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STEP BY STEP PROCEDURE TO FILL-UP NONIMMIGRANT VISA APPLICATION FORM:

  • 2. Click the tab VISAS – choose Non-Immigrant Visa in the drop down selection

  • 3. Scroll down, click DS-160 Online Visa Application Form, then DS-160 Nonimmigrant Visa Electronic Application or http://ceac.state.gov/genniv

  • 4. On the LOCATION, choose PHILIPPINES, MANILA in the drop down selection

  • 5. Click TEST PHOTO and upload a standard VISA size photo (for photo standard guide, go to: http://travel.state.gov/visa/visaphotoreq/visaphotoreq_5334.html ) Click Browse and choose the location where your photo was saved. Upload selected photo. Click NEXT, CONTINUE TO USE THIS PHOTO

  • 6. “/’

  • 7. Use the information given below to fill-up TRAVEL INFORMATION, US CONTACT INFORMATION, TEMPORARY WORK VISA INFORMATION and LOCATION INFORMATION (all highlighted in yellow)

  • 8. Upon completion, make sure to electronically SIGN and SUBMIT the form by yourself . Can Other People Assist Me with my Visa Application? Yes, you can get assistance from other people. Be aware, however, that under U.S. law (22 C.F.R. 41.103) you must electronically sign and submit your own application unless you qualify for an exemption. This means that you (the applicant) must click the "Sign Application" button, even if someone else helped you fill the application out. If someone else clicks the button instead of you, your application may not be accepted.

  • 9. Get the confirmation receipt, it will require an email address where to send the receipt, please copy furnish domingolt@state.gov

SAMPLE ANSWER SHEET ONLY

Security Question:

What is the given name of your mother’s mother? Please answer

Name Provided:

DELA CRUZ, JUAN

Full Name in Native Alphabet:

DOES NOT APPLY

Other Names Used:

NO

Telecode Name Used:

NO

Sex:

MALE

Marital Status:

SINGLE

Date of Birth:

17 APRIL 1978

Place of Birth:

CUBAO, QUEZON CITY, PHILIPPINES

Nationality:

PHILIPPINES

Other Nationalities:

NO

National Identification Number:

DOES NOT APPLY

U.S. Social Security Number:

DOES NOT APPLY

U.S. Taxpayer ID Number:

DOES NOT APPLY

Home Address:

23 RIZAL ST,

 

City:

SAMPALOC MANILA

State/Province:

DOES NOT APPLY

Postal Zone/ZIP Code:

1023

Country:

PHILIPPINES

 

Same Mailing Address? Primary Phone Number:

YES 63 9188624635

Secondary Phone Number:

632 8162589

Work Phone Number:

632 8963586

Email Address:

Delacruz@yahoo.com

Passport/Travel Document Type:

REGULAR

Passport/Travel Document Number:

YYY2345

Passport Book Number:

DOES NOT APPLY

 

Country/Authority that Issued Passport/Travel Document:

PHILIPPINES

 

City where issued:

MANILA

 

Country where issued:

PHILIPPINES

Issuance Date:

09 JANUARY 2010

Expiration Date:

09 JANUARY 2015

Have you ever lost a passport or had one stolen?

The List of Purposes of Trip to the U.S.

NO

Purpose of Trip to the U.S. (1):

FOREIGN GOVERNMENT OFFICIAL (A)

Specify:

FOREIGN OFFICIAL/EMPLOYEE (A2)

 

Intended Date of Arrival:

27 JULY 2013

 

Arrival City:

DULLES, WASHINGTON, D.C

 
 

Intended Length of Stay in U.S.:

1 WEEK(S)

 
GREENBELT MARRIOTT Address where you will stay in the U.S.: 6400 IVY LANE GREENBELT, MARYLAND 20770
GREENBELT MARRIOTT
Address where you will stay in the U.S.:
6400 IVY LANE
GREENBELT, MARYLAND 20770 USA
Sponsoring Mission/Organization:
DIPLOMATIC SECURITY / ANTITERRORISM
ASSISTANCE PROGRAM
Contact Name:
U.S. Address:
JAMES HENNESY
223O GALLOWS RD
Telephone Number:
Person/Entity Paying for Your Trip:
DUNN LORING, VA 22027
(571) 226-9677
COMPANY/ORGANIZATION
Name of Company/Organization Paying for Trip:
DIPLOMATIC SECURITY / ANTITERRORISM
ASSISTANCE PROGRAM
Telephone Number:
632 3012970
Relationship to You:
SPONSOR
Address of Company/Organization Paying:
US EMBASSY
City:
MANILA
State/Province:
DOES NOT APPLY
Postal Zone/ZIP Code:
1000
Country:
PHILIPPINES
Other Persons Traveling with You:
YES
Are you traveling as part of a group or
organization?
YES

Name of the Group:

PHILIPPINE JUDGES AND PROSECUTORS

Have you ever been in the U.S.? Have you ever been issued a U.S. visa?

Have you ever been refused a U.S. Visa, been refused admission to the United States, or withdrawn your application for admission at the port of entry?

Are you or have you ever been a U.S. legal permanent resident?

Has anyone ever filed an immigrant petition on your behalf with the United States Citizenship and Immigration Services?

YES/NO

YES/NO

YES/NO

YES/NO

YES/NO

Contact Person Name in the U.S.:

BEN PROCK

 

DIPLOMATIC SECURITY /

 

Organization Name in the U.S.:

ANTITERRORISM ASSISTANCE

PROGRAM

 

Relationship to You:

SPONSOR

 

U.S. Contact Address:

2230 GALLOWS RD

 

DUNN LORING, VIRGINIA 22027

Phone Number:

(571) 226-9647

 

Email Address:

 

Father's Surnames:

DELA CRUZ

Father's Given Names:

MARIO

Father's Date of Birth:

19 JANUARY 1953

Is your father in the U.S.? Mother's Surnames:

YES/NO DELA CRUZ

Mother's Given Names:

MARIA

Mother's Date of Birth:

17 JANUARY 1953

Is your mother in the U.S.?

YES/NO

Do you have any immediate relatives, not including parents in the U.S.?

YES/NO

Do you have any other relatives in the United States?

YES/NO

Primary Occupation:

GOVERNMENT

Present Employer or School Name:

PHILIPPINE NATIONAL POLICE

Present Employer or School Address:

CAMP BAGONG DIWA

City:

TAGUIG

State/Province:

METRO MANILA

Postal Zone/Zip Code:

1523

Country:

PHILIPPINES

Work Phone Number:

PHILIPPINES

Monthly Salary in Local Currency (if employed):

20000

Briefly Describe your Duties:

ENUMERATE YOUR DUTIES, ASSIGNMENTS, AND PREVIOUS TRAINING THAT WILL MAKE YOU QUALIFY TO PARTICIPATE IN THIS FORUM (THIS IS VERY IMPORTANT)

Do you have a communicable disease of public health significance? (Communicable diseases of public significance include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, and others diseases as determined by the Department of Health and Human Services.)

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?

YES/NO

YES/NO

YES/NO

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? Have you ever committed or conspired to commit a human trafficking offense in the

YES/NO

YES/NO

YES/NO

YES/NO

YES/NO

United States or outside the United States?

Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human trafficking offense in the United States or outside the United States and have you within the last five years, knowingly benefited from the trafficking activities?

Have you knowingly aided, abetted, assisted or colluded with an individual who has committed or conspired to commit a severe human trafficking offense in the United States or outside the United States?

YES/NO

YES/NO

Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the United States?

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 ever engaged in the recruitment or the use of the child soldiers? Have you, while serving as a government official, been responsible for or directly carried out, at any time, particularly severe violations of religious freedom?

YES/NO

YES/NO

YES/NO

YES/NO

YES/NO

YES/NO

YES/NO

YES/NO

YES/NO

Have you ever been directly involved in the establishment or enforcement of the population controls forcing a woman to undergo an abortion against her free choice or a YES/NO man or a woman to undergo sterilization against his or her free will?

Have you ever been directly involved in the coercive transplantation of human organs or bodily tissue?

YES/NO

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?

YES/NO

Have you ever withheld custody of a 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? Location where you will be submitting your application

Current Location:

MANILA, PHILIPPINES

YES/NO

YES/NO

YES/NO

Did anyone assist you in filling out this application?YES/NO

DO NOT MISS THIS LAST BUT IMPORTANT STEP:

E-Signature

I certify under penalty of perjury under the laws of the United States of America that the foregoing is true and correct.

Enter your Passport Number/Travel Document Number:

DO NOT MISS THIS LAST BUT IMPORTANT STEP: E-Signature I certify under penalty of perjury underDomingolt@state.gov " id="pdf-obj-5-11" src="pdf-obj-5-11.jpg">
DO NOT MISS THIS LAST BUT IMPORTANT STEP: E-Signature I certify under penalty of perjury underDomingolt@state.gov " id="pdf-obj-5-13" src="pdf-obj-5-13.jpg">

Enter the given code as shown:

DO NOT MISS THIS LAST BUT IMPORTANT STEP: E-Signature I certify under penalty of perjury underDomingolt@state.gov " id="pdf-obj-5-18" src="pdf-obj-5-18.jpg">
DO NOT MISS THIS LAST BUT IMPORTANT STEP: E-Signature I certify under penalty of perjury underDomingolt@state.gov " id="pdf-obj-5-20" src="pdf-obj-5-20.jpg">

Sample code only

Click the button below to electronically sign your application:

DO NOT FORGET TO CLICK THIS BUTTON

Sign and Submit Application

DO NOT FORGET TO ENTER THE EMAIL ADDRESSES PROVIDED AFTER SUMBITTING THE APPLICATION (domingolt@state.gov)

PRINT THE CONFIRMATION PAGE AND SUBMIT TO ATA OFFICE TOGETHER WITH ORIGINAL VALID PASSPORT AND 2pcs STANDARD VISA PHOTO

If you need further assistance, please contact:

Liezl Domingo

 

Mobile: 09178634278

 

Office: 3012970