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Sample Ds 160 Form Us Visa Application
Sample Ds 160 Form Us Visa Application
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SAMPLE - IMMIHELP.COM
Confirmation Number:
GUPTA , RAMESH
DOES NOT APPLY
YES
NONE , RAMESHBHAI
Sex:
Marital Status:
Date of Birth:
Place of Birth:
Nationality:
Other Nationalities:
MALE
MARRIED
01 JANUARY 1945
MUMBAI , MAHARASHTRA , INDIA
INDIA
NO
Travel Information
Principal Applicant?
YES
29 JUNE 2010
6 MONTH(S)
123 PARK AVENUE
EDISON, NEW JERSEY 08817
Person/Entity Paying for Your Trip:
OTHER PERSON
Name of Person Paying for Your Trip:
GUPTA , RAHUL
Telephone:
732-555-1212
Email Address:
rahul@yahoo.com
Relationship to You:
CHILD
Is the address of the party paying for your trip the NO
same as your Home or Mailing Address?
Paying Address:
123 PARK AVENUE
City:
EDISON
State/Province:
NJ
Postal Zone/ZIP Code:
08817
Country:
UNITED STATES OF AMERICA
YES
NO
NO
NO
NO
GUPTA , RAMILA
SPOUSE
GUPTA, RAHUL
DO NOT KNOW
RELATIVE
123 PARK AVENUE
EDISON, NEW JERSEY 08817
(732)555-1212
rahul@yahoo.com
Family Information
Father's Surnames:
Father's Given Names:
Father's Date of Birth:
Is your father in the U.S.?
Mother's Surnames:
Mother's Given Names:
Mother's Date of Birth:
Is your mother in the U.S.?
Full Name:
Date of Birth:
Nationality:
City of Birth:
GUPTA
AMRIT
10 JANUARY 1933
NO
GUPTA
SAVITA
10 FEBRUARY 1934
NO
YES
GUPTA , RAHUL
CHILD
U.S. CITIZEN
GUPTA , RAMILA
29 MARCH 1947
INDIA
DELHI
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INDIA
SAME AS HOME ADDRESS
BUSINESS
STAR BAZAAR
2345 KHAR LANE
MUMBAI
MAHARASHTRA
400011
INDIA
45,000
SALESMAN
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
Page 3 of 4
NO
Location Information
Current Location: 080%$,,1',$
Preparer of Application:
Did anyone assist you in filling out this
application?
NO
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