Professional Documents
Culture Documents
Us DS-160 Questionnaire
Us DS-160 Questionnaire
Us DS-160 Questionnaire
Name Provided:
Full Name in
Native Language:
Other Names Used
(i.e., maiden, religious, professional, alias, etc.):
Sex:
Marital Status:
Date of Birth:
Place of Birth:
Nationality:
Other Nationalities: □ Yes □ No
Do you hold a passport for □ Yes □ No
the other nationality above? Passport Number:
National Identification
Number:
U.S. Social
Security Number:
U.S. Taxpayer ID Number:
Home Address:
City:
State/Province:
Postal Zone/ZIP Code:
Country:
Same Mailing Address? □ Yes □ No
Address:
City:
State/Province:
Postal Zone/ZIP Code:
Country:
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:
Country Where Issued:
Issuance Date:
Expiration Date:
Have you ever lost a □ Yes □ No
passport or had one stolen? Passport Number:
Country/Authority that Issued Passport :
Travel Information
Are you the principal applicant? □ Yes □ No
Purpose of Your Trip to U.S.:
Specific Travel Plan? □ Yes □ No
Date of Arrival in U.S.:
Arrival Flight:
Arrival City:
Date of Departure from U.S.:
Departure Flight:
Departure City:
The Location you plan
to visit in the U.S.:
Address where you
will stay in the U.S:
Person/Entity
Paying for Your Trip:
Name of Company/
Organization Paying for Trip:
Telephone:
Relationship to You:
Is the address of the party paying for your□ Yes □
No
trip the same as your Home or Mailing Paying Address:
Address?
City:
State/Province:
Postal Zone/ZIP Code:
Country:
Other Persons Traveling □ Yes No□
with You: Surname:
Given Name:
Relationship with Person:
Are you traveling as part of □ Yes No□
a group or organization? Group Name:
Have you ever been in the U.S.? □ Yes □
No
Provide information on Date of Arrival:
your last five U.S. Visits: Length of Stay:
Do you or did you hold a □ Yes □No
U.S. Driver's License? Driver's License Number:
State of Driver's License:
Have you ever been issued □ Yes □
No
a U.S. Visa? Date Last Visa was Issued:
Visa Number:
Are you applying for the
same type of visa? □ Yes □ No
Are you applying in the same
country where the visa above is issued? □ Yes □ No
Have you been ten-printed? □ Yes □ No
Has your U.S. Visa ever been □ Yes □ No
lost or stolen? Year visa was lost or stolen:
Has your U.S. Visa ever been □ Yes □ No
cancelled or revoked? Explain:
Have you ever been refused a U.S. Visa? □ Yes □ No
Explain:
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.? □ Yes □ No
Father's Status:
Mother's Surnames:
Mother's Given Names:
Mother's Date of Birth:
Is you mother in the U.S.? □ Yes □ No
Mother's Status:
Do you have any immediate relatives, □ Yes □ No
not including parents in the U.S.? Surnames:
Given Names:
Relationship to You
Relative's Status:
Do you have any other relatives □ Yes □ No
in the United States? Surnames:
Given Names:
Relationship to You
Relative's Status:
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:
Address of Institution:
City:
State/Province:
Postal Zone/ZIP Code:
Country:
Course of Study:
Date of Attendance From:
Date of Attendance To:
Do you belong to a clan or tribe? □ Yes □ No
Have you ever been in any □ Yes □ No
country other than U.S.? Countries Visited:
Have you belonged to, contributed to, or
worked for any professional, social, or □ Yes □ No
charitable organization?
Do you have any specialized skills or
training, including firearms, explosives,
nuclear, biological, or chemical □ Yes □ No
experience?
Have you ever served in the military? □ Yes □ No
Have you ever served in, been a
member of, or been involved with a
paramilitary unit, vigilante unit, rebel □ Yes □ No
group, guerrilla group, or insurgent
organization?
Location Information
Current Location: MANILA, PHILIPPINES
Preparer of Application:
Did anyone assist you in filling out □ Yes □ No
this application? Preparer's Surnames:
Preparer's Given Names:
Organization Name:
Address:
City:
State/Province:
Postal Zone/ZIP Code:
Country:
Relationship to You: