al Information. Family Name (Last Name) Given Name (First Name) Middle Name (if any) 3. Date of Binh (dd/mm/yyyy) 4. Gender or Sex 02/21/1985 K Male Female K Other 5. Alien Registration lo• A- Number (A-Number) (if any) 6. U.S. Social Security Number (SSN) (if any) Part 2. Agency Informatio