The resulting claim form developed by the Government of Bosnia and Herzegovina includes entries providing the following information: the name, nationality and marital status of the claimant; the claimant's passport number, national card or certificate number; Iraqi residence permit number and national claim number; the date and place of birth of the claimant; the claimant's present residential and mailing addresses; the claimant's employer and address in Iraq; and the claimant's date of departure from Iraq and date of return to Bosnia and Herzegovina.