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1. Visa Class- (B1/B2)

2. Name (as Passport) (English & Bangla): Sheikh Mohammad Maroof, শেখ মোহাম্মাদ মারুফ
(Have you ever used other names? (maiden, religious, professional etc.): No

3. Passport no.: B00038285 Date of Birth: 23/02/1972 Place of Birth: Dhaka

4. Marital Status (Married/Single/Widowed/Divorced/Separated/Legally Separated): Married
5. Spouse Name: Tabassum Hossain
Date of Birth: 09/09/1978 Place of Birth: Chattogram
 National Identification Number. (If Applicable): 4195851573
 Do you hold or have you held any Nationality other than the one indicated? (Provide the Nationality &
Passport No.): No
 Are you a permanent Resident of a country/ region other than your country/region of origin (Nationality)? -
No
 U.S. Social Security Number. (If Applicable): No
 U.S. Taxpayer I*D Number. (If Applicable): No
6. When do you intend to arrive in the U.S? (Specific Date & Month): April 25 to May 03, 2023
7. How long do you intend to stay in the U.S.?( Length of stay): 08 days
8. At what address will you stay in the U.S.? –
Hotel:
Address:
9. Who will pay for you trip? (Name, Relation, Address, Contact Number, Email): Self

10. Names and relationship of persons traveling with you. (If Applicable)- N/A

11. Have you ever been in the U.S.? (If YES, provide the information of last 5 visits)
 Arrival date- 05 May 2022; Length of Stay ______ 07__________
 Arrival date- 21 April 2018; Length of Stay_______07__________
 Arrival date: 26 October 2019; Length of Stay_______06__________
 Arrival date- 28 March 2016; Length of Stay_______04__________
 Arrival date- 24 February 2015; Length of Stay_______09__________
Have you ever Overstayed in the U.S.? If yes, Explain: No
U.S. Driver’s license Number & State of driver’s license.( IF Applicable): No
12. Have you ever been issued a U.S visa? (Last visa issue date, Visa class, 8-digit visa Number: 22/03/2018;

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B1/B2, M6330927

13. Have you ever been Refused a U.S visa/Has your U.S visa ever been lost /stolen/cancelled/revoked?
When? Where? What type of visa? (If applicable): No

Has anyone ever filed an IMMIGRANT PETITION on your behalf with the United States Citizenship and
Immigration Services?
If Yes, explain- No
14. Home/ Present & Mailing Address with postal code: House-10, Road-55, Gulshan north avenue, Gulshan-2,
Dhaka-1212, Bangladesh.
Permanent Address: House-258, Apt-A2, Road-1, Block-B, Bashundhara R/A, Khilkhet, Dhaka-1229

15. Contact Number (Personal/Home/Business): +8801711535314

Provide all your additional contact numbers if you have used within the last five years: N/A

16. E mail address: smmaroof@thecitybank.com, maroof23@gmail.com

Provide all your additional email addresses if you have used within the last five years: N/A

17. List all Social Media (like Facebook, LinkedIn, Gmail, google+ etc.:) Platforms you have used within the last five
years- (if Yes provide Link):
Facebook profile link: https://www.facebook.com/sheikh.m.maroof?mibextid=LQQJ4d
LinkedIn profile link: http://linkedin.com/in/maroof-sheikh-mohammad-2a64a116

18. Provide the information of your Contact Person in the U.S/Organization in the U.S-
 Name- Farooq Mohammad Sheikh
 Address & Contact Number- 17 Red Oak Lane, Pittsford, NY-14534

 Relationship- Brother

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 Email- faruk.sheikh@gmail.com
19. Father’s Name & (Date of Birth if known): Sheikh Mohammad Mukhlesur Rahman
20. Mother’s Name & (Date of Birth if known): Feroza Begum
21. Are any of the following persons (Father/Mother, Son/Daughter, Husband/Wife, Brother/Sister,
Fiancé/Fiancée) in the U.S? Brother
(IF yes give the Name, Relationship, Status-U.S. Citizen, Green Card/LPR, Nonimmigrant)- U.S Citizen

Do you have any other relatives in the United States? (Yes/No): No

 Name of your Present Employer/Business/ Educational Institution- City Bank Limited, Head Office
 Address & Contact Number: 136, Gulshan Avenue, Gulshan-2, Dhaka-1212, Bangladesh

 Job/Business Starting Date (DD-MM-YY): 24/06/2007

 Your Designation & Duty: Additional Managing Director & Chief Business Officer

24. Monthly Salary/Income in local currency: BDT. 15,19,492/-

25. Last Two employment information, you have left within the last five years (If Applicable): N/A
Duration
Employer (Company) Supervisor Start to End
Address Contact No. Job title
Name Name (DDMMYY) -
(DDMMYY)

26. Educational Qualification from Secondary level and above:

Course of Study Duration: Start to End

Institutions Name Address
(DD/MM/YY) - (DD/MM/YY)
Dhaka University Nilkhet Rd, Masters in 1992
Dhaka 1000, Commerce &
Bangladesh Finance
Dhaka University Nilkhet Rd, Bachelors in 1990
Dhaka 1000, Commerce &
Bangladesh Finance

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Government Titumir College Bir Uttam A Higher Secondary 1988

K Khandakar Level (HSC)
Road,
Dhaka-1213
27. List all Languages you can speak: Bengali , English, Hindi

28. List all countries you have travelled within the last 5 years. (Country names only): India, UAE, United Kingdom,
United States of America, Oman, Nederlands, Germany, Malaysia, Singapore, Philippines, Thailand,
Switzerland, Czech Republic, Turkey & France
29. List all Professional, Social and Charitable Organizations to which you belong: Gulshan Club, Banani Club,
Baridhara Cosmopolitan Club & Dhaka Boat Club
30. Do you have any specialized skills or training experience? NO
(Firearms/Explosives/Nuclear/Biological/Chemical)
31. Have you ever served in the military? No
Branch Ran Military Specialty Duration: Start to End (DD/MM/YY
k

THIS PART IS NOT FOR B1/B2 CATEGORY VISA

1. For “F/M/J Visa” list 2 contact person (Without family member/ relative) in applicant’s country of
residence who can verify information. (Name, Address, Contact number, E-mail)-

--
--
2. Do you intend to study in the U.S.? (If yes give the course of study, name and complete address of the
school)- No

3. Do you intend to work in the U.S.? (If yes provide the name, complete address of the U.S. employer,
monthly salary in $USD)- No

4. Name of person/company who filed petition. (Provide application/petition number)-

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5. (Vessel/Aircraft) crew
 Job title, company name, company contact number)-
 Local agency name, contact person, Address, contact number-
 Vessel name & identification (IMO) number

1. Passport Photocopy (Photo and Personal Data Page)

2. Photo 2’’ X 2’’ With Soft Copy

3. Business/Service Card

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