2619/2016 Non-Immigrant vrsa- K6Vl ew l"'efsom;;, !-\UUI =::., r llV IlC. c , ... , a.> ~i-""' " ,,~•• ,, _ w_.

Edit Pers o nal Informatio n

Name Prav ided: "

Full Na me in Native Alphabe t :

Other Nam es Used:

Telecode Name Used :
Sex :
Mari tai Status :
Date cf Birth :
Cou ntry/Regio n of Birth :

Country/Region of Orig in ( Nationality) :

-------------------
Do you hold or hav e you held any nati onality other tha n the on e
indicated above on nati onality ? .

Are you a perma nent res ident of a country/ region othe r th an vou r
country/region of or igin (nationality) abov e?
Nati onal Identific at ion Num ber:
U.S. Soc lal Securi ty Numb er:
U.S. Taxpa ye r ID Num ber:

Ed it Address and Phone Information

Home Address :
City:
State/P r ov ince:
Postal Zone /ZIP Code :
Country/ Region:
Sam e Mailing Addre ss?
Primary Phone Numb er:
I
Seco nda ry Phone Number:

Work Phone Number:

I
Email Addr ess:

Ed it Pa s s Do rt / Trav el Doeu m en t I nformatio n

Passport/Tra vel oocument Ty pe :
I
Passpo rt/Travel Document Num ber :
. I
Passpo rt Book Numbe r :
I ~
( ::---;-;::----'--
'
Country / Autho rity that Iss ued Passport(Trav el Docume nt :
;------------­
I
City whe re issued : I
Sta te/Province wh ei e issued :
Country/R egio n where issued :
I ssua nce Date :
Ex piration Date :
Hav e y ou eve r lost a passport or had one stol en?
I·

htlps://ceac.state.gov/GenNIV/Generallreviewlreview_reviewpersonal.aspx?node=ReviewPersonaJ 212

, . ,
 l'iV! :- III1I I It ~J 01 u V l ~ c.. - l '\.tJV l 'O:'VV I l av~ UliVI I I I Q U V I I

Edit Travel Informatioo

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

Purpose of Tr ip to the U.S. (1):

Specify:

Have you ma de spec ific travel plans?

Provide a complete it inerary for your travel to t he U.S.

Date of Arrivai in U.S. :

Arrivai City:

Date of Departure from U.S.:

Departure City :

""
A'! -;:--------- _
t~j The Location(s) yo u pian to visit in the U.S.

Location (1):

. Ad dress where you will stay in the U.S. :

Person/Entity Paying for Your Trip:

Name of Company/Organization Payi ng for Tr ip:

Telephone Number:

Relationst)ip to You:

Add ress of Company/O rgan ization Paying: - - - - - - - - - - - - - - - - - - - - - - - - - - - ­

City :

State/Province :
Postal Zone /ZI? Code :
Country/Region:

Ed lt TiC!Vel Camoamons Informatlon

Other Persons Traveling with You:

Ed it Pre vi o u s U.S. Travel Information

!Si Have you ever bee n in the U.S.?

Date Ar rived ( 1) :

"

Length of Stay :

Date Arrived (2 ) :

Length of Stay :

Date Arrived (3 ) :

Length of Stay :

Do you or did you ever hoId a U.S. Driver's Ucense?

Have yo u ev er been issued a U.S. v isa?

Have yo u ever been refused a U.S. Vìsa, or been refused adm ission

to the United States, or withdrawn your app lication for adm ission at

the port of entry? .

Have you ever been denied t ravel authorizàtion by t he Departm ent cf

Hom el and Security through the Electronic System f or Trav e!

Authorizatio n ( ESTA)?

Has an yone ever fi led an im migrant petition on vou r behal f wit h th e

United States Citizens hip and Immigration Se rv ices?

-
https://ceac.state.gov/GenNIV/General/reviewtreview_reviewtravel.aspx?node=ReviewTravel
 V9/2016 Nonìmmlgrsnt Vlsa - R ev !61I1 u <:> vUlU"u. . ... _ •• . . _ _

Online Nonimmigrant Visa App lication (DS-160) Application ID AA006E UM NO

D.S. Contact Information

Edit U.S . Point of Contact Infonnatio n

Contac t Perso n Name in the U.S. :

Organization Nam e in the U.5 . :

Relationship to You:
,
U.S. Contaet Add ress:

Phone Number :
Email Address:

httos://ceac.state.gov/GenNIVIGeneral/reviewlreviewJ eviewUSCOI1tact.aspx?node=ReviewUSContact 1/1

 Nonimmigrant Visa - Revlew r-allluy "uV" "Ww ~"
.61912016

Applicatio n fD AA006EUMNO
Online Nonimmigrant Visa Application (DS-160)

Family Infonnation

Edit Familv Infonn atio n ' Re latives

Father 's Surn ames:

Fath er's Give n Narnes:

Father 's Date of Birth :

Is your fath er in th e U.s.?

Mother's Surn ames :

Mother's Giv en Nam es:

Mother's Date of Birth :

Is your mo the r in th e U.S.?

Do you have any im mediate re latives, n';;o:i='tTrin:;;c:j,lu;-;;d;nl;;'n'g;;'-;:p;;;a:;:;;n

ren1ts~innttt'hh;;,e---------- --1
U.S. ?

Do y ou hav e any othe r relativ es in, th e United Sta t es?

Edit Family Informa ti on: Spouse

5pouse's Full Name :

Spouse's Date of Birth:

Spouse's Country/Region of Orig in ( Na 'onality ) :

Spo use's City of Birth:

Spo use's Country/Region of Birth :

Spou se's Address:

nttn<.-I/r.p.;lc.state.aov/GenN IV/General/revifNilreview_revieNFamiIy.aspx?node=ReviewFamily 1/1

 NonimmigrantVisa- Review VVOf K , r:U U " c:lU U" U " ,.... . .. _- - ..
26/9/2016

Edit Present Work Information

Primary Occupation :

Specify Other:
Present Employer or School Name :
Present Emp loyer or School Address:

City :

State/Province :
Postal Zone/Zip Code:

Country / Region:
Wor k Phone Number:
.
Mont hly Salary in Lo c~1 Cur re ncy (if em ployed):

Briefly Descr ibe y our Duties :

----------~----------
Ed it Pre vi ous Wo rk Information

Were y ou previo usly employed?

[é=] Have you attended any educa-ti-'o-n-a-l -in-S-ti-·t-u-

ti-o-
n-s-a-t-a-se-c-o-n-
.d-a-r-y----.;-----:----­

lev el or above?

Name of I nstitu ti on (1) :

Addressof I nstit uti on:
City :

State/Provi nce :
Postal Zone/ZIP Code :

Country/Reg ion :
Course of Study:

Date of Attendance From:

Date of Atte nda nce To:

Edit Ad d it io n a l Information

Do you belong to a cla n or tribe?

~ Pre vi de a List of Languages You Spea k :

Language Name (1):

~ Have you trav eled to any countries/regions within the last five
yea rs?

Prov ide a Ust of Countries/Reg ions Vis ited

Count ry /Reg ion(l ) :

- I ._ .. - ­
Country/Re gion(2):
CoUntry/Reg ion (3):

Have y ou belonged to , contrib uted to, or work ed fo r any pr ofessio na l,

socìa l, or charita ble organization? -

Do you have any specialized sk ills or tra ining, such as firearms, VES NO
exp losive s, nuclear, biologica I, or chem ical experience ? VES NO
Have y ou eve r served in the military? VES NO
Hav e you ever serv ed in, been a member of, or bee n inv o!ved w tth a VES NO
param ilitary unlt, vigilante unlt, rebel group, guerr illa group, or
insurgent orga nization?

httDs:llceac.state.gov/GenNIV/GenerallreviewlreviewJeviewWorkEducation.aspx?node=ReviewWorkEducation 212
 .619/2016 Nonimmigrant Visa - KeVlew """,",u"'l . 0 0 0 _0 • • • _

Online Nonimmigrant Visa App lication (DS-160) Appl ica tion io AA006EUMNO

Security and Background Infonnation

Ed it Part 1

Do vo u hav e a communicable d isease of public hea lth sign ifica nce? (Co m m uni cable diseases of
pub llc sig nifi cance inclu de cha ncr oid, go no r rhea , gra nuloma inguinale, inf ecti ous le pr osy, VES NO
Iv m ph og ra nuloma vene reum , inf ecti ous stage sy ph ilis, active t ube rc ulos is, and cther disea ses as
determined bv the Department or Hea lth and Hum an Se rv ices. )
VES NO
VES NO
Do v ou have a mental or physical di sorde r th at poses or is lìkelv to pose a th reat to th e safetv or
welf a r e or yourself or others?

Are yo u or have y o u ever been a drug abuse r or addict?

Ed it Part 2

Hav e vou ever been arrested or conv icte d for anv offense or cr ime, ev en though subj ect of a
pardon, amnesty, or other sim ilar aetion?

Have you ever v iolated, or engaged in a conspiracv to violate, anv law r elat ing to controll ed
substances? VES NO
Are v ou coming to the United States to eng ag e in prostit ut io n or un!awful commercia lized v ice or VES NO.1
have vou be en en gaged in prosti t uti o n or procu ri ng pros tìtutes within t he past 10 vea rs? VES NO
Have you eve r been lnv o lved in, or do you see k to enga ge in, m oney la undering ? VES NO
Hav e you ever comm itted or conspired te co mmit a hum an trafficking offe nse in the Unite d Sta t es VES NO
~

or outside the United States?

VES NO
Are you the spouse, son, or daughter of an ind iv id uai wh o has com m itted or conspired to comm it VES NO ,
a hum an traffickin g offense in th e United Sta tes or outside th e United Sta tes and have vou within
th e last fi v e years, k nowìnq lv benefited from th e trafficking acti viti es ?

Hav e y ou kno wlnq ly aided, abetted, ass isted or coilud e d w ith an individuai wh o has committed o r
conspired to commit a severe human trafficking offense in th e United States or outs ide the United
States?

Ed it Part 3

Do vou seek to engage in espio na ge, sabotage , export co ntro l viol ati on s, or anv other ill ega l
activity wh ile in th e United Sta tes?

Do vou see k te e ngage in terroris t activities w hil e in the United Sta tes or have you eve r eng aged

VES NO

in t errorist acti v ities?

VES !NO

Have you ever or do v ou inte nd to provide fin a ncial ass ista nce or other support to te rro r ists o r
VES NO

t errorist orga nizations?

VES NO

A re vou a member or representative of a terrorist orça nlzatìo n?

VES NO

Hav e you ever ordered, incited, committed , assisted, or oth erwise participated in genocide ?
VES NO

Have v ou eve r comm itted, ordered, incited, ass isted, or oth erwise pa rti cipat ed in torture?
VES NO

Hav e vou committed, orde red , incited , ass isted, or oth erwise parti cipa te d in extrajudicial killing s,
VES · NO

po liti ca I k illings, or other acts of violence?

VES NO

Have vou ever engaged in the recruitment or th e use of the child so ld iers?
VES NO

Hav e y ou, wh ile serving as a governm ent offida I, been resp onsible for or directl y car r ied out, at
VES NO
I
a nv t ime, partìcu la rlv severe violatio ns of reli gi ous freedom?

Have vou ever been directly inv o lv ed in the establishment or enforce m ent of t he population

controls forcing a woman t o und ergo a n ab ortio n aga in st her fr ee choi ce or a m a n or a woman to

undergo sterilization aga inst his or her free w ill?

Have vou ever been directly inv olv ed in th e coerclve transpl antation of human organs or bodilv

t issue?

Edit Part 4
Have you ever been the subject of a rem oval o r dep ortat io n hearln ç?

httn<;:/lceac.state.QOV/GenNNlGenerallrevieNlreviEINJevievv'security.aspx?oode=ReviElNSecurity 112
 261912016 Nonim migrant Visa - Review Secunty Irnormauofl

Have you everso ~1»Jil? q,biPA~aw!lt.Pij;lfl{ij;Q.~I"I.~~ ~~ ~iO;;,Q~ l.I~e~r.

any other United 51i1tWinWUtl :mDNfi.INf43udlo "ilfmtm il~e~~tt~ · I r:RVIE
unlawful me ans?

Have y ou fail ed to attend a heari ng on removability or inadm issibility with in the last fiv e years?

Have you ever been unlawfully present, ove rsta ye d the amount of tim e granted by an

imm igration offi daI or otherwise violated th e term s of a U.S. v isa?

Edit Perì 5
Have y ou ev er with held custody of a U.S. cit izen chl ld outside the United States from a person

granted legai custo dy by a U.S. court?

VES NO
Have yo u voted in the United Sta tes in violat ion of any law or regu lation? VES NO
Have you ever re noun ced United States citizenship for the purpose of avo iding taxation? VES NO
VES
Have you attended a pu blic eleme nta ry schoo l on st udent CF) status or a publi c secondary school
after November 3D, 1996 with out reimbursing the school?
1.....-.- __ 1. _
-NO

httn.c;:lfceac.state.QOv/GenNIV/Generallreview/reviewJeview security.aspx?ncde=RerviewSecurity 212

 Online Nonirnmigrant Visa Application (DS-160) Appli cation ID AA006EUMNO

Location Information

Edit Location Information

Location where you will be submitting your appiication

Current Location: ROMA

M ILAN_O, '";

FIRENZE
NApOLI

https://ceac.state.gov/GenNIV/General/review/review_reviewlocation.aspx?node=ReviEN'JLocation 1/1