Professional Documents
Culture Documents
Consular Electronic Application Center - Print Application C'rp. 1 Uz 4
Consular Electronic Application Center - Print Application C'rp. 1 Uz 4
C'rp.1 uz 4
Confirmation Number:
Travel Information
Principal Applicant? LJ
YES
https://ceac.state.gov/GENNlVicommon/printapplication.aspx?guy1a5yrGw6x%2b7...25.03.2010
C:rp.2uz 4
YEs
LJ Haveyou ever beenin the U.S.? Previous U.S.Visitsin the last 5 years: 01 IUNE2005 TravelDate of Arrival(1) : 3 MONTH(S) Lengthof Stay: Do you or did you hold a U,S. Driver'sLicense? NO YES Haveyou ever beenissueda U.S.Visa? Ll 24 MAY2005 ' Date LastVisawas Issued: DO NOTKNOW VisaNumber: for Are you applying the sametype of visa? No YES Are you applying the same country in wherethe visa aboveis issuedand is this countryyour principal countryof residdnce? NO Havevou beenten-orinted? No Hasyour U.S.Visaever beenlost or stolen? or NO Hasyour U.S.Visaever beencancelled revoked? Haveyou ever beenrefuseda U.S.Visa,been No to refused admission the UnitedStates,or your application admission the at withdrawn for Dointof entrv?
Family Information
Father's Surnames: Father's GivenNames: Father's Dateof Birth: Is your father in the U.S.? Mother's Surnames: N4other's GivenNames: Mother's Dateof Birth; Is your motherin the U.S.? not relatives, Do you haveany immediate parentsin the U.S,? including in Do you haveany other relatives the United States? Primary Occupation: Present Emolover SchoolName: or Address: C'ty: State/Province:
https://ceac.state.gov/GENNIV/common/printapplication.aspx?8uYla5yrGw6Xo/o2b7...25.03.201
Crp. 3 ur 4
h@s://ceac.state.gov/GENNIV/common/printapplication.aspx?8uY1a5yrGw6X%2b7...25.03.2
'
'Crp.4us4
LocatlonInformation
Current Location:
Preparer of Application:
Did anyoneassistyou in fillingout this aoolication?
https://ceac.state.gov/GENNlV/common/printapplication.aspx?8uY1a5yrGw6X%2b7...25.03.2010