in the court verdict, actually served)__________________________________________________________________
_______________________________________________________________________________________________________________________________
4.6.4. Place of Serving the Punishment________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.7. Have you served in the A
rmed Forces?_____________________________________________________________________________________________
a) Liable for Military Service ____________________________________________________________________________________________________
b) Exempt from
Military Service__________________________________________________________________________________________________
4.7.1. Military Rank_______________________________________________________________________________________________________________
4.7.2. If you have not served, explain the reasons_______________________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.7.3. At the tim
e of exit, did you serve in the army of your country of last country of perm
anent residence: to complete com
pulsory military service/draft,
or perform duties under a m
ilitary service contract?
_______________________________________________________________________________________________________________________________
Military Rank____________________________________________________________________________________________________________________
4.7.4. Did the arm
ed forces you served in participate in active military operations at the tim
e of your exit from the last country of perm
anent residence? If yes, specify.
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
5. AD
DITIO
NA
L DATA
If you have some relevant inform
ation that is not included in the main text, please specify all data that you consider im
portant for decision-making on
recognition as refugee or person who needs com
plementary protection
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
Please notify if you agree to grant access to the materials in your personal �le to your law
yer, legal representative, United N
ations High Com
missioner for
Refugees (hereinafter, UN
HCR), or to a representative of non-governm
ent organizations of UN
HCR at any stage of consideration of your application for
recognition as refugee or person who needs com
plementary protection.
On "__" ________________ 20_
(Signature of Applicant)
On "__" ________________ 20_
(Last Nam
e, Signature of Legal Representative)
10
QU
ESTI
ON
NA
IRE
for a
per
son
appl
ying
for r
ecog
nitio
n as
refu
gee
or p
erso
n w
ho n
eeds
com
plem
enta
ry p
rote
ctio
n
Case
No.
___
____
____
____
Phot
oA
pplic
atio
n’s
Regi
stra
tion
No.
40 х
60
mm
siz
eRe
gist
ratio
n D
ate
1. A
PPLI
CAN
T’S
DAT
A
1.1.
Las
t N
ame_
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____
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____
____
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____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
__
1.1.
1. If
app
licab
le, i
ndic
ate
the
appl
ican
t’s p
revi
ous
last
nam
e (if
a fe
mal
e, in
dica
te m
aide
n na
me)
___
____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
1.2.
Firs
t Nam
e (o
ther
nam
es)_
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
1.2.
1. In
dica
te th
e ap
plic
ant’s
pre
viou
s �r
st n
ame
(if a
pplic
able
)___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
1.3.
Patr
onym
ic__
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
__
1.4.
Sex
: Mal
e/Fe
mal
e___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
1.4.
1. In
cas
e of
the
appl
ican
t’s s
ex c
hang
e, in
dica
te th
e tim
e an
d pl
ace_
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
1.5.
Dat
e of
Birt
h (D
ay, M
onth
, Yea
r) _
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
1.6.
Pla
ce o
f Birt
h (C
ount
ry, P
rovi
nce/
Regi
on, D
istr
ict,
City
, Vill
age,
Set
tlem
ent)
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
1.7.
Citi
zens
hip/
Nat
iona
lity
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
1.7.
1 Co
untr
y of
Per
man
ent R
esid
ence
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
1.8.
Pla
ce o
f Res
iden
ce in
Ukr
aine
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
1.9.
Las
t Cou
ntry
bef
ore
ente
ring
Ukr
aine
(ind
icat
e ac
tual
add
ress
ther
e at
the
time
of e
xit)
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
1.10
. Nat
iona
lity_
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
1.11
. Rel
igio
n___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
1.12
. Ide
nti�
catio
n do
cum
ents
you
can
pre
sent
(Birt
h Ce
rti�
cate
, Pas
spor
t: na
tiona
l, fo
r tra
velin
g ab
road
, ser
vice
, dip
lom
atic
, ide
ntity
car
d, ID
-car
d, o
ther
):
No.
Doc
umen
t Titl
eSe
ries,
Num
ber
Issu
ing
Auth
ority
Dat
e of
Issu
eEx
pire
s on
Not
es
1.13
. Mar
ital S
tatu
s __
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
1.14
. Fam
ily M
embe
rs A
ccom
pany
ing
App
lican
t:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
icD
egre
e of
Kin
ship
/ Rel
atio
nshi
pD
ay, M
onth
, Yea
r, an
d Pl
ace
of B
irth
1.14
.1. U
nder
age
Pers
ons
unde
r 18,
who
se L
egal
Rep
rese
ntat
ive
is A
pplic
ant:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
icD
egre
e of
Kin
ship
/ Re
latio
nshi
pD
ay, M
onth
, Yea
r, an
d Pl
ace
of B
irth
Doc
umen
t (Se
ries,
No.
, Dat
e of
Issu
e)
that
con
�rm
s th
is fa
ct
1.14
.2. L
egal
ly In
capa
ble
Pers
ons
unde
r App
lican
t’s C
usto
dy/C
are:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
ic
Deg
ree
of K
insh
ip/
Rela
tions
hip
Day
, Mon
th, Y
ear,
and
Plac
e of
Birt
hD
ocum
ent (
Serie
s, N
o., D
ate
of Is
sue)
th
at c
on�r
ms
this
fact
1.15
. Fam
ily M
embe
rs N
ot A
ccom
pany
ing
App
lican
t:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
ic
Deg
ree
of K
insh
ip/
Rela
tions
hip
Day
, Mon
th, Y
ear,
and
Plac
e of
Birt
hAd
dres
s of
Per
man
ent R
esid
ence
1.16
. Edu
catio
n:
Nam
e of
Edu
catio
nal
Inst
itutio
n (s
tart
ing
from
m
iddl
e/hi
gh sc
hool
yea
rs)
Loca
tion
Year
s of
Stu
dyD
iplo
ma
(Num
ber,
Qua
li�ca
tion,
Sp
ecia
lty/P
rofe
ssio
n - i
f app
licab
le)
1.17
. You
r Nat
ive L
angu
age?
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
1.17
.1. W
hat L
angu
ages
do
You
know
(com
man
d: �
uent
, rea
ding
and
spea
king
, rea
ding
and
tran
slat
ing
usin
g di
ctio
narie
s)?_
____
____
____
____
____
____
_
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
1.18
. Wor
k H
isto
ry fo
r the
last
10
year
s?
Nam
e of
Org
aniz
atio
n (In
stitu
tion)
Loca
tion/
Addr
ess
Posi
tion
Year
s/Pe
riods
of W
ork
1.18
.1. I
f une
mpl
oyed
dur
ing
that
per
iod,
indi
cate
the
reas
on(s
)___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
1.18
.2. A
re y
ou c
urre
ntly
em
ploy
ed?
If ye
s, in
dica
te th
e lo
catio
n, p
ositi
on, a
nd ti
me
you
star
ted
wor
king
at y
our c
urre
nt p
lace
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
1.19
. Hav
e yo
u su
�ere
d fr
om th
e fo
llow
ing
dise
ases
: pul
mon
ary
tube
rcul
osis
, oss
eous
tube
rcul
osis
, inf
ectio
us d
isea
ses?
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1.20
. Wha
t dis
ease
(s) a
re y
ou c
urre
ntly
su�
erin
g fr
om?_
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1.21
. AID
S te
stin
g re
sults
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2. E
XIT
FRO
M T
HE
LAST
CO
UN
TRY
OF
PERM
AN
ENT
RESI
DEN
CE
2.1.
Whe
n di
d yo
u le
ave
your
last
cou
ntry
of p
erm
anen
t res
iden
ce?_
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2.2.
Did
you
hav
e a
perm
it to
leav
e y
our l
ast c
ount
ry?_
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2.3.
Wha
t typ
e of
tran
spor
tatio
n di
d yo
u us
e fo
r exi
ting
the
last
cou
ntry
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2.4.
Indi
cate
the
coun
trie
s and
citi
es y
ou c
ross
ed in
tran
sit_
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2.5.
How
long
did
you
sta
y at
tran
sit c
ente
rs?
Indi
cate
the
loca
tion
Dur
atio
n of
Sta
y
2.6.
Hav
e yo
u ev
er a
pplie
d fo
r asy
lum
or f
or th
e re
fuge
e st
atus
in o
ther
cou
ntrie
s? If
yes
, ind
icat
e th
e tim
e an
d pl
ace
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2.7.
If n
o, in
dica
te th
e re
ason
(s)_
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3. E
NTR
Y IN
TO U
KRA
INE
3.1.
Dat
e an
d Pl
ace
of C
ross
ing
the
Ukr
aini
an B
orde
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3.2.
Wha
t tra
nspo
rtat
ion
was
use
d du
ring
entr
y in
to U
krai
ne?_
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3.3.
In w
hat m
anne
r did
you
cro
ss th
e bo
rder
? (s
ecre
tly, o
r bas
ed o
n o�
cial
per
mit,
vis
a, in
vita
tion,
wor
k co
ntra
ct, o
ther
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3.4.
Wha
t doc
umen
t did
you
use
/pre
sent
for e
nter
ing
Ukr
aine
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3.5.
Wha
t are
the
lega
l gro
unds
for y
our s
tay
in U
krai
ne?
(vis
a, re
fuge
e st
atus
, no
grou
nds/
illeg
ally
, oth
er)_
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3.6.
Hav
e yo
u ev
er a
pplie
d fo
r acq
uisi
tion
of th
e re
fuge
e st
atus
in o
ther
regi
ons
o f U
krai
ne?
Mig
ratio
n Se
rvic
e Bo
dy
App
licat
ion
Dat
eAd
opte
d D
ecis
ion
4. R
EASO
NS
FOR
LEAV
ING
TH
E CO
UN
TRY
OF
PERM
AN
ENT
RESI
DEN
CE4.
1. S
peci
fy th
e re
ason
s fo
r lea
ving
you
r las
t cou
ntry
of p
erm
anen
t re
side
nce
(indi
cate
fact
s of
vio
lenc
e or
per
secu
tion
of y
ou o
r you
r fam
ily m
embe
rs, o
r re
al th
reat
s of
per
secu
tion
unde
r the
circ
umst
ance
s de
scrib
ed in
Art
icle
1 o
f the
Law
of U
krai
ne “O
n Re
fuge
es a
nd P
erso
ns W
ho N
eed
Com
plem
enta
ry o
r Te
mpo
rary
Pro
tect
ion
in U
krai
ne”.
Att
ach
any
docu
men
tary
pro
of.)
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4.2.
Spe
cify
pol
itica
l, m
ilita
ry, r
elig
ious
, or p
ublic
org
aniz
atio
ns in
you
r cou
ntry
of p
erm
anen
t res
iden
ce y
ou o
r you
r fam
ily m
embe
rs h
ave
mem
bers
hip
in
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4.3.
Des
crib
e yo
ur a
ctiv
ity in
the
abov
e or
gani
zatio
ns__
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4.4.
Hav
e yo
u ev
er b
een
invo
lved
in in
cide
nts,
with
the
use
of p
hysi
cal f
orce
, in
conn
ectio
n w
ith y
our r
acia
l and
nat
iona
l orig
in, r
elig
ious
con
vict
ions
, pol
itica
l vi
ews,
etc?
If y
es, d
escr
ibe
the
char
acte
r of t
hose
inci
dent
s an
d yo
ur in
volv
emen
t in
deta
il.
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4.5.
Hav
e yo
u ev
er b
een
subj
ecte
d to
adm
inis
trat
ive
mea
sure
s (d
eten
tion,
arr
est)
? If
yes,
indi
cate
the
reas
ons.
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4.6.
Hav
e yo
u ev
er b
een
held
crim
inal
ly li
able
? If
yes,
spec
ify:_
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4.6.
1. N
atur
e of
Vio
latio
n of
Law
, its
Leg
al C
lass
i�ca
tion_
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4.6.
2. Im
pose
d Se
nten
ce, T
ype
of P
unis
hmen
t___
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4.6.
3. Te
rm o
f Im
pris
onm
ent (
as st
ated
in th
e co
urt v
erdi
ct, a
ctua
lly se
rved
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4.6.
4. P
lace
of S
ervi
ng th
e Pu
nish
men
t___
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4.7.
Hav
e yo
u se
rved
in th
e A
rmed
For
ces?
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_
a) L
iabl
e fo
r M
ilita
ry S
ervi
ce _
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b) E
xem
pt fr
om M
ilita
ry S
ervi
ce__
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4.7.
1. M
ilita
ry R
ank_
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4.7.
2. If
you
hav
e no
t ser
ved,
exp
lain
the
reas
ons_
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4.7.
3. A
t the
tim
e of
exi
t, di
d yo
u se
rve
in th
e ar
my
of y
our c
ount
ry o
f las
t cou
ntry
of p
erm
anen
t res
iden
ce: t
o co
mpl
ete
com
puls
ory
mili
tary
ser
vice
/dra
ft,
or p
erfo
rm d
utie
s un
der a
mili
tary
ser
vice
con
trac
t?
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Mili
tary
Ran
k___
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_
4.7.
4. D
id th
e ar
med
forc
es y
ou s
erve
d in
par
ticip
ate
in a
ctiv
e m
ilita
ry o
pera
tions
at t
he ti
me
of y
our e
xit f
rom
the
last
cou
ntry
of p
erm
anen
t res
iden
ce?
If ye
s, sp
ecify
.
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5. A
DD
ITIO
NA
L D
ATA
If yo
u ha
ve s
ome
rele
vant
info
rmat
ion
that
is n
ot in
clud
ed in
the
mai
n te
xt, p
leas
e sp
ecify
all
data
tha
t yo
u co
nsid
er im
port
ant
for
deci
sion
-mak
ing
on
reco
gniti
on a
s re
fuge
e or
per
son
who
nee
ds c
ompl
emen
tary
pro
tect
ion
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Plea
se n
otify
if y
ou a
gree
to g
rant
acc
ess
to th
e m
ater
ials
in y
our p
erso
nal �
le to
you
r law
yer,
lega
l rep
rese
ntat
ive,
Uni
ted
Nat
ions
Hig
h Co
mm
issi
oner
for
Refu
gees
(her
eina
fter
, UN
HCR
), or
to a
repr
esen
tativ
e of
non
-gov
ernm
ent o
rgan
izat
ions
of U
NH
CR a
t any
sta
ge o
f con
side
ratio
n of
you
r app
licat
ion
for
reco
gniti
on a
s re
fuge
e or
per
son
who
nee
ds c
ompl
emen
tary
pro
tect
ion.
On
"__"
___
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_ 20
_(S
igna
ture
of A
pplic
ant)
On
"__"
___
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_ 20
_ (L
ast N
ame,
Sig
natu
re o
f Leg
al R
epre
sent
ativ
e)
11
QU
ESTI
ON
NA
IRE
for a
per
son
appl
ying
for r
ecog
nitio
n as
refu
gee
or p
erso
n w
ho n
eeds
com
plem
enta
ry p
rote
ctio
n
Case
No.
___
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Phot
oA
pplic
atio
n’s
Regi
stra
tion
No.
40 х
60
mm
siz
eRe
gist
ratio
n D
ate
1. A
PPLI
CAN
T’S
DAT
A
1.1.
Las
t N
ame_
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1.1.
1. If
app
licab
le, i
ndic
ate
the
appl
ican
t’s p
revi
ous
last
nam
e (if
a fe
mal
e, in
dica
te m
aide
n na
me)
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1.2.
Firs
t Nam
e (o
ther
nam
es)_
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1.2.
1. In
dica
te th
e ap
plic
ant’s
pre
viou
s �r
st n
ame
(if a
pplic
able
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1.3.
Patr
onym
ic__
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1.4.
Sex
: Mal
e/Fe
mal
e___
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1.4.
1. In
cas
e of
the
appl
ican
t’s s
ex c
hang
e, in
dica
te th
e tim
e an
d pl
ace_
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1.5.
Dat
e of
Birt
h (D
ay, M
onth
, Yea
r) _
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1.6.
Pla
ce o
f Birt
h (C
ount
ry, P
rovi
nce/
Regi
on, D
istr
ict,
City
, Vill
age,
Set
tlem
ent)
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1.7.
Citi
zens
hip/
Nat
iona
lity
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1.7.
1 Co
untr
y of
Per
man
ent R
esid
ence
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1.8.
Pla
ce o
f Res
iden
ce in
Ukr
aine
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1.9.
Las
t Cou
ntry
bef
ore
ente
ring
Ukr
aine
(ind
icat
e ac
tual
add
ress
ther
e at
the
time
of e
xit)
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1.10
. Nat
iona
lity_
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1.11
. Rel
igio
n___
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1.12
. Ide
nti�
catio
n do
cum
ents
you
can
pre
sent
(Birt
h Ce
rti�
cate
, Pas
spor
t: na
tiona
l, fo
r tra
velin
g ab
road
, ser
vice
, dip
lom
atic
, ide
ntity
car
d, ID
-car
d, o
ther
):
No.
Doc
umen
t Titl
eSe
ries,
Num
ber
Issu
ing
Auth
ority
Dat
e of
Issu
eEx
pire
s on
Not
es
1.13
. Mar
ital S
tatu
s __
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1.14
. Fam
ily M
embe
rs A
ccom
pany
ing
App
lican
t:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
icD
egre
e of
Kin
ship
/ Rel
atio
nshi
pD
ay, M
onth
, Yea
r, an
d Pl
ace
of B
irth
1.14
.1. U
nder
age
Pers
ons
unde
r 18,
who
se L
egal
Rep
rese
ntat
ive
is A
pplic
ant:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
icD
egre
e of
Kin
ship
/ Re
latio
nshi
pD
ay, M
onth
, Yea
r, an
d Pl
ace
of B
irth
Doc
umen
t (Se
ries,
No.
, Dat
e of
Issu
e)
that
con
�rm
s th
is fa
ct
1.14
.2. L
egal
ly In
capa
ble
Pers
ons
unde
r App
lican
t’s C
usto
dy/C
are:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
ic
Deg
ree
of K
insh
ip/
Rela
tions
hip
Day
, Mon
th, Y
ear,
and
Plac
e of
Birt
hD
ocum
ent (
Serie
s, N
o., D
ate
of Is
sue)
th
at c
on�r
ms
this
fact
1.15
. Fam
ily M
embe
rs N
ot A
ccom
pany
ing
App
lican
t:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
ic
Deg
ree
of K
insh
ip/
Rela
tions
hip
Day
, Mon
th, Y
ear,
and
Plac
e of
Birt
hAd
dres
s of
Per
man
ent R
esid
ence
1.16
. Edu
catio
n:
Nam
e of
Edu
catio
nal
Inst
itutio
n (s
tart
ing
from
m
iddl
e/hi
gh sc
hool
yea
rs)
Loca
tion
Year
s of
Stu
dyD
iplo
ma
(Num
ber,
Qua
li�ca
tion,
Sp
ecia
lty/P
rofe
ssio
n - i
f app
licab
le)
1.17
. You
r Nat
ive L
angu
age?
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1.17
.1. W
hat L
angu
ages
do
You
know
(com
man
d: �
uent
, rea
ding
and
spea
king
, rea
ding
and
tran
slat
ing
usin
g di
ctio
narie
s)?_
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1.18
. Wor
k H
isto
ry fo
r the
last
10
year
s?
Nam
e of
Org
aniz
atio
n (In
stitu
tion)
Loca
tion/
Addr
ess
Posi
tion
Year
s/Pe
riods
of W
ork
1.18
.1. I
f une
mpl
oyed
dur
ing
that
per
iod,
indi
cate
the
reas
on(s
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1.18
.2. A
re y
ou c
urre
ntly
em
ploy
ed?
If ye
s, in
dica
te th
e lo
catio
n, p
ositi
on, a
nd ti
me
you
star
ted
wor
king
at y
our c
urre
nt p
lace
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1.19
. Hav
e yo
u su
�ere
d fr
om th
e fo
llow
ing
dise
ases
: pul
mon
ary
tube
rcul
osis
, oss
eous
tube
rcul
osis
, inf
ectio
us d
isea
ses?
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1.20
. Wha
t dis
ease
(s) a
re y
ou c
urre
ntly
su�
erin
g fr
om?_
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1.21
. AID
S te
stin
g re
sults
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2. E
XIT
FRO
M T
HE
LAST
CO
UN
TRY
OF
PERM
AN
ENT
RESI
DEN
CE
2.1.
Whe
n di
d yo
u le
ave
your
last
cou
ntry
of p
erm
anen
t res
iden
ce?_
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2.2.
Did
you
hav
e a
perm
it to
leav
e y
our l
ast c
ount
ry?_
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2.3.
Wha
t typ
e of
tran
spor
tatio
n di
d yo
u us
e fo
r exi
ting
the
last
cou
ntry
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2.4.
Indi
cate
the
coun
trie
s and
citi
es y
ou c
ross
ed in
tran
sit_
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2.5.
How
long
did
you
sta
y at
tran
sit c
ente
rs?
Indi
cate
the
loca
tion
Dur
atio
n of
Sta
y
2.6.
Hav
e yo
u ev
er a
pplie
d fo
r asy
lum
or f
or th
e re
fuge
e st
atus
in o
ther
cou
ntrie
s? If
yes
, ind
icat
e th
e tim
e an
d pl
ace
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2.7.
If n
o, in
dica
te th
e re
ason
(s)_
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3. E
NTR
Y IN
TO U
KRA
INE
3.1.
Dat
e an
d Pl
ace
of C
ross
ing
the
Ukr
aini
an B
orde
r___
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3.2.
Wha
t tra
nspo
rtat
ion
was
use
d du
ring
entr
y in
to U
krai
ne?_
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3.3.
In w
hat m
anne
r did
you
cro
ss th
e bo
rder
? (s
ecre
tly, o
r bas
ed o
n o�
cial
per
mit,
vis
a, in
vita
tion,
wor
k co
ntra
ct, o
ther
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3.4.
Wha
t doc
umen
t did
you
use
/pre
sent
for e
nter
ing
Ukr
aine
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3.5.
Wha
t are
the
lega
l gro
unds
for y
our s
tay
in U
krai
ne?
(vis
a, re
fuge
e st
atus
, no
grou
nds/
illeg
ally
, oth
er)_
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3.6.
Hav
e yo
u ev
er a
pplie
d fo
r acq
uisi
tion
of th
e re
fuge
e st
atus
in o
ther
regi
ons
o f U
krai
ne?
Mig
ratio
n Se
rvic
e Bo
dy
App
licat
ion
Dat
eAd
opte
d D
ecis
ion
4. R
EASO
NS
FOR
LEAV
ING
TH
E CO
UN
TRY
OF
PERM
AN
ENT
RESI
DEN
CE4.
1. S
peci
fy th
e re
ason
s fo
r lea
ving
you
r las
t cou
ntry
of p
erm
anen
t re
side
nce
(indi
cate
fact
s of
vio
lenc
e or
per
secu
tion
of y
ou o
r you
r fam
ily m
embe
rs, o
r re
al th
reat
s of
per
secu
tion
unde
r the
circ
umst
ance
s de
scrib
ed in
Art
icle
1 o
f the
Law
of U
krai
ne “O
n Re
fuge
es a
nd P
erso
ns W
ho N
eed
Com
plem
enta
ry o
r Te
mpo
rary
Pro
tect
ion
in U
krai
ne”.
Att
ach
any
docu
men
tary
pro
of.)
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____
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____
___
4.2.
Spe
cify
pol
itica
l, m
ilita
ry, r
elig
ious
, or p
ublic
org
aniz
atio
ns in
you
r cou
ntry
of p
erm
anen
t res
iden
ce y
ou o
r you
r fam
ily m
embe
rs h
ave
mem
bers
hip
in
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___
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___
4.3.
Des
crib
e yo
ur a
ctiv
ity in
the
abov
e or
gani
zatio
ns__
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____
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____
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____
_
4.4.
Hav
e yo
u ev
er b
een
invo
lved
in in
cide
nts,
with
the
use
of p
hysi
cal f
orce
, in
conn
ectio
n w
ith y
our r
acia
l and
nat
iona
l orig
in, r
elig
ious
con
vict
ions
, pol
itica
l vi
ews,
etc?
If y
es, d
escr
ibe
the
char
acte
r of t
hose
inci
dent
s an
d yo
ur in
volv
emen
t in
deta
il.
____
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____
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____
___
4.5.
Hav
e yo
u ev
er b
een
subj
ecte
d to
adm
inis
trat
ive
mea
sure
s (d
eten
tion,
arr
est)
? If
yes,
indi
cate
the
reas
ons.
____
____
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____
____
____
____
___
4.6.
Hav
e yo
u ev
er b
een
held
crim
inal
ly li
able
? If
yes,
spec
ify:_
____
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___
4.6.
1. N
atur
e of
Vio
latio
n of
Law
, its
Leg
al C
lass
i�ca
tion_
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_
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____
___
4.6.
2. Im
pose
d Se
nten
ce, T
ype
of P
unis
hmen
t___
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__
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___
4.6.
3. Te
rm o
f Im
pris
onm
ent (
as st
ated
in th
e co
urt v
erdi
ct, a
ctua
lly se
rved
)___
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___
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____
___
4.6.
4. P
lace
of S
ervi
ng th
e Pu
nish
men
t___
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____
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____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
____
____
____
____
____
____
____
____
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___
4.7.
Hav
e yo
u se
rved
in th
e A
rmed
For
ces?
____
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____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_
a) L
iabl
e fo
r M
ilita
ry S
ervi
ce _
____
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____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
b) E
xem
pt fr
om M
ilita
ry S
ervi
ce__
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____
4.7.
1. M
ilita
ry R
ank_
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____
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____
____
____
____
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____
____
____
____
____
____
____
____
__
4.7.
2. If
you
hav
e no
t ser
ved,
exp
lain
the
reas
ons_
____
____
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____
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____
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____
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__
____
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____
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____
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____
____
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____
____
____
____
____
___
4.7.
3. A
t the
tim
e of
exi
t, di
d yo
u se
rve
in th
e ar
my
of y
our c
ount
ry o
f las
t cou
ntry
of p
erm
anen
t res
iden
ce: t
o co
mpl
ete
com
puls
ory
mili
tary
ser
vice
/dra
ft,
or p
erfo
rm d
utie
s un
der a
mili
tary
ser
vice
con
trac
t?
____
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____
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____
____
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____
____
____
____
____
____
___
Mili
tary
Ran
k___
____
____
____
____
____
____
____
____
____
____
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____
____
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____
____
____
____
_
4.7.
4. D
id th
e ar
med
forc
es y
ou s
erve
d in
par
ticip
ate
in a
ctiv
e m
ilita
ry o
pera
tions
at t
he ti
me
of y
our e
xit f
rom
the
last
cou
ntry
of p
erm
anen
t res
iden
ce?
If ye
s, sp
ecify
.
____
____
____
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____
____
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____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
5. A
DD
ITIO
NA
L D
ATA
If yo
u ha
ve s
ome
rele
vant
info
rmat
ion
that
is n
ot in
clud
ed in
the
mai
n te
xt, p
leas
e sp
ecify
all
data
tha
t yo
u co
nsid
er im
port
ant
for
deci
sion
-mak
ing
on
reco
gniti
on a
s re
fuge
e or
per
son
who
nee
ds c
ompl
emen
tary
pro
tect
ion
____
____
____
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____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
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___
Plea
se n
otify
if y
ou a
gree
to g
rant
acc
ess
to th
e m
ater
ials
in y
our p
erso
nal �
le to
you
r law
yer,
lega
l rep
rese
ntat
ive,
Uni
ted
Nat
ions
Hig
h Co
mm
issi
oner
for
Refu
gees
(her
eina
fter
, UN
HCR
), or
to a
repr
esen
tativ
e of
non
-gov
ernm
ent o
rgan
izat
ions
of U
NH
CR a
t any
sta
ge o
f con
side
ratio
n of
you
r app
licat
ion
for
reco
gniti
on a
s re
fuge
e or
per
son
who
nee
ds c
ompl
emen
tary
pro
tect
ion.
On
"__"
___
____
____
____
_ 20
_(S
igna
ture
of A
pplic
ant)
On
"__"
___
____
____
____
_ 20
_ (L
ast N
ame,
Sig
natu
re o
f Leg
al R
epre
sent
ativ
e)
12
QU
ESTION
NA
IREfor a person applying for recognition as refugee or person w
ho needs complem
entary protection
Case No. _______________
PhotoA
pplication’s Registration No.
40 х 60 mm
sizeRegistration D
ate
1. APPLICA
NT’S D
ATA
1.1. Last Nam
e___________________________________________________________________________________________________________________
1.1.1. If applicable, indicate the applicant’s previous last name (if a fem
ale, indicate maiden nam
e) ______________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
1.2. First Nam
e (other names)________________________________________________________________________________________________________
1.2.1. Indicate the applicant’s previous �rst name (if applicable)___________________________________________________________________________
_______________________________________________________________________________________________________________________________
1.3. Patronymic____________________________________________________________________________________________________________________
1.4. Sex: Male/Fem
ale______________________________________________________________________________________________________________
1.4.1. In case of the applicant’s sex change, indicate the time and place_____________________________________________________________________
1.5. Date of Birth (D
ay, Month, Year) _________________________________________________________________________________________________
1.6. Place of Birth (Country, Province/Region, District, City, Village, Settlem
ent)_______________________________________________________________
_______________________________________________________________________________________________________________________________
1.7. Citizenship/Nationality ________________________________________________________________________________________________________
1.7.1 Country of Permanent Residence________________________________________________________________________________________________
1.8. Place of Residence in Ukraine____________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
1.9. Last Country before entering Ukraine (indicate actual address there at the tim
e of exit)____________________________________________________
_______________________________________________________________________________________________________________________________
1.10. Nationality__________________________________________________________________________________________________________________
1.11. Religion____________________________________________________________________________________________________________________
1.12. Identi�cation documents you can present (Birth Certi�cate, Passport:
national, for traveling abroad, service, diplomatic, identity card, ID
-card, other):
No.
Docum
ent TitleSeries, N
umber
Issuing AuthorityD
ate of IssueExpires on
Notes
1.13. Marital Status _______________________________________________________________________________________________________________
1.14. Family M
embers Accom
panying Applicant:
Last Nam
e, First Nam
e (Nam
es), Patronymic
Degree of Kinship/ Relationship
Day, M
onth, Year, and Place of Birth
1.14.1. Underage Persons under 18, w
hose Legal Representative is Applicant:
Last Nam
e, First Nam
e (N
ames), Patronym
icD
egree of Kinship/ Relationship
Day, M
onth, Year, and Place of BirthD
ocument (Series, N
o., Date of Issue)
that con�rms this fact
1.14.2. Legally Incapable Persons under Applicant’s Custody/Care:
Last Nam
e, First Nam
e (N
ames), Patronym
ic D
egree of Kinship/ Relationship
Day, M
onth, Year, and Place of BirthD
ocument (Series, N
o., Date of Issue)
that con�rms this fact
1.15. Family M
embers N
ot Accompanying A
pplicant:
Last Nam
e, First Nam
e (N
ames), Patronym
ic D
egree of Kinship/ Relationship
Day, M
onth, Year, and Place of BirthAddress of Perm
anent Residence
1.16. Education:
Nam
e of Educational Institution (starting from
m
iddle/high school years)
LocationYears of Study
Diplom
a (Num
ber, Quali�cation,
Specialty/Profession - if applicable)
1.17. Your Native Language?_________________________________________________________________________________________________________
1.17.1. What Languages do You know
(comm
and: �uent, reading and speaking, reading and translating using dictionaries)?__________________________
_______________________________________________________________________________________________________________________________1.18. W
ork History for the last 10 years?
Nam
e of Organization (Institution)
Location/AddressPosition
Years/Periods of Work
1.18.1. If unemployed during that period, indicate the reason(s)___________________________________________________________________________
_______________________________________________________________________________________________________________________________
1.18.2. Are you currently em
ployed? If yes, indicate the location, position, and time you started w
orking at your current place________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
1.19. Have you su�ered from
the following diseases: pulm
onary tuberculosis, osseous tuberculosis, infectious diseases?_____________________________
_______________________________________________________________________________________________________________________________
1.20. What disease(s) are you currently su�ering from
?__________________________________________________________________________________
_______________________________________________________________________________________________________________________________
1.21. AID
S testing results___________________________________________________________________________________________________________
2. EXIT FROM
THE LA
ST COU
NTRY O
F PERMA
NEN
T RESIDEN
CE
2.1. When did you leave your last country of perm
anent residence?________________________________________________________________________
_______________________________________________________________________________________________________________________________
2.2. Did you have a perm
it to leave your last country?___________________________________________________________________________________
2.3. What type of transportation did you use for exiting the last country?____________________________________________________________________
2.4. Indicate the countries and cities you crossed in transit________________________________________________________________________________
_______________________________________________________________________________________________________________________________
2.5. How
long did you stay at transit centers?
Indicate the locationD
uration of Stay
2.6. Have you ever applied for asylum
or for the refugee status in other countries? If yes, indicate the time and place _______________________________
_______________________________________________________________________________________________________________________________
2.7. If no, indicate the reason(s)______________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
3. ENTRY IN
TO U
KRAIN
E
3.1. Date and Place of Crossing the U
krainian Border_____________________________________________________________________________________
_______________________________________________________________________________________________________________________________
3.2. What transportation w
as used during entry into Ukraine?_____________________________________________________________________________
3.3. In what m
anner did you cross the border? (secretly, or based on o�cial perm
it, visa, invitation, work contract, other)____________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
3.4. What docum
ent did you use/present for entering Ukraine?____________________________________________________________________________
_______________________________________________________________________________________________________________________________
3.5. What are the legal grounds for your stay in U
kraine? (visa, refugee status, no grounds/illegally, other)_________________________________________
_______________________________________________________________________________________________________________________________
3.6. Have you ever applied for acquisition of the refugee status in other regions o f U
kraine?
Migration Service Body
Application D
ateAdopted D
ecision
4. REASO
NS FO
R LEAVING
THE CO
UN
TRY OF PERM
AN
ENT RESID
ENCE
4.1. Specify the reasons for leaving your last country of permanent residence (indicate facts of violence or persecution of you or your fam
ily mem
bers, or real threats of persecution under the circum
stances described in Article 1 of the Law
of Ukraine “O
n Refugees and Persons Who N
eed Complem
entary or Tem
porary Protection in Ukraine”. A
ttach any documentary proof.)
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.2. Specify political, military, religious, or public organizations in your country of perm
anent residence you or your family m
embers have m
embership in
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.3. Describe your activity in the above organizations___________________________________________________________________________________
4.4. Have you ever been involved in incidents, w
ith the use of physical force, in connection with your racial and national origin, religious convictions, political
views, etc? If yes, describe the character of those incidents and your involvem
ent in detail.
_______________________________________________________________________________________________________________________________
4.5. Have you ever been subjected to adm
inistrative measures (detention, arrest)? If yes, indicate the reasons.
_______________________________________________________________________________________________________________________________
4.6. Have you ever been held crim
inally liable? If yes, specify:_____________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.6.1. Nature of Violation of Law
, its Legal Classi�cation__________________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.6.2. Imposed Sentence, Type of Punishm
ent_________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.6.3. Term of Im
prisonment (as stated in the court verdict, actually served)__________________________________________________________________
_______________________________________________________________________________________________________________________________
4.6.4. Place of Serving the Punishment________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.7. Have you served in the A
rmed Forces?_____________________________________________________________________________________________
a) Liable for Military Service ____________________________________________________________________________________________________
b) Exempt from
Military Service__________________________________________________________________________________________________
4.7.1. Military Rank_______________________________________________________________________________________________________________
4.7.2. If you have not served, explain the reasons_______________________________________________________________________________________
_______________________________________________________________________________________________________________________________
4.7.3. At the tim
e of exit, did you serve in the army of your country of last country of perm
anent residence: to complete com
pulsory military service/draft,
or perform duties under a m
ilitary service contract?
_______________________________________________________________________________________________________________________________
Military Rank____________________________________________________________________________________________________________________
4.7.4. Did the arm
ed forces you served in participate in active military operations at the tim
e of your exit from the last country of perm
anent residence? If yes, specify.
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
5. AD
DITIO
NA
L DATA
If you have some relevant inform
ation that is not included in the main text, please specify all data that you consider im
portant for decision-making on
recognition as refugee or person who needs com
plementary protection
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
Please notify if you agree to grant access to the materials in your personal �le to your law
yer, legal representative, United N
ations High Com
missioner for
Refugees (hereinafter, UN
HCR), or to a representative of non-governm
ent organizations of UN
HCR at any stage of consideration of your application for
recognition as refugee or person who needs com
plementary protection.
On "__" ________________ 20_
(Signature of Applicant)
On "__" ________________ 20_
(Last Nam
e, Signature of Legal Representative)
13
QU
ESTI
ON
NA
IRE
for a
per
son
appl
ying
for r
ecog
nitio
n as
refu
gee
or p
erso
n w
ho n
eeds
com
plem
enta
ry p
rote
ctio
n
Case
No.
___
____
____
____
Phot
oA
pplic
atio
n’s
Regi
stra
tion
No.
40 х
60
mm
siz
eRe
gist
ratio
n D
ate
1. A
PPLI
CAN
T’S
DAT
A
1.1.
Las
t N
ame_
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____
____
____
____
____
____
____
____
____
____
____
__
1.1.
1. If
app
licab
le, i
ndic
ate
the
appl
ican
t’s p
revi
ous
last
nam
e (if
a fe
mal
e, in
dica
te m
aide
n na
me)
___
____
____
____
____
____
____
____
____
____
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___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
1.2.
Firs
t Nam
e (o
ther
nam
es)_
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
1.2.
1. In
dica
te th
e ap
plic
ant’s
pre
viou
s �r
st n
ame
(if a
pplic
able
)___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
1.3.
Patr
onym
ic__
____
____
____
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__
1.4.
Sex
: Mal
e/Fe
mal
e___
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1.4.
1. In
cas
e of
the
appl
ican
t’s s
ex c
hang
e, in
dica
te th
e tim
e an
d pl
ace_
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1.5.
Dat
e of
Birt
h (D
ay, M
onth
, Yea
r) _
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1.6.
Pla
ce o
f Birt
h (C
ount
ry, P
rovi
nce/
Regi
on, D
istr
ict,
City
, Vill
age,
Set
tlem
ent)
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___
1.7.
Citi
zens
hip/
Nat
iona
lity
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____
1.7.
1 Co
untr
y of
Per
man
ent R
esid
ence
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1.8.
Pla
ce o
f Res
iden
ce in
Ukr
aine
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___
1.9.
Las
t Cou
ntry
bef
ore
ente
ring
Ukr
aine
(ind
icat
e ac
tual
add
ress
ther
e at
the
time
of e
xit)
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1.10
. Nat
iona
lity_
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_
1.11
. Rel
igio
n___
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_
1.12
. Ide
nti�
catio
n do
cum
ents
you
can
pre
sent
(Birt
h Ce
rti�
cate
, Pas
spor
t: na
tiona
l, fo
r tra
velin
g ab
road
, ser
vice
, dip
lom
atic
, ide
ntity
car
d, ID
-car
d, o
ther
):
No.
Doc
umen
t Titl
eSe
ries,
Num
ber
Issu
ing
Auth
ority
Dat
e of
Issu
eEx
pire
s on
Not
es
1.13
. Mar
ital S
tatu
s __
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_
1.14
. Fam
ily M
embe
rs A
ccom
pany
ing
App
lican
t:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
icD
egre
e of
Kin
ship
/ Rel
atio
nshi
pD
ay, M
onth
, Yea
r, an
d Pl
ace
of B
irth
1.14
.1. U
nder
age
Pers
ons
unde
r 18,
who
se L
egal
Rep
rese
ntat
ive
is A
pplic
ant:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
icD
egre
e of
Kin
ship
/ Re
latio
nshi
pD
ay, M
onth
, Yea
r, an
d Pl
ace
of B
irth
Doc
umen
t (Se
ries,
No.
, Dat
e of
Issu
e)
that
con
�rm
s th
is fa
ct
1.14
.2. L
egal
ly In
capa
ble
Pers
ons
unde
r App
lican
t’s C
usto
dy/C
are:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
ic
Deg
ree
of K
insh
ip/
Rela
tions
hip
Day
, Mon
th, Y
ear,
and
Plac
e of
Birt
hD
ocum
ent (
Serie
s, N
o., D
ate
of Is
sue)
th
at c
on�r
ms
this
fact
1.15
. Fam
ily M
embe
rs N
ot A
ccom
pany
ing
App
lican
t:
Last
Nam
e, F
irst N
ame
(Nam
es),
Patr
onym
ic
Deg
ree
of K
insh
ip/
Rela
tions
hip
Day
, Mon
th, Y
ear,
and
Plac
e of
Birt
hAd
dres
s of
Per
man
ent R
esid
ence
1.16
. Edu
catio
n:
Nam
e of
Edu
catio
nal
Inst
itutio
n (s
tart
ing
from
m
iddl
e/hi
gh sc
hool
yea
rs)
Loca
tion
Year
s of
Stu
dyD
iplo
ma
(Num
ber,
Qua
li�ca
tion,
Sp
ecia
lty/P
rofe
ssio
n - i
f app
licab
le)
1.17
. You
r Nat
ive L
angu
age?
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_
1.17
.1. W
hat L
angu
ages
do
You
know
(com
man
d: �
uent
, rea
ding
and
spea
king
, rea
ding
and
tran
slat
ing
usin
g di
ctio
narie
s)?_
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_
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1.18
. Wor
k H
isto
ry fo
r the
last
10
year
s?
Nam
e of
Org
aniz
atio
n (In
stitu
tion)
Loca
tion/
Addr
ess
Posi
tion
Year
s/Pe
riods
of W
ork
1.18
.1. I
f une
mpl
oyed
dur
ing
that
per
iod,
indi
cate
the
reas
on(s
)___
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___
1.18
.2. A
re y
ou c
urre
ntly
em
ploy
ed?
If ye
s, in
dica
te th
e lo
catio
n, p
ositi
on, a
nd ti
me
you
star
ted
wor
king
at y
our c
urre
nt p
lace
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1.19
. Hav
e yo
u su
�ere
d fr
om th
e fo
llow
ing
dise
ases
: pul
mon
ary
tube
rcul
osis
, oss
eous
tube
rcul
osis
, inf
ectio
us d
isea
ses?
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1.20
. Wha
t dis
ease
(s) a
re y
ou c
urre
ntly
su�
erin
g fr
om?_
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1.21
. AID
S te
stin
g re
sults
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___
2. E
XIT
FRO
M T
HE
LAST
CO
UN
TRY
OF
PERM
AN
ENT
RESI
DEN
CE
2.1.
Whe
n di
d yo
u le
ave
your
last
cou
ntry
of p
erm
anen
t res
iden
ce?_
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2.2.
Did
you
hav
e a
perm
it to
leav
e y
our l
ast c
ount
ry?_
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__
2.3.
Wha
t typ
e of
tran
spor
tatio
n di
d yo
u us
e fo
r exi
ting
the
last
cou
ntry
?___
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_
2.4.
Indi
cate
the
coun
trie
s and
citi
es y
ou c
ross
ed in
tran
sit_
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2.5.
How
long
did
you
sta
y at
tran
sit c
ente
rs?
Indi
cate
the
loca
tion
Dur
atio
n of
Sta
y
2.6.
Hav
e yo
u ev
er a
pplie
d fo
r asy
lum
or f
or th
e re
fuge
e st
atus
in o
ther
cou
ntrie
s? If
yes
, ind
icat
e th
e tim
e an
d pl
ace
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2.7.
If n
o, in
dica
te th
e re
ason
(s)_
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_
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___
3. E
NTR
Y IN
TO U
KRA
INE
3.1.
Dat
e an
d Pl
ace
of C
ross
ing
the
Ukr
aini
an B
orde
r___
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__
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___
3.2.
Wha
t tra
nspo
rtat
ion
was
use
d du
ring
entr
y in
to U
krai
ne?_
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3.3.
In w
hat m
anne
r did
you
cro
ss th
e bo
rder
? (s
ecre
tly, o
r bas
ed o
n o�
cial
per
mit,
vis
a, in
vita
tion,
wor
k co
ntra
ct, o
ther
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___
3.4.
Wha
t doc
umen
t did
you
use
/pre
sent
for e
nter
ing
Ukr
aine
?___
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___
3.5.
Wha
t are
the
lega
l gro
unds
for y
our s
tay
in U
krai
ne?
(vis
a, re
fuge
e st
atus
, no
grou
nds/
illeg
ally
, oth
er)_
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3.6.
Hav
e yo
u ev
er a
pplie
d fo
r acq
uisi
tion
of th
e re
fuge
e st
atus
in o
ther
regi
ons
o f U
krai
ne?
Mig
ratio
n Se
rvic
e Bo
dy
App
licat
ion
Dat
eAd
opte
d D
ecis
ion
4. R
EASO
NS
FOR
LEAV
ING
TH
E CO
UN
TRY
OF
PERM
AN
ENT
RESI
DEN
CE4.
1. S
peci
fy th
e re
ason
s fo
r lea
ving
you
r las
t cou
ntry
of p
erm
anen
t re
side
nce
(indi
cate
fact
s of
vio
lenc
e or
per
secu
tion
of y
ou o
r you
r fam
ily m
embe
rs, o
r re
al th
reat
s of
per
secu
tion
unde
r the
circ
umst
ance
s de
scrib
ed in
Art
icle
1 o
f the
Law
of U
krai
ne “O
n Re
fuge
es a
nd P
erso
ns W
ho N
eed
Com
plem
enta
ry o
r Te
mpo
rary
Pro
tect
ion
in U
krai
ne”.
Att
ach
any
docu
men
tary
pro
of.)
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4.2.
Spe
cify
pol
itica
l, m
ilita
ry, r
elig
ious
, or p
ublic
org
aniz
atio
ns in
you
r cou
ntry
of p
erm
anen
t res
iden
ce y
ou o
r you
r fam
ily m
embe
rs h
ave
mem
bers
hip
in
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4.3.
Des
crib
e yo
ur a
ctiv
ity in
the
abov
e or
gani
zatio
ns__
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_
4.4.
Hav
e yo
u ev
er b
een
invo
lved
in in
cide
nts,
with
the
use
of p
hysi
cal f
orce
, in
conn
ectio
n w
ith y
our r
acia
l and
nat
iona
l orig
in, r
elig
ious
con
vict
ions
, pol
itica
l vi
ews,
etc?
If y
es, d
escr
ibe
the
char
acte
r of t
hose
inci
dent
s an
d yo
ur in
volv
emen
t in
deta
il.
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4.5.
Hav
e yo
u ev
er b
een
subj
ecte
d to
adm
inis
trat
ive
mea
sure
s (d
eten
tion,
arr
est)
? If
yes,
indi
cate
the
reas
ons.
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4.6.
Hav
e yo
u ev
er b
een
held
crim
inal
ly li
able
? If
yes,
spec
ify:_
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4.6.
1. N
atur
e of
Vio
latio
n of
Law
, its
Leg
al C
lass
i�ca
tion_
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_
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___
4.6.
2. Im
pose
d Se
nten
ce, T
ype
of P
unis
hmen
t___
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__
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4.6.
3. Te
rm o
f Im
pris
onm
ent (
as st
ated
in th
e co
urt v
erdi
ct, a
ctua
lly se
rved
)___
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____
___
4.6.
4. P
lace
of S
ervi
ng th
e Pu
nish
men
t___
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_
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4.7.
Hav
e yo
u se
rved
in th
e A
rmed
For
ces?
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_
a) L
iabl
e fo
r M
ilita
ry S
ervi
ce _
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b) E
xem
pt fr
om M
ilita
ry S
ervi
ce__
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4.7.
1. M
ilita
ry R
ank_
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__
4.7.
2. If
you
hav
e no
t ser
ved,
exp
lain
the
reas
ons_
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__
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4.7.
3. A
t the
tim
e of
exi
t, di
d yo
u se
rve
in th
e ar
my
of y
our c
ount
ry o
f las
t cou
ntry
of p
erm
anen
t res
iden
ce: t
o co
mpl
ete
com
puls
ory
mili
tary
ser
vice
/dra
ft,
or p
erfo
rm d
utie
s un
der a
mili
tary
ser
vice
con
trac
t?
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____
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____
____
___
Mili
tary
Ran
k___
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____
_
4.7.
4. D
id th
e ar
med
forc
es y
ou s
erve
d in
par
ticip
ate
in a
ctiv
e m
ilita
ry o
pera
tions
at t
he ti
me
of y
our e
xit f
rom
the
last
cou
ntry
of p
erm
anen
t res
iden
ce?
If ye
s, sp
ecify
.
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____
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____
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___
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____
____
____
____
____
____
____
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___
5. A
DD
ITIO
NA
L D
ATA
If yo
u ha
ve s
ome
rele
vant
info
rmat
ion
that
is n
ot in
clud
ed in
the
mai
n te
xt, p
leas
e sp
ecify
all
data
tha
t yo
u co
nsid
er im
port
ant
for
deci
sion
-mak
ing
on
reco
gniti
on a
s re
fuge
e or
per
son
who
nee
ds c
ompl
emen
tary
pro
tect
ion
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___
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Plea
se n
otify
if y
ou a
gree
to g
rant
acc
ess
to th
e m
ater
ials
in y
our p
erso
nal �
le to
you
r law
yer,
lega
l rep
rese
ntat
ive,
Uni
ted
Nat
ions
Hig
h Co
mm
issi
oner
for
Refu
gees
(her
eina
fter
, UN
HCR
), or
to a
repr
esen
tativ
e of
non
-gov
ernm
ent o
rgan
izat
ions
of U
NH
CR a
t any
sta
ge o
f con
side
ratio
n of
you
r app
licat
ion
for
reco
gniti
on a
s re
fuge
e or
per
son
who
nee
ds c
ompl
emen
tary
pro
tect
ion.
On
"__"
___
____
____
____
_ 20
_(S
igna
ture
of A
pplic
ant)
On
"__"
___
____
____
____
_ 20
_ (L
ast N
ame,
Sig
natu
re o
f Leg
al R
epre
sent
ativ
e)
14
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Passport: Series _________ No. _________________________________, D
ate of Issue and Issuing Authority (if available)
_________________________________________________________________________________________________________________Citizenship/N
ationality ____________________________________________________________________________________________
Country of Permanent Residence ____________________________________________________________________________________
Place of Residence in Ukraine _______________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________Availability of Perm
it for Stay in Ukraine and Its Expiration D
ate___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Applicant’s Signature
_____________________________ “____” __________________20___
Legal Representative’s Signature
_____________________________ “____” __________________20___
Translator’s Signature
_____________________________
“____” __________________20___
Supplement. List of attached docum
ents (Part 7, Article 7 of the Law
of Ukraine “O
n Refugees and Persons Who N
eed Complem
entary or Tem
porary Protection in Ukraine»)
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Subm
itted for further consideration on “_____”___________________ 20________________________________________________________________________________________________________________________________
(Last Nam
e, Position, Signature of O�
cial of the Migration Service O
�ce/Body)
15
accommodation centre, you should go and reside there. You have to undergo a medical examination upon request and appear at appropriate SMS o�ce when requested to come for appointments.
You have to inform the SMS o�ce on your new registration address if you change it, or if you plan to relocate to a di�erent region of Ukraine.
If I appeal against a negative decision of the SMS, what is my legal status in Ukraine?
As long as you are �ling legal appeal against a negative decision of the SMS, you are considered an asylum-seeker, and will be issued with a certi�cate on application for protection in Ukraine. So, if you get a negative decision and appeal on time, then your certi�cate on application for protection in Ukraine will be renewed each 3 months within the whole appeal period.
What happens to me if I don’t �le an appeal against a negative decision of the SMS?
If you do not �le an appeal, and you have no other legal basis for stay in Ukraine, then your stay will become illegal. You may be detained and charged with illegal stay in Ukraine. You may face deportation.
Is the information I provide to the SMS con�dential?
The SMS is obliged to treat your application and the information you share with them as con�dential. The law states that the authorities of Ukraine should avoid sharing any information provided by asylum-seekers with their country of origin.
How can I �le a complaint if I feel I am treated unfairly?
If you feel that you have been treated unfairly, you should �le a complaint to the Central State Migration Service. You may call the SMS on their hotline at: +38(044) 278 50 30. You may send them a complaint by email at E-mail: [email protected] and/or [email protected]. You may send a letter of complaint to 9 Volodymyrska Str., Kyiv, 01025, Kyiv (01025, м. Київ, вул. Володимирська, 9). If you would like to make a complaint about corruption, you can write to antikorupcija@ dmsu.gov.ua or call the anti-corruption hotline at: +38 (044) 253-71-09, +38 (044) 253-7110. There is also a schedule for making complaints in person at the o�ce of the SMS on 9 Volodymyrska Str., in Kyiv. Currently the reception hours are on Tuesdays and Thursdays from 9:00 – 13:00; Mondays and Wednesdays from 14.00 – 17.00 and Fridays from 9:00 – 16.45 with an hour-long break for lunch from 13.00 – 14.00.
IV. What happens after I get a decision from the SMS? What happens if the SMS grants me refugee status or complementary protection in Ukraine?
You will have many rights like Ukrainian citizens, including those to free movement and choice of residence, education, medical assistance, insurance and health care, family unity, marriage, labour, business activity, social bene�ts, and legal assistance. You continue to be obliged to respect the Constitution and laws of Ukraine.
Migration Service will issue you a certi�cate of a refugee status or complementary protection. You can stay legally in Ukraine on the basis of this document for an unlimited period, unless there are conditions which cause you to lose your refugee status or complementary protection. You must, however, inform Migration Service of any change of your address in Ukraine and extend the validity of your certi�cate of a refugee or a person in need of complementary protection every 5 years.
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Passport: Series _________ No. _________________________________, D
ate of Issue and Issuing Authority (if available)
_________________________________________________________________________________________________________________Citizenship/N
ationality ____________________________________________________________________________________________
Country of Permanent Residence ____________________________________________________________________________________
Place of Residence in Ukraine _______________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________Availability of Perm
it for Stay in Ukraine and Its Expiration D
ate___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Applicant’s Signature
_____________________________ “____” __________________20___
Legal Representative’s Signature
_____________________________ “____” __________________20___
Translator’s Signature
_____________________________
“____” __________________20___
Supplement. List of attached docum
ents (Part 7, Article 7 of the Law
of Ukraine “O
n Refugees and Persons Who N
eed Complem
entary or Tem
porary Protection in Ukraine»)
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Subm
itted for further consideration on “_____”___________________ 20________________________________________________________________________________________________________________________________
(Last Nam
e, Position, Signature of O�
cial of the Migration Service O
�ce/Body)
16
You can apply to the State Migration Service to obtain a travel document, allowing you to travel abroad.
Your family members, that is spouse, children under the age of eighteen, parents incapable of working or other persons under your guardianship, if also in Ukraine, will be also be granted refugee status or complementary protection. If your family members (among those listed above) are in a di�erent country, you can apply for them to join you in Ukraine.
If you have refugee status, you can apply for Ukrainian citizenship after three years.
The State Migration Service and non-governmental organisations can give you more information on the rights and duties associated with refugee status and complementary protection, as well as on assistance available to support your integration into Ukrainian society.
What happens if the SMS rejects my application for refugee status or complementary protection?
If the SMS decides to reject your application for refugee status/complementary protection, they will issue you a written notice of this fact. If you are rejected, you have the right to appeal against this rejection within �ve working days. If you wish to seek legal assistance in �ling an appeal, you should do that immediately. A lawyer can help you to �le an appeal to the court.
As long as you �le an appeal, the SMS will extend the validity period of your certi�cate on application for protection in Ukraine each 3 months within the whole appeal period and you will have a legal basis for stay in Ukraine. If you do not appeal or your appeals are rejected, you will have to leave the territory of Ukraine unless you have other lawful reasons for staying.
17
Annex 2
A list of the State Migration Service o�ces’ addresses and contacts as of 15.05.2018:
Directorate of the SMSU in Vinnytsia region (also covers Zhytomir region)
Vinnytsya city, 2105015-A Soborna Str.,tel/fax: (0432) 52 03 09e-mail: [email protected]
Directorate of the SMSU in Volyn region(also covers Rivno region)
Lutsk city, 43000, 17 Shevchenka Str. tel. (0332) 74-24-76e-mail: [email protected]
Chief Directorate of the SMSU in Dnipropetrivsk region(also covers Zaporizhzhya region)
Dnipro city,7 Lypynskoho Str.tel. (056) 745-04-74e-mail: [email protected]
Chief Directorate of the SMSU in Zakarpattya region
Uzhgorod city, 880002 Zagorska Str.tel: (0312) 64 23 48 fax: (0312) 64 31 99; (0312) 64 40 12e-mail: [email protected]
Directorate of the SMSU in Kyiv region(also covers Kyiv City)
Kyiv city34 Lesi Ukrainky Boulevard, entrance 2, o�ce. 314. tel. (044) 285-03-56e-mail: [email protected]
Chief Directorate of the SMSU in Lviv region(also covers Ivano-Frankivsk region)
Lviv city 79007, 11 Sichovykh Striltsiv Str.tel/fax (032) 261-09-30, (032) 261-49-02e-mail: [email protected], [email protected]
Chief Directorate of the SMSU in Odesa region(also covers Mykolaiv and Kherson and regions)
Odesa city,64 Preobrazhenska Str.,tel. (048) 705-31-88e-mail: [email protected]
Directorate of the SMSU in Poltava region(also covers Kirovograd and Cherkasy regions)
Poltava city, 360034 Shkilny Provulok tel/fax (05322) 2-98-71e-mail: [email protected]
Directorate of the SMSU in Sumy region
Sumy city,27 Herasima Kondratieva Str.tel: (0542) 61 12 50fax: (0542) 61 01 90e-mail: [email protected]
18
Chief Directorate of the SMSU in Kharkiv region(also covers Donetsk and Luhansk regions)
Kharkiv city, Dvadtsyat Tretyoho Serpnya Str. 13-a, tel. (057) 340-40-15e-mail: [email protected]
Directorate of the SMSU in Khmelnitskiy region(also covers Ternopil and Chernivtsi regions)
Khmelnitskiy city 87 Hrushevskogo Str.,tel. (0382) 70-43-19e-mail: [email protected]
Directorate of the SMSU in Chernihiv region
Chernihiv city 14027, 51-A Shevchenka Str., tel/fax (04622) 3-34-91e-mail: [email protected]
19
Annex 3Addresses of Organizations Rendering Assistance to Refugees in Ukraine
UNHCR Representation in Ukraine 16 Lavrska Str., Kyiv 01015, Ukraine Switchboard: (044)288-9424 Protection Unit: (044) 288-9686 (reception day Wednesday 10.00 – 17.00); Fax: (044) 288-9850e-mail: [email protected]; [email protected]://www.unhcr.org.ua/uk/
Charitable Organization “Charitable Fund "The Right to Protection"Legal assistance
Kyiv 04071 55 Shchekavytska Str. tel.: (044) 337-17-62 e-mail: [email protected]
Field o�ces: Chernihiv, 14000 57/1 Goncha Str., Mob: +38 (050) 440 5599 Tel: +38 (046) 267 5281
Lutsk please contact o�ce in Kyiv: tel.: (044) 337-17-62 e-mail: [email protected]
Lviv, 79005 13 Shota Rustavely Str., o�ce 10, Lviv Mob: +38 (093) 023 0855 Tel: +38 (032) 276 1921
Kharkiv 61024 85 Chernyshevska str. tel. 057-751-17-64; +38 (094) 8111764 e-mail: [email protected], Web-site: http://r2p.org.ua/en/
Charitable Foundation “ROKADA”Social assistance
Kyiv 03065 7 Vasylya Chumaka Str. tel: (044) 501-5696 fax: (044) 501-5695 e-mail: o�[email protected] mailing address: Kyiv-65, P.O.Box 108
Caritas KyivSocial assistance
Kyiv 02139Mykytenka Str., 7-bTel: (067) 400 78 40,(067) 400 64 21
Caritas KharkivSocial assistance
Kharkiv 61001Molochna Str., 3 (2 �oor) tel: +38 050 3000 248
20
Caritas OdesaSocial assistance
Odesa 65014, Lermontovs’kyi Lane, 13Tel: (095) 295 77 30
Caritas ZakarpattyyaSocial assistance
Zakarpats’ka Region 89427, Mynai vil., Patrus-Karpats’kyi Str., 2-a (2nd �oor)Tel: (050) 949 36 76
International Foundation of Health and Environment Protection "Region Karpat" (NEEKA)Legal and Social assistance
Mukachevo city 89600 3 Michurina Str. tel.: (03131) 321-22 fax: (03131) 314-50 e-mail: [email protected]
Public Movement ”Desyate kvitnya” Legal and Social assistance
Odesa 6507815 Heroyiv Krut, o�ce 501 tel. (048) 766 0004, (093) 662 85 24 e-mail: [email protected] http://desyatekvitnya.comFacebook: https://www.facebook.com/Desyate Kvitnya
