TO:

DEPARTMENT OF STATE

WASHINGTON

NOTIFICATION OF APPOINTMENT OF FOREIGN DIPLOMATIC OFFICER

The Secretary of State, Attention: Office of Protoco!

1. FULL NAME (First, Middle, Last) (Please Copitalize Last Name) 2. RESIDENCE ADDRESS IN U.S.

4. NAME AND DATE AND PLACE OF BIRTH OF CHILDREN RESIDING IN U.S. (Note: Permanent departure of a child from the U.S. prior to termination of parent's diplomatic assignment, as well as subsequent arrival of a dependent child from abroad, is to be reported to Protocol by diplomatic note.)

DATE

UNITED STATES OF AMERICA

DEPARTMENT OF STATE

NOTIFICATION OF STATUS WITH A FOREIGN GOVERNMENT

To the Secretary of State, Attention: Office of Protocol

In accordance with applicable laws and regulations, the following information is submitted for the purpose of regularizing my status as an official or employee of a foreign government.

6. PORT OR PLACE, DATE AND MANNER OF LATEST ARRIVAL IN UNITED STATES AND NAME OF VESSEL, IF ANY

9. NAME AND NATIONALITY OF HUSBAND OR WIFE. AND ADDRESS IF SEPARATE FROM SIGNER'S

(Please describe)

10. NAMES, DATES OF BIRTH, AND NATIONALITY OF CHILDREN, AND THEIR ADDRESSES IF DIFFERENT FROM SIGNER'S

11. NAMES AND NATIONALITIES OF OTHER RELATIVES WHO ARE MEMBERS OF SIGNER'S HOUSEHOLD

12 NAMES AND NATIONALITIES OF PERSONAL AND DOMESTIC EMPLOYEES WHO ARE MEMBERS OF OR ARE EMPLOYED IN SIGNER'S HOUSEHOLD

FORM DS-394 Rev. 3-74

13. EXACT TITLE OF POSITION OR JOB INCLUDING RANK IF APPLICABLE

PAGE 2

13 A. FOR CONSULAR OFFICERS ONLY: IF AN AMERICAN CITIZEN (0) DO YOU HOLD A POSITION UNDER THE FEDERAL GOVERNMENT OR UNDER A STATE, LOCAL, OR COUNTY GOVERNMENT:

(b) DO YOU HOLD A COMMISSION AS A RESERVE OFFICER IN THE ARMED FORCES OF THE UNITED STATES:

14. DATE OF ASSUMPTION OF PRESENT DUTIES IN THE UNITED STATES

15. IF THE SIGNER PERFORMS OTHER THAN USUAL DIPLOMATIC OR CONSULAR FUNCTIONS, OR IS AT PRESENT ENGAGED IN, OR PROPOSES TO ENGAGE IN, ANY INFORMATION SERVICE, PUBLIC RELATIONS. PUBLICITY ACTIVITIES, OR ANY SIMILAR ACTIVITIES A DETAILED STATEMENT SHOULD BE ATTACHED HERETO MAKING SPECIFIC REFERENCE TO SUCH ACTIVITIES

16. NATURE AND PLACE OR PLACES OF OCCUPATION OR EMPLOYMENT DURING THE PAST 5 YEARS

17. COMPLETE ADDRESS OF OFFICE WHERE DUTIES ARE ACTUALLY PERFORMED

18. HOME ADDRESS IN THE UNITED STATES, OR ADDRESSES IF MORE THAN ONE

19. IF DECLARATION TO BECOME AN AMERICAN CITIZEN HAS BEEN FILED, STATE THE DATE AND PLACE OF APPLICATION

20. IF AN IMMIGRANT, HAVE YOU FILED WITH THE ATTORNEY. GENERAL A "WAIVER OF RIGHTS, PRIVILEGES, EXEMPTIONS AND IMMUNITIES" UNDER SECTION 247 (B) OF THE IMMIGRATION AND NATIONALITY ACT?

21. IF NOT, HAS STATUS BEEN CHANGED FROM IMMIGRANT CLASSIFICATION TO NON-IMMIGRANT (li "Yes", give date)

22. I understand that the unauthorized acceptance of any type of private employment, full or part-time, outside of a diplomatic mission or international organization, by myself or by a member of my family, would constitute a violation of my official status in this country and could result in revocation of such status.