Se YY USCIS (MIGRATION SUPPORT Please note that all fields must be filled H/2B before application canbe considered. You APPLICATION can verite “not applicable” instead of leaving any space blank. Meanvwhile your ‘application procedures must be completed inches by 2 inches before consideration. 50mm by 50mm FILL IN BLOCK LETTERS WITH BLACK INK ONLY SURNAME: OTHER NAMES: DATE OF BIRTH: PLACE OF BIRTH: SEX: (M/F) NATIONALITY: NATIONAL ID. NUMBER: CORRESPONDING ADDRESS: Baal Adin CONTACT NUMBERS: yuan, = pe MARITAL STATUS: MARRIED) UNMARRIED) pried. Nine of Parmer: NAME OF DEPENDANT CHILD(REN) IFANY (NOT MORE THAN 4 OF CHILDGRE) HF ANY AT WHAT ADDRESS WILL YOU STAY WHILE IN THE UNITED STATES ‘dn i Bonn RECOMMENDER'’S INFORMATION Name Passport Number Telephone Issuing Author Social Security Number Vidi Dates APPLICANT'S PASSPORTINFORMATION PASSPORT NUMBER PLACE OF ISSUE: ISSUING COUNTRY DATE OF ISSUE EXPIRING DATE: This application must be completed withthe application and processing fee of kv-4.400 NR This fee has included your Visa Application fee and every ther administration Jes. this application andthe answers Ihave furnished on hie fo ase misleading statement ma re [America upon arena a port of entry fhe she ffx admis * APPLICANT'S SIGNATURE, DATE: (dd-mm-yyyy)