I-PERSONAL,ADDRESS,PHONE AND PASSPORT INFORMATION

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Maximilian McCormick
6 years ago
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1 USA DS 160 ON LINE VISA APPLICATION FORM IPERSONAL,ADDRESS,PHONE AND PASSPORT INFORMATION 1) NAME PROVIDED: 2) FULL NAME IN NATIVE PLACE: 3) OTHER NAMES USED: 4) SEX: 5) MARITUL STATUS: 6) DATE OF BIRTH: 7) PLACE OF BIRTH: 8) STATE OF BIRTH: 9) NATIONALITY: 10) OTHER NATIONALITY: 11) NATIONAL IDENTIFICATION NUMBER: 12) US SOCIAL SECURITY NUMBER: 13) US TAX PAYER ID NUMBER: 14) HOME ADDRESS: 15) CITY : 16) STATE /PROVIENCE: 17) POSTAL ZONE ZIP CODE: 18) COUNTRY: 19) SAME MAILING ADDRESS: 20) HOME PHONE NUMBER: 21) WORK PHONE NUMBER: 22) MOBILE/CELL PHONE NUMBER: 23) ADDRESS: 24) PASSPORT NUMBER: 25) PASSPORT BOOK NUMBER: 26) COUNTRY/AUTHURITY THAT ISSUED PASSPORT: INDIA 27) CITY WHERE PASSPORT ISSUED: 28) STATE/PROVIENCE WHERE PASSPORT ISSUED: 29) COUNTRY WHERE PASSPORT ISSUED:INDIA 30) PASSPORT ISSUED DATE: 31) PASSPORT EXPIRATION DATE: 32) HAVE YOU EVER LOST YOUR PASSPORT OR HAD BEEN STOLEN: 11TRAVEL INFORMATION 1) ARE YOU THE PRINCIPAL APPLICANT: 2) PURPOSE OF YOUR TRIP TO US:

2 3) OTHER POURPOSE THAN SPECIFY: 4) HAVE YOU DONE SPECIFIC PLAN OF YOUR TRAVEL: 5) INTENDED DATE OF TRAVELLING TO US: 6) INTENDED LENGTH OF STAY IN US: 7) ADDERESS WHERE YOU STAY IN THE US: 8) PERSON WHO IS PAYING FOR THE TRIP: 9) NAME OF THE COMPANY/ORGANISATION PAYING FOR THE TRIP: 10) TELEPHONE OF THE COMPANY: 11) WHAT RELATION DO YOU HAVE WITH THE COMPANY: 12) IS THE ADDRESS OF THE PARTY PAYING FOR YOUR TRIP THE SAME AS YOUR HOME ADDRESS OR MAILING ADDRESS 13) ARE THERE OTHER PERSONS TRAVELLING: 14) NAMES OF THE PEOPLE IF TRAVELLING WITH YOU:,, 15) HAVE YOU EVER BEEN IN THE US: 16) PREVIOUS VISITS TO US IN THE LAST FIVE YEARS:,, 17)( FOR ALL THE VISITS) DATE OF TRAVEL/MONTH/YEAR /LENGTH AND OF STAY IN US.:,, 18) DO YOU OR DID YOU HOLD A US DRIVERS LICENCE: 19) HAVE YOU EVER BEEN IN THE USA: 20 WHICH IS THE LAST DATE OF YOUR US VISA ISSUED: 21) WHAT IS THE VISA NUMBER OF YOUR LAST VISA ISSUED: 22) ARE YOU APPLYING FOR THE SAME TYPE OF VISA: 23) ARE YOU APPLYING IN THE SAME COUNTRY WHERE YOUR

3 PREVIOUS VISA WAS ISSUED AND IS THIS COUNTRY YOUR PRINCIPAL COUNTRY OF RESIDENCE: 24) HAVE YOU TEN PRINTED: 25) HAS YOUR US VISA EVER BEEN LOST OR STOLEN: 26) HAS YOUR US VISA EVER BEEN CANCELLED OR REVOKED: 27) HAVE YOU EVER BEEN REFUSED FOR A US VISA, IF BEEN REFUSED THAN EXPLAIN THE REASON AND THE DATE AND YEAR. ADMISSION TO THE UNITED STATES, OR WITHDRAWN YOUR APPLICATION FOR THE ADMISSION AT THE POINT OF ENTRY: 111US CONTACT INFORMATION 1) CONTACT PERSON NAME IN THE USA: 2) ORGANISATION NAME IN THE USA: 3) RELATION TO YOU: 4) US CONTACT ADDRESS: 5) CITY: 7) STATE: 8) PIN CODE IN US: 9) PHONE NUMBER: 10) ADDRESS: 1VFAMILY INFORMATION 1) FATHERS FULL NAME WITH SURMAME: 2) DATE OF BIRTH OF FATHER: 3) IS YOUR FATHER IN THE US: 4) MOTHERS FULL NAME WITH SURNAME: 5) DATE OF BIRTH OF MOTHER: 6) IS YOUR MOTHER IN THE US: 7) DO YOU HAVE ANY IMMEDIATE RELATIVES, NOT INCLUDING PARENTS IN THE USA: IF IMMEDIATE RELATIVE ARE THERE THAN GIVE THE DETAIL WITH THE US ADDRESS AND THEIR VISA STATUS HOLDING IN US: 8) DO YOU HAVE ANY OTHER RELATIVES

4 IN THE USA. = YES OR NO 9) SPOUSE FULL NAME : 10) SPOUSE DATE OF BIRTH: 11) SPOUSE NATIONALITY: 12) SPOUSE CITY OF BIRTH: 13) SPOUSE COUNTRY/ STATE OF BIRTH:, 14) SPOUSE ADDRESS: VWORK / EDUCATION/ TRAINING INFORMATION 1) PRIMARY OCCUPATION : 2) PLEASE SPECIFY IF OTHER: 3) PRESENT EMPLOYER OR SCHOOL ADDRESS: 4) CITY: 5) STATE/PROVIENCE: 6) POSTAL ZONE ZIP CODE: 7) COUNTRY: 8) MONTHLY SALARY IN LOCAL CURRENCY: 9) DESCRIBE BRIEFLY ABOUT YOUR PRESENT JOB DUTIES : 10) WERE YOU PREVIOUSLY EMPLOYED:YES OR NO IF EMPLOYED THAN 11) PLEASE MENTION THE COMPLETE DETAILS OF YOUR PREVIOUS EMPLOYMENT ALONG WITH THE DATE/MONTH/YEAR,AND THE MANAGER OR THE SUPERVISORS FULL NAME AND SURNAME INCHARGE OF YOU WITH HIS AND THE COMPANYS NAME AND CONTACT NUMBERS, AND THE JOINING AND LEAVING DATE IN THE ORGANISATION, AND DESRIBE YOUR JOB DUTIES. 12) HAVE YOU ATTENDED ANY EDUCATIONAL INSTITUTIONS OTHER THAN ELEMEMTARY SCHOOL.: 13) NAME OF THE INSTITUTIONS : 14) ADDRESS OF THE INSTITUTION: 15) CITY:

5 16) STATE PROVIENCE: 17) POSTAL ZIP CODE: 18) COUNTRY: 19) COURSE OF STUDY: 20) DATE OF ATTENDANCE FROM: 21) DATE OF ATTENDANCE TO: 22) DO YOU BELONG TO A TRIBE: 23) HAVE YOU TRAVELLED TO ANY COUNTRIES WITH IN THE LAST FIVE YEARS: PLEASE MENTION THE COUNTRIES NAME.:,,,, 24) HAVE YOU BELONGED TO CONTRIBUTED TO OR WORKED FOR ANY PROFESSIONAL, SOCIAL OR CHARITABLE ORGINASATION: 24) DO YOU HAVE A SPECIALIZED SKILLS OR TRAINING INCLUDING FIRE ARMS, EXPLOSIVE NUCLEAR, BIOLOGICAL,OR CHEMICAL EXPERIENCE.: 25) HAVE YOU EVER SERVED IN THE MILITARY: 26) HAVE YOU EVER SERVED IN,BEEN A MEMBER OF OR BEEN INVOLVED WITH A PARAMILITARY UNIT VIGILANTE REBEL,GROUP,GUERRILLA,GROUP,OR,INSURGENT ORGANIZATION : V1SECURITY AND BACKGROUND INFORMATION JUST TIK ON YES OR NO BUT NEED TO READ CAREFULLY 1) DO YOU HAVE A OMMUNICABLE DISEASE OF PUBLIC: HEALTH SIGNIFICANCE SUCH AS TUBERCULOSIS (TB): YES/:NO 2) DO YOU HAVE A MENTAL OR PHYSICAL DISORDER THAT POSES OR IS LIKELY TO POSE A THREAT TO THE SAFETY OR WELFARE OF YOUR SELF OR OTHERS: 3) ARE YOU OR HAVE YOU EVER BEEN A DRUG ABUSER ORADICT: YES/ NO 4) HAVE EVER BEEN ARRESTED OR CONVICTED FOR ANY OFFENCE OR A CRIME EVEN THOUGH SUBJECT OF A PERSON, AMNESTY, OR OTHER SIMILAR ACTION: 5) HAVE EVER VOILETED, OR ENGAGED IN A CONSPIRACY TO VOILATE,ANY LAEW RELATING TO CONTROLLED SUBSTANCES. NO 6) ARE YOU COMING TO USA TO ENGAGE IN PROSTITUTION OR

6 UN LAWFUL COMMERCIALIZED VICE OR HAVE YOU BEEN ENGAGED IN PROSTITUTION OR PROCURRING PROSITITUTES WITHIN THE PAST 10 YEARS: 7) HAVE YOU EVER BEEN INVOLVED IN OR DO YOU SEEK TO ENGAGE IN MONEY LAUNDERING. 8) DO YOU SEEK TO ENGAGE IN ESPIONAGE, SABOTAGE EXPORT CONTROL VIOLATION.OR ANY OTHER ILLEGAL ACTIVITY WHILE IN THE USA: 9) DO YOU SEEK TO ENGAGE IN TERRIOST ACTIVITIES WHILE IN THE USA OR HAVE YOU ENGAGED IN TERRORIST ACTIVITIES 10) HAVE YOU EVER OR DO YOU INTEND TO PROVIDE FINANCIAL ASSISTANCE OR OTHER SUPPORT TO TERRORIST ORGANIZATIONS.: 11) HAVE YOU EVER ORDERED, INCITED, COMMITED,ASSISTED,OR OTERWISE PARTICIPATED IN GENOCIDE: 12) HAVE YOU EVER COMMITED, ORDERED,INCITEDASSISTED OR OTHER WISE PARTICIPATED IN TORTURE: 13) HAVE YOU COMMITED, ORDERED, INCITED SSISTED OROTHER WISE PARTICIPATED IN EXTRAJUDICIAL KILLINGS, POLITICAL KILLINGS OR OTHER ACTS OF VIOLENCE:NO 14) HAVE YOU WHILE SERVING AS A GOVERNMENT OFFICIAL BEEN RESPONSIBLE FOR ORDIRECTLY CARRIED OUTANY TIME.: 15) PARTICULARLY SERVE VIOLATIONS OF RELIGION FREEDOM 16) HAVE YOU EVER BEEN THE SUBJECT OF A REMOVAL OR DEPORTATATION HEARING. 17) HAVE YOU EVER SOUGHT TO OBTAIN OR ASSIST OTHERS TO OBTAIN A VISA ENTRY INTO THE USA OR ANY OTHER UNITED STATES IMMIGRATION BENEFIT BY FRAUD OR WILFUL MISREPRESENTATION OR OTHER UNLAWFUL MEANS. 18) HAVE YOU FAILLED TO ATTEND A HEARING ON REMOVABILITY OR INADMISSIBILITY WITH THE LAST FIVE YEARS: 19) HAVE YOU EVER BEEN UN LAW FULLY PRESENT, OVER STAYED THE OMOUNT OF TIME GRANTED BY THE IMMIGRATION OFFICIAL OR OTHER WISE VIOLATED THE TERMS OF A US VISA: 20) HAVE EVER WITHHELD CUSTODY OF US, CITIZEN CHILD OUTSIDE THE UNITED STATES FROM A PERSON GRANTED LEGAL CUSTODY BY US COURT: 21) HAVE YOU EVER BEEN VOTED IN THE UNITED STATES IN VIOLATION OF ANY LAW OR REGULATION: 22) HAVE YOU EVER RENOUNENCED UNITED STATES CITIZEN

7 FOR THE PURPOSE OF AVOIDING TAXATION: 23) HAVE YOU ATTENDED A PUBLIC ELEMENTARY SCHOOL ON STUDENT: 24) STATUS OR A PUBLIC SECONDARARY SCHOOL AFTER NOVEMBER 30, 1996 WITHOUT REIMBURSING THE SCHOOL: V11CREW INFORMATION 1) SPECFIC JOB TITLE ABOARD AIRCRAFT OR VESSEL: 2) NAME OF THE COMPANY THAT OWNS THE AIRCRAFT OR THE VESSEL YOU WILL BE WORKING ON: 3) COMPANY TELEPHONE NUMBER: 4) DID YOU ACQUIRE YOUR POSITION USING A RECRUITING /MANNING/CREWING AGENCY: 5) ARE YOU SERVING ABOARD A SEAGOING SHIP OR VESSEL: 6) SEAGOING SHIP/ VESSEL NAME: 7) SEAGOING SHIP/ VESSEL IDENTIFICATION NUMBER: V111LOCATION INFORMATION 1) CURRENT LOCATION: 1X PREPARER OF APPLICATION 1) DID ANYONE ASSIST YOU IN FILLING THE APPLICATION: 2) PREPARER SURNAME: 3) PREPARER GIVEN NAME: 4) ORGANIZATION NAME: 5) STREET ADDRESS: 6) CITY: 7) STATE/PROVINCE: 8) POSTAL ZONE/ZIP CODE: 9) COUNTRY: 10) RELATIONSHIP TO YOU.

Personal Information 1

Personal Information 1 NOTE: Data on this page must match the information as it is written in your passport. Surnames (e.g., FERNANDEZ GARCIA) Given Names (e.g., JUAN MIGUEL) OMB CONTROL NUMBER: 1405-0182