2122/24, 10:13 PM Tne Cj SCAN Immigrant Visa - Review Personal, Address, and Phone Online Immigrant Visa and Alien Registration Application (DS-260) Personal, Address, and Phone Information Note: You have completed data entry for your ‘Immigrant Visa and Allen Registration’ application. Before submitting the application, please review your entries below, To navigate to the next section to be reviewed, click the ‘Next’ button on the bottom of the page. If an entry is incorrect, click on the links on the right side of the page, which will direct you to the page where you entered the data. Once you have reviewed all sections, you will be cirected to the Sign and Submit page to complete the application process. Name Provided: Full Name in Native Language: Other Names Used Sex Current Marital Status Date of Birth: City of Birth State/Province of Birth Country/Region of Birth: Country/Region of Origin (Nationality): Document Type: Document 10: Country/Authority that Issued Document: Issuance Date: Expiration Date: Do you hald or have you held any nationality other than the tne you have indicated above? Present Address: City State/Province Postal Zone/2IP Code: Country/Region: From Dete: Al Have you lived anywhere other than this address since the age of sixteen? Previous Address (1) city State/Province: PHAM , THIEN VAN THIEN VAN PHAM NO MALE MARRIED (09 JANUARY 1960 DA NANG DA NANG VIETNAM VIETNAM PASSPORT 2530272 VIETNAM 29 NOVEMBER 2016 29 NOVEMBER 2026 No 358 TRAN PHU STREE GIA RAY TOWN XUAN LOC DONG NAL 810000 VIETNAM SUNE 2001 ves XUAN TAM XUAN LOC DONG NAI ntpssceac stte-govlVAppllVAnpreviewireview_reviewpersonal aspx?nade=ReviewPersonal we2122124, 10:13 PM Immigrant Visa - Review Personal, Addr Postal Zone/ZIP Code: Country/Region: From To: Primary Phone Number: Secondary Phone Number: Work Phone Number: Other Telephone Numbers Used Email Address: Other Email Addresses Used: Social Media Provider/Platform: Social Media User ID: Other Social Media Used Is your Malling Address the same as your Present Address? Permanent Address Name of person currently living at address: U.S. Address: Phone Number: Is this addrass where you want your Permanent Residence Card (Green Caré) mailed? 810000 VIETNAM JANUARY 1976 May 2001 0963309746 DOES NOT APPLY DOES NOT APPLY No THAOPHAM93.UEH@GMAIL.COM No Facebook ‘THIEN PHAM No ves [AMY THAO PHAM 2108 STARGRASS DR KATY, TEXAS 77494 (733)213-6251 Yes hitps:iloeee state. goullVApplVAppireviewiteview_reviewpersonal.aspx nede=ReviewPersonal 222122/24, 10:13 PM Immigrant Visa - Review Family Information Tne Cj SCAN Online Immigrant Visa and Alien Registration Application (DS-260) Family Information Father's Surnames: PHAM Father's Given Names: ‘CANH VAN Date of Birth: 1928 City of Birth HAL HAU State/Province of Birth: NAM DINH Country/Region of Birth: VIETNAM Is your father stil ving? No Year of death 2001 Mother's Surnames at Birth: NGUYEN Mother's Given Names: THOM THE Date of Birth: 1939 City of Birth TRUC NINH State/Province of Birth NAM DINH Country/Region of Birth: VIETNAM Is your mother stil living? ves Current Address: XUAN TAM city: XUAN LOC State/Province: DONG Nat Postal Zone/ZIP Code: 810000 Country/Region: VIETNAM Spouse's Full Name: DINH, THUY THI THU, Spouse's Date of Birth: (06 JUNE 1966 Spouse's City of Birth: HUE ‘Spouse's State/Province of Birth: THUA THIEN HUE Spouse's Country/Region of Birth VIETNAM Spouse's Address: ‘SAME AS PRESENT ADDRESS Occupation BUSINESS Date of Marriage: (05 JANUARY 1990 Marriage City XUAN LOC Marriage State/Province: DONG NA Marriage Country/Region: VIETNAM Is your spouse immigrating to the U.S.with you? ves Do you have any Previous Spouses? NO Bl do you have any children? Yes ntpszceac.stte-govlVAppllVAnpreviewireview_reviewFamilyaspx?node-ReviewFamily 192122124, 10:13 PM Number of Children: Cchilé Name (2): Date of Birth City of Birtn State of Birth Country/Region of Birth: Does this child live with you? Address: city: State/Province: Postal Zone/ZIP Code: Country/Region: Is this child immigrating to the U.S. with you? Is this child immigrating to the U.S, at a later date to join you? Child Name (2): Date of Birth: City of Birtn State of Birth Country/Region of Birth: Does this child live with you? Address: city: State/Province Postal Zone/ZIP Code Country/Region Is this child immigrating to the U.S. with you? Is this child immigrating to the U.S. at a later date to join you? Cchité Name (3) Date of Birth City of Birtn State of Birth Country/Region of Birth: Does this child live with you? Address: city: State/Province: Postal Zone/2IP Code: Country/Region: 1s this child immigrating to the U.S. with you? Is this child immigrating to the U.S, at a later date to join you? Review Family Information PHAM , THANH DUY 01 JANUARY 1991 XUAN LOC DONG Nat vieTNam No IN3 STREET, PHU HONG THINK THUAN AN BINH DUONG. 820000 VIETNAM No No PHAM , AMY THAO. (4 sawuaRy 1993 [=] XUAN LOC DONG NAI VIETNAM No 2106 STARGRASS DR Kary TEKAS 77494 UNITED STATES OF AMERICA No No PHAM , THAT DUY (05 NOVEMBER 2003 XUAN LOC DONG NAT VIETNAM No 2106 STARGRASS DR Kary TEXAS 77494 UNITED STATES OF AMERICA No. No hitps:ilosse state. goullVApplVApplreview!eview_reviewFamilyaspx?node=ReviewFamiy 282122124, 10:13 PM Immigrant Visa - Review Family Information a92122/24, 10:13 PM Immigrant Visa - Review Previous US. Travel Information Online Immigrant Visa and Alien Registration Application (DS-260) Previous U.S. Travel Information Have you ever been in the U.S.? No Have you ever been Issued a U.S. Visa? NO Have you ever been refused a U.S. Vise, been refuses No admission to the United States, or withdrawn your application Tor admission at the port of entry? ntpszceac.stte-goulVAppllVAppreviewireview_reviewpreviousustravel.aspx?node"ReviewPreviousUSTravel uw2122/24, 10:14 PM Immigrant Visa - Review Work/Education/ Training Information we) US. DEP. annie acne — Online Immigrant Visa and Alien Registration Application (DS-260) Work / Education / Training Information Primary Occupation: BUSINESS Present Employer or School Name: SELF-EMPLOYED Address: 358 TRAN PHU STR GIA RAY TOWN City XUAN LOC State/Province: DONG NAL Postal Zone/2IP Code: 10000 Country/Region: VIETNAM Do you have other occupations? No In which occupation do you intend to werk in the U.S.? BUSINESS Have you traveled to any countries/regions within the last five NO years? Have you ever served in the military? No nitpssceac.state.qovll/Appi VAnpreviewireview_reviewWorkEducation.aspx?nede=ReviewWorkEducation uw2122/24, 10:14 PM Immigrant Visa - Review Pettioner Information we) US. Pea acne I Online Immigrant Visa and Alien Registration Application (DS-260) Petitioner Information Petitioner is my: HID Petitioner Name: PHAM , AMY THAO Petitioner Address: 2106 STARGRASS DR City KATY State/Province: TEXAS Postal Zone/2IP Code: 77494 Country/Region: UNITED STATES OF AMERICA Telephone: (713)213-6251 Mobile/Cell Telephone: (713)213-6251 Email Address: AMYPHAM2106K@GMAIL.COM ntpssceac.state-govlVAppllVAnpreviewireview_reviewpetitoneraspx?node-ReviewPetioner uw2122/24, 10:14 PM Immigrant Visa - Review Security and Background Information US. DEPARTMENT of, STAT Online Immigrant Visa and Alien Registration Application (DS-260) Security and Background Information Do you have a communicable disease of public health significance such as tuberculosis (T8)? No Do you have documentation to establish that you have received vaccinations in accordance with U.S. law? NO Explain: 1 D0 NOT KNOW WHICH VACCINATIONS I SHOULD GET YET, AFTER I HAVE THE INTERVIEW SCHEDULE, I WILL MAKE AN APPOINTMENT TO GET ALL THE REQUESTED VACCINATIONS, Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare NO of yourself or others? ‘Are you or have you ever been a drug abuser or adcict? No Have you ever been arrested or convicted for any offense or crime, even though subject of @ pardon, NO amnesty, or other similar action? Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances? NO ‘Are you the spouse, son, or daughter of an Individual who has violated any controlled substance No trafficking law, and have knowingly benefites from the trafficking activities in the past five years? ‘Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have NO ‘you been engaged in prostitution or procuring prostitutes within the past 10 years? Have you ever been involved in, or do you seek to engage in, money laundering? No Have you ever committed or conspired to commit a human trafficking offense in the United States or NO. outside the United States? Have you ever knowingly aided, abetted, assisted, or colluded with an individual who has been identified NO by the President of the United States as a person who plays a significant role in a severe form of trafficking in persons? ‘Are you the spouse, son, or daughter of an Individual who has committed or conspired to commit a No human trafficking offense in the United States or outside the United States and have you within the last five years, knowingly Denefited from the trafficking activities? Do you seek to engage in espionage, sabotage, export control violations, or any ather ilegal activity while NO inthe United States? Do you seek to engage in terrorist activities while in the United States or have you ever engaged in No terrorist activities? Have you ever or de you intend to provide financial assistance or other support to terrorists or terrorist NO. organizations? ‘Are you a member or representative of a terrorist organization? No ‘Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity, including NO providing financial assistance or other support ta terrorists or terrorist organizations, in the last five years? Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide? No Have you ever committed, ordered, incited, assisted, or otherwise participated In torture? No Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political NO killings, or other acts of violence? Have you ever engaged in the recruitment of or the use of child soldiers? No Have you, while serving as @ government official, been responsible for or directly carried out, at any time, NO particularly severe violations of religious freedom? {Are you a member of or affiliated with the Communist or other totalitarian party? No ntps:ceac.state-goulVAppllVAnpreviewireview_reviewsecury.aspx?ned eviewSecurty we2122724, 10:14 PM Immigrant i Review Securty and Background Information Have you ever directly or indirectly assisted or supported any of the groups in Columbia known as the Revolutionary Armed Forces of Columbia (FARC), National Ligeration Army (ELN), or United Self-Defense Forces of Columbia (AUC)? Have you ever, through abuse of governmental or political position converted for personal gain, confiscated or expropriated property in a foreign nation to which a United States national had claim of ownership? ‘Are you the spouse, minor child, oF agent of an individual who has through abuse of governmental or political position converted for personal gain, confiscated or expropriated property in a foreign nation to wien @ United States national had claim of ownership? Have you ever been directly involved in the establishment or enforcement of population controls forcing @ ‘woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization against his or her free choice? Have you ever disclose¢ or trafficked in confidential U.S, business information obtained in connection with USS. participation in the Chemical Weapons Convention? ‘Are you the spouse, minor child, or agent of an individual who has disclosed or trafficked in confidential U.S. business information obtained in connection with U.S. participation in the Chemical Weapons Convention? 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 dy fraud or willful misrepresentation or other unlawful means? Have you ever been removed or deported from any country? Have you ever withheld custody of a U.S, citizen child outside the Ur legal custody by a U.S. court? States from @ person granted Have you ever intentionally assisted another person in withholding custody of @ U.S. citizen child outside the United States from a person granted legal custody by a U.S. court? Have you voted in the United States in violation of any law or regulation? Have you ever renounced United States citizenship for the purpose of avoiding taxation? Have you attended a public elementary school or a public secondary school on student (F) status after November 30, 1996 without reimbursing the school? Do you seek to enter the United States for the purpose of performing skilled or unskilled labor but have rot yet been certified by the Secretary of Labor? ‘ace you a graduete of a foreign mecical school seeking to perform medical services in the United States but Rave not yet passed the National Board of Medical Examiners examination or its equivalent? ‘Are you a health care worker seeking to perform such work in the United States but have not yet received certification from the Commission on Graduates of Foreign Nursing Schools or from an equivalent appraved independent credentialing organization? ‘Are you permanently ineligible for U.S, citizenship? Have you ever departed the United States in order to evade military service during a time of wer? ‘Are you coming to the U.S. to practice polygamy? ‘Are you a former exchange visitor (2) who has not yet fulfiled the two-year foreign residence requirement? Has the Secretary of Homeland Security of the United States ever determined that you knowingly made a {rivolous application for asylum? {Ace you likely to become a public charge after you are admitted to the United States? No No No No No No No No No No No No No No No No No No No 222122/24, 10:14 PM Immigrant Visa - Review Social Securty Number Information we) US. DEP. annie acne — Online Immigrant Visa and Alien Registration Application (DS-260) Social Security Number Information Have you ever applied for a Social Security number? No Do you want the Social Security Administration to issue @ Social Secu! number and a card? ves Do you authorize disclosure of information from this form to the Department of Homeland Security, YES the Social Security Administration, and such other U.S. Government agencies as may be required (of assigning you a social security number (SSN) and Issuing you @ Social Security card and do you authorize the Sacial Security Administration to share your SSN with the Department of Homeland Security? ntpssceac stte-govlVAppllVAnpreviewireview_reviewssn aspx?node=ReviewSSN a