Visa Information

Aadher card No:

Date of broth:
Passport No:
Passport issue date:
Passport Expiry date:
Places of Birth:
Passport of Issue:

Father full Name: -

Contact No: -
Email id: -
Address:
Mobile No:
Date of birth:

Mother full Name: -

Contact No: -
Email id: -
Address:
Mobile No:
Date of birth:

Edit U.S. Point of Contact Information:

Contact Person Name in the U.S:
Surnames:
Given Names:
Date of Birth
Organization Name in the U.S.
Relationship to You:
U.S. Contact Address:
Phone Number:
Email Address:

Have you ever been in the U.S.?

Date of Arrived: -
Length of stay: -
Do you or did you ever hold a U.S. Driver’s License?
Driver's License Number: -
State of Driver's License: -
Has your U.S. Visa ever been cancelled or revoked?
Explain: -
Father Date of Birth: -
Mother Date of Birth: -

Primary occupation / School Name 10, 12 and degree

Present Employer or School Name:
Street Address (Line 1)
Street Address (Line 2)
City
State/Province
Postal Zone/ZIP Code
Phone Number
Country/Region
Start Date
End date:

Address where you will stay in the U. S:

Address:
City:
Pin Code:
Mobile No:
Mail Id:

Briefly describe your duties: (Most Important)

Were you previously employed?

Employer Street Address (Line 1)

Employer Street Address (Line 2)
City
State/Province
Postal Zone/ZIP Code
Phone Number
Country/Region
Job Title
Supervisor's Surname
Supervisor's Given Names
Start Date
Briefly describe your duties:

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:
Do you have any immediate relatives, not including parents in the U.S.?
Do you have any other relatives in the United States?
Are there other persons traveling with you?
Have you ever been in the U.S.? If yes
Date Arrived (1):
Length of Stay:
Do you or did you hold a U.S. Driver's License?
Have you ever been issued a U.S. Visa?
Date Last Visa was Issued:
Visa Number:
Are you applying for the same type of visa?
Are you applying in the same country where the visa above is issued and is this country your
principal country of residence?
Have you been ten-printed?
Has your U.S. Visa ever been lost or stolen?
Has your U.S. Visa ever been cancelled or revoked?
Have you ever been refused a U.S. Visa, or been refused admission to the United States, or
withdrawn your application for admission at the port of entry?
Has anyone ever filed an immigrant petition on your behalf with the United States Citizenship
and Immigration Services?
Have you traveled to any countries/regions within the last five years?
Provide a List of Countries/Regions
Visited Country/Region (1):
Have you belonged to, contributed to, or worked for any professional, social, or charitable
organization?
Do you have any specialized skills or training, such as firearms,
explosives, nuclear, biological, or chemical experience?
Have you ever served in the military?
Have you ever served in, been a member of, or been involved with a paramilitary unit, vigilante
unit, rebel group, guerrilla group, or insurgent organization?
Father’s / Mother’s friends Local Point of Contact Information
Local contact (1)
Surnames
Given Names
Last Name
Street Address (Line 1)
Street Address (Line 2)
City
State/Province
Postal Zone/ZIP Code
Country/Region
Telephone Number
Email Address

Local contact (2)

Surnames
Given Names
Last name:
Street Address (Line 1)
Street Address (Line 2)
City
State/Province
Postal Zone/ZIP Code
Country/Region
Telephone Number
Email Address