The DNA Identity Testing Laboratory is accredited
by the American Association of Blood Banks.
APPLICATION FOR DNA IMMIGRATION TESTING
Please complete this application and fax, e-mail or mail back to arrange a DNA test for immigration. A copy of the letter from INS requesting DNA testing must be included. Please print all information. A case consultant will notify the Contact Person (in the U.S.) to confirm receipt of the application and schedule DNA collection appointment(s) and/or request additional information.
I. Type of Test Requested (please check all that apply):
Paternity Test (Trio of alleged father, mother and child), $460.00
Paternity Test (Alleged father and child only), $460.00
Maternity Test (Alleged mother and child only), $460.00
Kinship (Sibling, Aunt/Uncle, Grandparent) Test, $500.00 for two relatives
Each additional person, $200.00.
Number of additional people to be tested:
Network (in U.S.) DNA Collection Fee, $50.00/person:
Number of people to attend a Network DNA collection facility:
The above fees do not include shipping and handling, as these fees may vary by country. These fees will be confirmed with the Contact Person when the case is set up.
II. Contact Information:
Contact Person should be: Attorney(s)
1st Tested Party listed on page 2
Attorney’s Name:
Address:
City:
State:
Zip:
Representing:
Phone:
Fax:
Attorney’s Name:
Address:
City:
State:
Zip:
Representing:
Phone:
Fax:
III. Parties To Be Tested:
Contact Person’s Name:
Phone
Role in this case (please check one):
Mother
Father
Child
Sister
Brother
Aunt
Uncle
Grandmother
Grandfather
Date of Birth:
Race:
City :
State :
Zip:
Country:
Name:
Phone
Role in this case (please check one):
Mother
Father
Child
Sister
Brother
Aunt
Uncle
Grandmother
Grandfather
Date of Birth:
Race:
City :
State :
Zip:
Country:
Name:
Phone
Role in this case (please check one):
Mother
Father
Child
Sister
Brother
Aunt
Uncle
Grandmother
Grandfather
Date of Birth:
Race:
City :
State :
Zip:
Country:
Name:
Phone
Role in this case (please check one):
Mother
Father
Child
Sister
Brother
Aunt
Uncle
Grandmother
Grandfather
Date of Birth:
Race:
City :
State :
Zip:
Country:
IV. Appointment(s):
Schedule parties:
Together:
Separate:
Requested appointment(s) for:
Name:
Day:
M
T
W
R
F
Month:
Time:
AM PM
Schedule parties:
Together:
Separate:
Requested appointment(s) for:
Name:
Day:
M
T
W
R
F
Month:
Time:
AM PM
Please note that we do not schedule appointments for the parties which are outside of the U.S. The U.S. Embassy in the country from which the overseas parties are located will contact those parties to arrange an appointment for DNA collection, once the case is set up.
V. Method of Payment:
If you choose to pay by money order or cashier’s check , make payable to Bio-Synthesis, Inc. Overseas money orders must be issued by the U.S. Postal Service. All funds must be payable in US dollars.
Please Check one:
Money Order
Cashier’s Check
American Express
Visa
Mastercard
Discover
If you choose to pay with Credit Card, please complete following:
Credit Card Number:
Expiration Date:
Amount authorized: US$:
CVV Code:
Name as it appears on the card:
(3 or 4 Digit on front/back of card)
Cardholder’s billing address:
I hereby give permission to Bio-Synthesis, Inc. to charge the above account for :
Deposit 50% of total amount
Full amount, once confirmed with Case consultant
(Signature of
Cardholder)
(Date Signed)
All information on this form will be used solely for this DNA analysis. No other agency or outside party will have access to this information without your written, notarized consent or without legal process.
