USA APPLICATION FORM DS-160

Preffered Date & language 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? Ten Print

You have provided
finger prints for all your
Have your US visa been lost / Stolen? fingers as opposed to
having provided only
two finger prints?
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?
Name of Institiute, Address, Course of Study, Attended Date - From and To
Name of Institiute, Address, Course of Study, Attended Date - From and To
Name of Institiute, Address, Course of Study, Attended Date - From and To
 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 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?

Did anyone assist you in filling out this application?

Organization Name
Address
Relationship
Ten Print
You have provided
finger prints for all your
fingers as opposed to
having provided only
two finger prints?