Nonimmigrant Visa Application

Application - Sensitive But Unclassified(SBU) Photo Provided:

Confirmation Number:

Personal, Address, Phone, and Passport Information

Name Provided:

Full Name in Native Language:

Other Names Used:

Sex:

Marital Status:

Date of Birth:

Place of Birth:

Nationality:

Other Nationalities:

National Identification Number:

Home Address:

City:

State/Province:

Postal Zone/ZIP Code:

Country:

Same Mailing Address?

Home Phone Number:

Work Phone Number:

Work Fax Number:

Mobile/Cell Phone Number:

Email Address:

Passport Number:

Passport Book Number:

Country/Authority that Issued Passport:

City Where Issued:

State/Province Where Issued:

Country Where Issued:

Issuance Date:

Expiration Date:

Have you ever lost a passport or had one stolen?

Travel Information

Principal Applicant?

▲ Purpose of Your Trip to U.S.

Purpose (1) :

Intended Date of Arrival:

Intended Length of Stay in U.S.:

Address where you will stay in the U.S:

Person/Entity Paying for Your Trip:

Name of Person Paying for Your Trip:

Telephone:

Email Address:

Relationship to You:

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

Paying Address:

City:

State/Province:

Postal Zone/ZIP Code:

Country:

▲ Other Persons Traveling with You:

Are you traveling as part of a group or organization?

Persons Traveling with You: Name (1) :

Relationship to You:

Have you ever been in the U.S.?

Have you ever been issued a U.S. visa?

Have you ever been refused a U.S. Visa, been refused admission to the United States, or withdrawn your application for admission at the

point of entry?
U.S. Contact Information

Contact Person Name in the U.S.:

Organization Name in the U.S.:

Relationship to You:

U.S. Contact Address:

Phone Number:

Email Address:

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.?

▲ Do you have any immediate relatives, not including parents in the U.S.?

Relative Name (1) :

Relationship to you:

Status: U.S. CITIZEN

Spouse's Full Name:

Spouse's Date of Birth:

Spouse's Nationality:

Spouse's City of Birth:

Spouse's Country of Birth:

Spouse’s Address:

Work / Education / Training Information

Primary Occupation:

Present Employer or School Name:

Address:

City:
State/Province: Postal Zone/Zip Code:

Country:

Month Salary in Local Currency:

Briefly Describe your Duties:

Do you have a communicable disease of public health significance such as tuberculosis (TB)?
⃝ NO ⃝ YES
Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare or
yourself or other?
⃝ NO ⃝ YES
Are you or have you ever been a drug abuser or addict?
⃝ NO ⃝ YES
Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty,
or other similar action?
⃝ NO ⃝ YES
Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?
⃝ NO ⃝ YES
Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you
been engaged in prostitution or procuring prostitutes within the past 10 years?
⃝ NO ⃝ YES
Have you ever been involved in, or do you seek to engage in, money laundering?
⃝ NO ⃝ YES
Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in
the United Stated?
⃝ NO ⃝ YES
Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist
activities?
⃝ NO ⃝ YES
Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist
organizations?
⃝ NO ⃝ YES
Are you a member or representative of a terrorist organization?
⃝ NO ⃝ YES
Have you ever ordered, incited, committed, assisted or otherwise participated in genocide?
⃝ NO ⃝ YES
Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?
⃝ NO ⃝ YES
Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political
killings, or other acts of violence?
⃝ NO ⃝ YES
Have you, while serving as a government official, been responsible for or directly carried out, at any time,
particularly severe violations of religious freedom?
⃝ NO ⃝ YES
Have you ever been the subject of a removal or deportation hearing?
⃝ NO ⃝ YES
Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other
United States immigration benefit by fraud or willful misrepresentation or other unlawful means?
⃝ NO ⃝ YES
Have you ever failed to attend a hearing or removability or inadmissibility within the last five years?
⃝ NO ⃝ YES
Have you ever been unlawfully present, overstayed the amount of time granted by an immigration official or
otherwise violated the terms of a US Visa?
⃝ NO ⃝ YES
Have you ever withheld custody of a US Citizen child outside the United States from a person granted leagal
custody by a US Court?
⃝ NO ⃝ YES
Have you ever voted in the United Stated in violation of any law or regulation?
⃝ NO ⃝ YES
Have you ever renounced United States citizenship for the purpose of avoiding taxation?
⃝ NO ⃝ YES
Have you ever attended a public elementary school on student (F) status or a public secondary school after
November 30, 1996 without reimbursing the school?
⃝ NO ⃝ YES
 COMMON QUESTIONS IN THE INTERVIEW

1. Are You Married? If Yes, What Does Your Spouse Do? For How
Long Have You Been Married?
2. Are You Traveling With Someone Else?
3. Can You Show Your Bank Statement?
4. Do You Have a Job-Leave Approval Letter From Your
Employer?
5. Do You Have Any Children? If Yes, How Old Are They, What
Do They Do?
6. Do You Pay Income Tax?
7. Have You Booked Or Bought The Flight Ticket?
8. Have You Ever Travelled To Other Places?
9. How Do We Know You Will Return Home Within The Visa
Allowed Period?
10. How long are you going to Stay?
11. How Much Is Your Salary or How Much Do You Earn?
12. How Much This Journey Will Cost You?
13. What did you say does your mother do?
14. What is the Purpose of Your Visit?
15. Where Are You Going To Stay?
16. Who Lives With You Now And What Do They Do?
17. I Don’t Think You Will Come Back, What’s Your Comment?