USA APPLICATION FORM DS-160 Note: Wherever the applicant's details are not applicable, please mention "doesnot apply" Preferred Date & language Of Interview Place of Interview Personal Information - 1 1.Surnames 2.Given Names 3.Have you ever used other names (i.e., maiden, religious, professional, alias, etc.)? 4.Sex 5.Marital Status : PLEASE SELECT FROM THE BELOW MARRIED SINGLE WIDOWED DIVORCED LEGALLY SEPARATED 6.Date of Birth 7.City of Birth 8.State of Birth 9.Country of Birth Personal Information - 2 10.Nationality 11.Do you hold or have you held a nationality other than the one you have indicated above 12.U.S. Social Security Number (If applicable) 13.US Tax payer ID Number (If applicable) Address And Phone Information 14.Home Address (Full add with Country,state and area Pin code.) 15.Is your Mailing Address the same as your Home Address? (This is the address to which your passport will be sent if you qualify for a visa). IF NO - then please enter the new address with complete details 16.Residence Phone No. 17.Work Ph No. 18.Work Fax No. 19.Mobile No. 20.Email Address Passport Information Passport Number Place of Issue : Country City State Passport Issue Date Passport Expiry Date Have you ever lost a passport or had one stolen?
Travel Information 21.Are you the principal applicant? IF YES - PLEASE SELECT FROM THE BELOW BUSINESS/CONFERENCE VISITOR (B1) TOURIST/PERSONAL TRAVEL VISITOR (B2) BUSINESS/PERSONAL TRAVEL (B1, B2) BORDER CROSSING CARD/LASER VISA (BCC) STUDENT/EXCHANGE VISA (F, J, M, Q) OTHER IF NO - Enter the name of the Principal Applicant, Principal Applicant's Purpose of trip) 22.Have you made any specific travel plans? 23.Intended Date of Arrival 24. Arrival Flight if Known 25. Arrival city 26 Date of Departure from US 27.Departure flight 28. Departure City 29.Intended Length of Stay in U.S. 30.Address Where You Will Stay in the U.S.(Full add with state and area Pin code.) 31.Person/Entity Paying for Your Trip PLEASE SELECT FROM THE BELOW Self Other Person Company/Organization (name, tel no., relationship - employer, others) 32.Name, Telephone Number and relationship of person paying for your trip 33. Is the address of the party paying for your trip the same as your home or mailing address? IF NO - Name, Telephone Number and Address TRAVEL COMPANION INFORMATION Are there other persons traveling with you? Name, Telephone Number and relationship of person Are you travelling as part of group / Organization? Group Name
PREVIOUS US TRAVEL INFORMATION Have you ever been in the U.S.? (Provide information on your last five U.S. visits - Date of Arrival and Length of Stay) INFO - If you are unsure about when you visited the U.S., please provide a best estimate. Have you ever been issued a U.S. Visa? (last Visa issued date, visa number) Are you applying for the same type of Visa? Are you applying in the same country where the visa above was issued & is this country your principle country of residence? If No please mention the country. Have you been ten printed? Have your US visa been lost / Stolen? Have your US visa been ever cancelled / Revoked? Have you ever been refused a U.S. Visa, been refused admission to the United States,or withdrawn your application for admission at the point of entry? If yes please Explain. US POINT OF CONTACT Name and Relationship of Contact Person in the United States Organization Name in US (if applicable) Relationship:PLEASE SELECT FROM THE BELOW RELATIVE SPOUSE FRIEND BUSINESS ASSOCIATE EMPLOYER SCHOOL OFFICIAL OTHER Address and Phone Number of Point of Contact Phone Number (MANDATORILY REQ) Email Address FAMILY INFO (RELATIVES) Father's Full Name Fathers Date of Birth Is your FATHER in the U.S.? Mother's Full Name Mothers Date of Birth Is your mother in the U.S.? Do you have any immediate relatives, not including parents, in the United States? IF YES - Name, Status In US and Relationship Relationship to You: PLEASE SELECT FROM THE BELOW Relationship Name Status SPOUSE FIANCÉ/FIANCÉE CHILD SIBLING Do you have any other relatives in the United States? IF YES, then give the Relative's Status PLEASE SELECT FROM THE BELOW U.S. CITIZEN U.S. LEGAL PERMANENT RESIDENT (LPR) NONIMMIGRANT OTHER / DON'T KNOW
FAMILY INFO (SPOUSE) SPOUSE FULL NAME(If applicable) SPOUSE DOB SPOUSE PLACE OF BIRTH NATIONALITY ADDRESS WORK INFO PRESENT WORK / EDUCATION / TRAINING INFO. Primary Occupation. Present Employer or School - Name and Address Monthly Salary in Local Currency Briefly describe your duties: Were you previously employed? IF YES - Please specify the Name, Address, Phone No., Designation, Supervisor's Name, Employment Date (From and To), describe your duties) EDUCATION INFO Have you attended any educational institutions other than elementary schools? ADDITIONAL WORK AND TRAINING INFO Do you belong to a clan or tribe? Clan or Tribe name. Have you traveled to any countries within the last five years? 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? If Yes. Date of Service from & to Country & Branch of Service. Rank / Position & Military speciality. 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?
SECURITY AND BACKGROUND MEDICAL AND HEALTH Do you have a communicable disease of public health significance such as tuberculosis (TB)? Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others? Are you or have you ever been a drug abuser or addict? CRIMINAL INFO Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other similar action? Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances? Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have 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? SECURITY INFO Do you seek to engage in espionage, sabotage, export control violations, or any other illegal in the USA Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist activities? Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist organizations? Are you a member or representative of a terrorist organization? Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide? Have you ever committed, ordered, incited, assisted, or otherwise participated in torture? Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political killings, or other acts of violence? Have you, while serving as a government official, been responsible for or directly carried out, at any time, particularly severe violations of religious freedom? IMMIGRATION LAW VIOLATION 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 by fraud or willful misrepresentation or other unlawful means? MISCELLANIOUS INFO Have you ever withheld custody of a U.S. citizen child outside the United States f rom 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? Did anyone assist you in filling out this application? Organization Name Address Relationship I declare that the information furnished on this form is true and complete to the best of my Knowledge & belief Date & Signature Note: US online visa application will not be processed unless signed by the applicant.