nonimmigrant visa application personal information...

Nonimmigrant Visa Application

OMB CONTROL NUMBER: 1405-0182

FORM NUMBER: DS-160

EXPIRATION DATE: 07/31/2011

Personal Information 1

ESTIMATED BURDEN: 75 MIN

NOTE: Data on this page must match the information as it is written in your passport.

Surnames (e.g., FERNANDEZ GARCIA) Help: Surnames

Enter all surnames as listed in your passport.If only one name is listed in your passport,enter that surname.

Given Names (e.g., JUAN MIGUEL) Help: Given Names

If your passport does not include a givenname, please enter ‘FNU’ in Given Names.

Q: Have you ever used other names (i.e., maiden, religious, professional, alias,etc.)?

Help: Given Names

A: Yes No

Other Surname Used

If you only have other surnames to enter,enter the same given names as above.Conversely, if you only have other givennames to enter, enter the same surname asabove.

Other Given Name Used

Other Surname Used


Other Surname Used


Other Surname Used


Full Name in Native Alphabet

Does Not Apply Help: Date of Birth

Sex Marital StatusIf day or month is unknown, enter as shown inpassport.

Male Female - SELECT ONE -

Date of Birth (Format: DD-MMM-YYYY)

City of Birth

State/Province of Birth Does Not Apply Help: Country of Birth

Country of Birth

The name of the country should be the namethat is currently in use for the place where youwere born.


Personal Information 2Nationality

Q: Do you hold or have you held a nationality other than the one you have indicated above?

A: Yes No If yes, provide the following information:

Other nationality

Q: Do you hold a passport for the nationality above?

A: Yes No

If yes, provide the following information:

Passport Number

Other nationality

Q: Do you hold a passport for the nationality above?

A: Yes No

If yes, provide the following information:

Passport Number

Help: Identification Numbers

National Identification Number

Does Not Apply

U.S. Social Security Number

Does Not Apply

U.S. Taxpayer ID Number

Does Not Apply

If you do not have a NationalIdentification Number, U.S. SocialSecurity Number, or U.S. TaxpayerID Number, then check ‘Does NotApply’.


Address and Phone Information

Home Address

Street Address (Line 1)

Street Address (Line 2) *Optional

City

State/Province

Does Not Apply

Postal Zone/ZIP Code

Does Not Apply

Country

Mailing Address

Q: Is your Mailing Address the same as your HomeAddress? (This is the address to which yourpassport will be sent if you qualify for a visa).

A: Yes No



City

State/Province

Does Not Apply

Postal Zone/ZIP Code

Does Not Apply

Country

Phone

Home Phone Number

Work Phone Number

Does Not Apply

Work Fax Number

Does Not Apply

Mobile/Cell Phone Number

Does Not Apply

Email Address

Email Address

Does Not Apply

(e.g., [email protected])


Passport Information

Passport Number

Passport Book Number Help: Passport Book Number

Does Not Apply

Country/Authority that Issued Passport

Where was the Passport Issued?

City

State/Province *If shown on passport

Country

The Passport Book Number iscommonly called the inventorycontrol number. You may or maynot have a Passport Book Numberon your passport. The location ofthe Passport Book Number on yourpassport may vary depending onthe country that issued yourpassport. Please contact yourpassport issuing authority if you areunable to determine whether or notyour passport contains a PassportBook Number.

Issuance Date Expiration Date Help: Expiration Date

(Format: DD-MMM-YYYY) (Format: DD-MMM-YYYY)

In most cases your passport musthave at least six months of validitybeyond the date of your visaapplication and/or your arrival in theUnited States.

Q: Have you ever lost a passport or had one stolen?

A: Yes No If yes, provide the following information:

Passport Number Passport Number

Does Not Apply Does Not Apply

Country/Authority that Issued Passport Country/Authority that Issued Passport


Travel Information

NOTE: Provide the following information concerning your travel plans.

Q: Are you the principal applicant? Help: Principal Applicant

A: Yes No If no, enter Surname and Given Names of the Principal.

Surname of Principal Applicant Given Names of Principal Applicant

Purpose of Trip to U.S.-SELECT ONE-Other - Specify-SELECT ONE-Application Receipt/Petition Number

Principal Applicant’s SEVIS ID

Principal Applicant’s Company Name

Purpose of Trip to U.S.-SELECT ONE-Other - Specify-SELECT ONE-Application Receipt/Petition Number

Principal Applicant’s SEVIS ID

All visitors for business orpleasure are principalapplicants, even if you aretraveling with your family. Ifyou are coming to the UnitedStates in a category of visathat permits you to work, study,or get married, you are theprincipal applicant. You are notthe principal applicant if youare accompanying yourspouse or parent who iscoming to the United States ina category of visa that permitsthem to work, study, or getmarried.

Help: Application Receipt/Petition NumberUsed if trip purpose is Fiancé/ Spouse of U.S. Citizen(K) or if applicant is not Principal and Other Specify isTemporary Employee (H1, H2), Trainee (H3), Intra-company Transfer (L), Spouse/Child of PermanentResident (V), Extraordinary Person (O), Athlete-Entertainer (P1), Cultural Artist (P3).

Help: Principal Applicant’s SEVIS ID

Only used if applicant is not Principal and trip purposeis Student/Exchange (F,J,M,Q)

Help: Principal Applicant’s Company Name

Only used if applicant is not Principal and trip purposeOther-Specify is Treaty Trader/Investor (E1, E2).

Address Where You Will Stay in the U.S.

Street Address (Line 1):

Street Address (Line 2) *Optional:

City:

State:

Zip Code: (e.g., 55555 or 55555-5555)


Travel Information

Person/Entity Paying for Your Trip: -SELECT ONE-

Help: Payer – If SELF, then skip Payer information. Otherwise provide information for either OTHER PERSON or COMPANY/ORGANIZATION.

Other Person Paying for Your TripSurnames:

Given Names:

Email Address:

(e.g., [email protected]) Does Not Apply

Telephone Number:

Relationship to You: -SELECT ONE-

Company/Organization Paying for Your Trip

Name of Company/Organization Paying for Your Trip

Telephone Number:

Relationship to You: -SELECT ONE-

Q: Is the address of the party paying for your trip the same as your Home or Mailing Address?

A: Yes No Help: Payer Address – Only fill in address if Payer is NOT SELF and different than Home/Mailing Address.

Address of Other Person or Company/Organization Paying for Your Trip



City:

State/Province: Does Not Apply

Postal Zone/Zip Code: Does Not Apply

Country:

Q: Have you made specific travel plans?

A: Yes No If no, enter Surname and Given Names of the Principal.

No Specific Travel Plans

Intended Arrival Date

(DD-MMM-YYYY)

Intended Stay Length

SELECT ONE

Yes Specific Travel Plans

Date of Arrival in the U.S.

(DD-MMM-YYYY)

Arrival Flight (if known):

Arrival City

Date of Departure from the U.S.

(DD-MMM-YYYY)

Departure Flight (if known):

Departure City

Help: Travel Plans

If you are unsure of yourDate of Arrival in theU.S. or Date ofDeparture from U.S.,please provide anestimate.

Locations You Plan to Visit in the U.S. (Only required if Specific Travel Plans have been made)


Travel Companions InformationNOTE: Provide the following travel companion information.

Q: Are there other persons traveling with you?

A: Yes No

Q: Are you traveling as part of a group or organization? If yes, enter the group name.

A: Yes No Group name:

Surnames of Person Traveling With You

Given Names of Person Traveling With You

Relationship with Person

-SELECT ONE-




-SELECT ONE-




-SELECT ONE-




-SELECT ONE-




-SELECT ONE-




-SELECT ONE-




-SELECT ONE-




-SELECT ONE-


Previous U.S. Travel Information

NOTE: Provide the following previous U.S. travel information. Provide complete and accurate information to all questionsthat require an explanation.

Q: Have you ever been in the U.S.? Q: Do you or did you ever hold a U.S. Driver’s License?

A: Yes No A: Yes No

Provide information on your last five U.S. visits:

Date of Arrival

(DD-MMM-YYYY)

Length of Stay

SELECT ONE

Date of Arrival

(DD-MMM-YYYY)

Length of Stay

SELECT ONE

Date of Arrival

(DD-MMM-YYYY)

Length of Stay

SELECT ONE

Date of Arrival

(DD-MMM-YYYY)

Length of Stay

SELECT ONE

Date of Arrival

(DD-MMM-YYYY)

Length of Stay

SELECT ONE

Provide the information on your previous U.S. Driver’s Licenses:

Driver’s License Number

Do Not Know

State of Driver’s License


Do Not Know



Do Not Know


Q:Have you ever beenissued a U.S. Visa?

YesA:

No

Date Last Visa Was Issued

Visa Number

Not Known

Q:Applying for thesame type of Visa?

YesA:

No

Q:Have you ever beenten-printed?

YesA:

No

Q:Applying in the same country where the above visawas issued and is this your country of residence?

A: Yes No

Q: Has your U.S. Visa ever been lost or stolen?

A: Yes No If yes, enter the year:

Enter year of lost/stolen U.S. Visa:

Q:Have you ever been refused a U.S. Visa oradmission to the U.S., or withdrawn your applicationfor admission at the point of entry?

A: Yes No If yes, explain:

Q: Has your US Visa ever been cancelled or revoked?

A: Yes No If yes, explain:


U.S. Point of Contact Information

Contact person or Organization in the United States Help: Contact

Contact Person

Surnames

Given Names Do Not Know

Your U.S. point of contactcan be any individual inthe U.S. who knows youand can verify, ifnecessary, your identity.

Organization Name

Do Not Know

Relationship to You

- SELECT ONE -

Address and Phone Number of Point of Contact

U.S. Street Address (Line 1)

U.S. Street Address (Line 2) *Optional

City

State

ZIP Code (if Known)

(e.g., 55555 or 55555-5555)

Phone Number

(e.g., 555-555-5555)

Email Address

(e.g., [email protected])


Family Information: Relatives

Father’s Full Name and Date of Birth

Surnames:

Do Not Know

Given Names:

Do Not Know

Date of Birth

(DD-MMM-YYYY)

Do Not Know

Q: Is your father in the U.S.?

A: Yes No

If yes, select your father’s status.

Father’s Status

-SELECT ONE-

Mother’s Full Name and Date of Birth

Surnames:

Do Not Know

Given Names:

Do Not Know

Date of Birth

(DD-MMM-YYYY)

Do Not Know

Q: Is your mother in the U.S.?

A: Yes No

If yes, select your mother’s status.

Mother’s Status

-SELECT ONE-

Q:Do you have any immediaterelatives, not including parents, inthe United States?

A: Yes No

Q:Do you have any other relatives inthe United States?

A: Yes No

Help: Immediate Relatives

Means fiancé, spouse,child, or sibling.

Provide Information About Your Immediate Relatives in the United States

Surnames:

Given Names

Relationship to you: -SELECT ONE-

Relative’s Status -SELECT ONE-

Surnames:

Given Names



Surnames:

Given Names



Surnames:

Given Names



Surnames:

Given Names



Surnames:

Given Names



Surnames:

Given Names



Surnames:

Given Names




Family Information: Spouse

NOTE: Enter current spouse information. If divorced, enter previous spouse information.

Spouse's Full Name (include Maiden Name)

Spouse’s Surnames

Spouse’s Given Names

Spouse’s Nationality

Spouse’s Date of Birth

(DD-MMM-YYYY) Spouse’s Place of Birth

City

Country

Spouse's Address

Spouse’s Address

-SELECT ONE- Provide the following information if spouse’s address is other.


U.S. Street Address (Line 2) *Optional:

City:


Postal Zone/ZIP Code: Does Not Apply

Country:

Date and Place of Marriage

Date: (DD-MMM-YYYY)

City:

State: Does Not Apply

Country:


Present Work/Education/Training Information

NOTE: Provide the following information concerning your current employment or education.

Primary Occupation

-SELECT ONE-

Specify Other or Explain Not Employed

Present Employer or School Name

Present Employer or School Address



City

State/Province

Does Not Apply

Postal Zone/Zip Code

Does Not Apply

Country

Monthly Salary in Local Currency (if employed)

Does Not Apply

Briefly describe your duties:


Previous Work/Education/Training Information

Q: Were you previously employed?

A: Yes No Help: Previous Employers – Provide your employment information for the last five years, if applicable.

Employer Name Job Title

Employer Street Address Line 1 Supervisor Surnames

Employer Street Address Line 2 *Optional Supervisor Given Names

City: State: Does Not Apply

Telephone Number: Postal Zone/ZIP Code: Does Not Apply

Country:

Employment Date From Employment Date To

(DD-MMM-YYYY) (DD-MMM-YYYY)

Briefly describe you duties:

Employer Name Job Title

Employer Street Address Line 1 Supervisor Surnames

Employer Street Address Line 2 *Optional Supervisor Given Names

City: State: Does Not Apply

Telephone Number: Postal Zone/ZIP Code: Does Not Apply

Country:

Employment Date From Employment Date To


Briefly describe you duties:


Previous Work/Education/Training Information

Q: Have you attended any educational institutions other than elementary schools?

A: Yes No Help: Previous Institutions – Provide information below for institutions attended, not including elementary.

Name of Institution

Street Address Line 1

Street Address Line 2 *Optional

City:State: Does Not ApplyPostal Zone/ZIP Code: Does Not Apply

Country:Course of Study:

Attendance Date From Attendance Date To


Name of Institution







Name of Institution







Name of Institution







Name of Institution







Name of Institution








Additional Work/Education/Training Information

NOTE: Provide the following work, education, or training related information. Provide complete and accurate informationto all questions that require an explanation.

Q: Do you belong to a clan or tribe? If yes, please provide the clan or tribe name.

A: Yes No

Q: Have you traveled to any countries within the last five years?

A: Yes No If yes, provide a list of countries visited.

Countries visited in the last five years:

Q: Have you belonged to, contributed to, or worked for any professional, social, or charitable organization?

A: Yes No If yes, provide a list of organizations.

Organizations belonged to, contributed to, or worked for:

Q: Do you have any specialized skills or training in firearms, explosives, nuclear, biological, or chemical experience?

A: Yes No If yes, explain

Q: Have you been involved with a paramilitary, vigilante, rebel, guerrilla, or insurgent organization?

A: Yes No If yes, explain


Additional Work/Education/Training Information

Q: Have you ever served in the military?

A: Yes No If yes, provide the information below.

Name of the Country

Branch of Service

Rank/Position

Military Specialty

Date of Service From

(DD-MMM-YYYY)

Date of Service To

(DD-MMM-YYYY)

Name of the Country

Branch of Service

Rank/Position

Military Specialty


(DD-MMM-YYYY)

Date of Service To

(DD-MMM-YYYY)

Name of the Country

Branch of Service

Rank/Position

Military Specialty


(DD-MMM-YYYY)

Date of Service To

(DD-MMM-YYYY)

Name of the Country

Branch of Service

Rank/Position

Military Specialty


(DD-MMM-YYYY)

Date of Service To

(DD-MMM-YYYY)


Security and Background: Medical and Health Information

NOTE: Provide the following security and background information. Provide complete and accurate information to allquestions that require an explanation. A visa may not be issued to persons who are within specific categoriesdefined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any ofthe following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if youanswer YES you may be required to personally appear before a consular officer.

Q: Do you have a communicable disease of public health significance such as tuberculosis (TB)?

A: Yes No If yes, explain.

Q:Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare ofyourself or others?


Q: Are you or have you ever been a drug abuser or addict?



Security and Background: Criminal Information


Q:Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, orother similar action?


Q: Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?


Q:Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you beenengaged in prostitution or procuring prostitutes within the past 10 years?


Q: Have you ever been involved in, or do you seek to engage in, money laundering?



Security and Background: Security Information


Q:Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in theUnited States?


Q:Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terroristactivities?


Q: Have you ever or do you intend to provide financial assistance or other support to terrorist organizations?


Q: Are you a member or representative of a terrorist organization?



Security and Background: Security Information


Q: Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?


Q: Have you ever ordered, incited, committed, assisted, or otherwise participated in torture?


Q:Have you ordered, incited, committed, assisted, or otherwise participated in extrajudicial killings, political killings,or other acts of violence?


Q:Have you, while serving as a government official, been responsible for or directly carried out, at any time,particularly severe violations of religious freedom?



Security and Background: Immigration Law Violation Information

Q: Have you ever been the subject of a removal or deportation hearing?


Q:Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other UnitedStates immigration benefit by fraud or willful misrepresentation or other unlawful means?


Q: Have you ever failed to attend a hearing on removability or inadmissibility within the last five years?


Q:Have you ever been unlawfully present, overstayed the amount of time granted by an immigration official orotherwise violated the terms of a U.S. visa?



Security and Background: Miscellaneous Information

Q:Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted legalcustody by a U.S. court?


Q: Have you voted in the United States in violation of any law regulation?


Q: Have you ever renounced United States citizenship for the purpose of avoiding taxation?


Q:Have you ever attended a public elementary school on student (F) status or a public secondary school afterNovember 30, 1996 without reimbursing the school?



Temporary Worker Visa Information

NOTE: You have indicated that the purpose of your trip to the U.S. is to work temporarily. Provide the followinginformation concerning your employer.

Help: ApplicationReceipt/PetitionNumber

Where Do You Intend to Work?

Name of Employer



City

State

Zip Code

(e.g., 55555 or 55555-5555)

Enter monthly salary (in USD)

$

Q: Do you have an application receipt/petition number?

A: Yes No If yes, provide the following information.

Name of Person/Company who Filed Petition

Application Receipt/Petition Number

(e.g., ABC1234567890)

Your applicationreceipt/petition numberwas given to you by theDepartment of HomelandSecurity’s United StatesCitizenship andImmigration Services(USCIS) after you filedyour petition application ata USCIS Service Center.The applicationreceipt/petition number is13 characters long andthe first three charactersare letters.


Sign and Submit

Preparer of the Application

Q: Did anyone assist you in filling out this application?

A: Yes No If yes, provide the Preparer’s information below.

Preparer Information

Surnames:

Given Names: Does Not Apply

Organization Name: Does Not Apply



City:


Postal Zone/Zip Code: Does Not Apply

Country:

Relationship to You:

Applicant Passport Number:DS160

nonimmigrant visa application personal information...

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