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PROMPT SHEET FOR COMPLETING DS-160

Kindly read the form and then fill in CAPS neatly.

Language for Interview –Marathi/Hindi/English/Gujarati

Please TICK 1
PERSONAL INFORMATION 1
Surname (As per passport, If blank, write entire name
here leaving next Given Name B L A N K) JOSEPH

Given names SHANE

Full name in Native Alphabet (Click 'Does Not Apply'
button) NA
Have you ever used other names (Complete if applicable
OR choose 'NO') NA

Sex (Choose Male OR Female) MALE

Marital Status (Single/Married/Widowed/Divorced) SINGLE

Date of Birth (Enter DOB as per passport) 06/06/2018

Place of Birth (Enter as per passport) NERUL,MAHARASHTRA

State/Province of Birth (Click Does Not Apply button) NA

Country of Birth (Choose Country from drop down list) INDIA

PERSONAL INFORMATION 2

Nationality (Choose from drop down list) INDIAN

Do you hold other Nationality (Choose YES or NO as
applicable) NO
National Identification Number (Click Does Not Apply'
button) NA

US Social Security Number (Click Does Not Apply' button) NA

US Taxpayer ID Number (Click Does Not Apply' button) NA

Click Next: Address and Phone
FORTUNE HEIGHTS, FLAT NO 303, NEAR
GOKULDHAM, SECTOR 35-D, KHARGHAR,
NAVI MUMBAI
Home Address (Please Enter)

State/Province MAHARASHTRA

Postal Zonal Zip Code 410210

Country. INDIA

Email ID : - NA /ASHI31180@YAHOO.CO.IN

Home Phone, Land Line, if any NA

Work-Place Phone NA

Work Email ID NA

Mobile/Cell phone number. 9004684181

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Click Next: Passport

Passport Number. T7770543

Country/Authority that issued Passport (Please Enter e. g.
Ireland) INDIA

Where was Passport issued MUMBAI

NA
State/Province (If mentioned on Passport)

Country INDIA

Issuance Date of passport. 16/08/2019

Expiration Date of passport. 15/08/2024

Was your passport/Visa ever lost/stolen – Give Details

NO

Click Next: Travel

Are you the principal applicant (Choose Yes/No) Answer
the additional question: Surnames of Principal Applicant
Given Names of Principal Applicant Principal Applicant's NO.
Purpose of Trip to U.S. JOSEPH ASHA GREGORY

Purpose of Trip to USA.

TO JOIN CRUISE VESSEL M.S VEENDAM AT

FORT LAUDERDALE TO SAIL WITH
HUSBAND (EMPLOYEE )

Intended Date of arrival in US (Any tentative date will do) (Tentative D) 5TH NOVEMBER 2019

Intended length of stay in US(Tentative Months/Wks/Dys) (Tentative Stay) 4 MONTHS

Locations you plan to visit (NA if not ready with plan)
Arrival City in USA; Airline which you tentatively plan to
fly(NA if not ready with plan)
(If already decided) FORT LAUDERDALE ,
KEY WEST (FLORIDA), CHARLOTTE AMALIE
(ST. THOMAS), SAN JUAN
(If already decided)FORT LAUDERDALE
AIRLINE: NA

Departure City from USA. (NA if not ready with plan). (If already decided)FORT LAUDERDALE
( Add of Hotel )

Address where you will stay in US (If you don't have an HILTON FORT LAUDERDALE MARINA
address please enter CIEE's address (your US Sponsor) 1881 SE 17TH ST,
below or any intended hotel address with pincode and FORT LAUDERDALE, FLORIDA 33316
telephone no. PHONE NO. +1 954-463-4000

Street Address Line 1 (300 Fore Street)

Street Address Line 2

City (Portland)

State (Maine)

Zip Code (04101)

Person/ Entity Paying for your trip expenses.
Surname/Name
Relation to You : JOSEPH GREGORY JOHN
Tel No – FATHER
Mob No –
E-mail ID 9930764458
GRREG_16@YAHOO.COM
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Click Next: Travel Companions

1.JOSEPH ASHA GREGORY - MOTHER

2.JOSEPH ADAARA GREGORY - SISTER

3.

Are there other persons traveling with you? If not 4.

traveling with family members, choose NO Enter person(s)
traveling with youSurnames of Person Traveling With You, 5.
Given Names of Person Traveling With You, Relationship
with Person.

Click Next: Previous US Travel

Have you ever been in the USA Choose YES or NO as
applicable (if yes, Provide information on your last five NOT TRAVELED TO USA
U.S. visits:Date of Arrival (dd/mm/year),
Length of stay.
Have you ever been issued a US Visa Choose YES or NO NO
as applicable (if yes, enter details as requested Previous
U.S. VisasDate Last Visa Was Issued, Visa Number)

Are you applying for the same type of visa?

NO
Are you applying in the same country where the visa NO
above was issued and is this country your principal
country of residence? NO

Have you been ten-printed? Sl No of Most recent Visa-

Has your U.S. Visa ever been lost or stolen? Dt of Issuance :

Has your U.S. Visa ever been cancelled or revoked?

Does your current visa mention

Departmental Clearance Received/Obtained ?

Have you ever been refused a US Visa? Choose YES or
NO as applicable (if yes, enter details as DD/MM/Year,
visa category of rejection and from which place applied)
NO
If refused, Dt when attended the last
interview and the reason for refusal
214(b),221(g)etc (as on refusal slip)

US Contact – Pls mention one of the two - Person or

org that actually applies to your visit, not both

Contact Person - Surname BOXILL

Given Names
(ONLY 1 of the two amongst Contact Or Org
can be written) MARIA

Organization Name (Pls mention if this is applicable) HOLLAND AMERICA LINE

Relationship to You. HUSBAND’S (FLEET RESOURCE SUPPORT
COORDINATOR – HUMAN RESOURCES )
Address with pincode& Phone of Contact (If you don't 450 3RD AVENUE WEST
have an address please enter CIEE's address (your US SEATTLE, WA 98119-4002
Sponsor) below) PHONE- 206 626 9000

Street Address Line I (300 Fore Street)

Street Address Line 2

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City (Portland)

State (Maine)

Zip Code (04101)

Phone Numbers {(888)268-624}

Email Address

Click Next: Family

Fathers Full Name

with date of birth. JOSEPH GREGORY JOHN

D.O.B – 16/05/1979
Is he in the USA now ? NO

Mothers Full Name

with date of birth. JOSEPH ASHA GREGORY

D.O.B – 03/11/1980
Is she in the USA now ? NO
Do you have any immediate relatives in USA. (Choose YES
or NO as applicable) Means fiancé/fiancée, spouse
(husband/wife), child (son/daughter), or sibling
(brother/sister). Also mention visa type. NO

Do you have any other relatives in USA? Choose YES or

NO as applicable) If yes then Provide the following
information:
 Surnames,
 Given Names,
 Relationship to you,
 Relative's status .i.e. citizen, work visa etc. NO
Non-Immigrant / Green Card / US Citizen

Family Information: Spouse NOTE: Enter current spouse

information. If divorced, enter previous spouse
information-
 Spouse's Surnames-
 Spouse's Given Names-
 Spouse's Date of Birth-
 Spouse's Nationality-
 Spouse's Place of Birth (City and country)-
 Spouse's Address-
NA

Click Next: Work/Education/Training

Primary Occupation (Business/Service/Practising Doctor)
NA
Present Employer (wkg) or School Name (students)
NA
 Present employer or School address-

 pin code-

 contact number-

 email address-
 Start Date of employment / Business
NA
Monthly Salary Choose (applicable only if employed) NA
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Briefly describe your duties with designation Enter (please

provide brief details of your activities)
NA
Were you previously employed (provide
details of last 5 years of employment)
PRIOR to this job ?
Cliick Next: Additional Work/Education/Training
Information NA
Co Name-

Add –

Telephone No-
Co E-mail Id -
Supervisor Name -
Designation held –
Worked from – to (DD/MM/YYYY)
___________ TO ______________

Co Name-

Add –

Telephone No-
Co E-mail Id -
Supervisor Name -
Designation held –
Worked from – to (DD/MM/YYYY)
___________ TO ______________

Name & Address -

Have you attended any educational institutions other than Course Studied –
elementary school? NA FROM – TO Dates _______ to __________

Name of institution: NA
Course of Study

Address of institution, city, state/province, country, course Countries traveled to -

of study, date of attendance from, date of attendance to: 1.
2.
Have you traveled to any countries within the last 3.
fiveyears? (PlsMention countries Visited) NO 4.
5.
6.
Have you belonged to, contributed to, or worked for any professional, 7.
social, or charitable organization? 8.
9.
10.
NO

Do you belong to a clan or tribe? NO Yes/No

Click Next: Security and Background

Medical & Health Information (Please answer all 3
questions TRUTHFULLY)
1) Do you have a communicable disease of public health
significance such as tuberculosis (TB)?
2) Do you have a mental or physical disorder that poses NO
or is likely to pose a threat to the safety or welfare of
yourself or others?
3) Are you or have you ever been a drug abuser or NO
addict? NO
Click Next: Criminal
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Criminal Information (Please answer all 4 questions

TRUTHFULLY)
1) Have you ever been arrested or convicted for any
offense or crime, even though subject of a pardon,
amnesty, or other similar action?
2) Have you ever violated, or engaged in a conspiracy to
violate, any law relating to controlled substances? ( No; No; No; No )
3) 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?
4) Have you ever been involved in, or do you seek to
engage in, money laundering?

Click Next: Security

Security Information
1) Do you seek to engage in espionage, sabotage, export
control violations, or any other illegal activity while in the
United States?
2) Do you seek to engage in terrorist activities while in the
United States or have you ever engaged in terrorist
activities?
3) Have you ever or do you intend to provide financial (No; No; No; No; No; No; No)
assistance or other support to terrorists or terrorist
organizations?
4) Are you a member or representative of a terrorist
organization?
5) Have you ever ordered, incited, committed, assisted, or
otherwise participated in genocide?
6) Have you committed, ordered, incited, assisted, or
otherwise participated in extrajudicial killings, political
killings, or other acts of violence?
7) Have you, while serving as a government official, been
responsible for or directly carried out, at any time,
particularly severe violations of religious freedom?

Click Next: Immigration Law Violations

Immigration Law Violations (Please answer the question

TRUTHFULLY) Have you ever sought to obtain or assist NO
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?
Click Next: Miscellaneous

Miscellaneous Information (Please answer all 3 questions

TRUTHFULLY)
1) 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? ( NO; NO; NO)
2) Have you voted in the United States in violation of any
law or regulation?
3) Have you ever renounced United States citizenship for
the purpose of avoiding taxation?

NOTE : -
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The US Consulate prescribes no definite list of documents but advises visa

applicants to keep handy those docs that are indicative or supportive of
applicant’sprevalent circumstances as mentioned on visa application. This list
is, therefore, simply indicative and may differ with each applicant. You are
advised to carry any additional docs that you believe might help portray your
case a shade better. Eventually, rarely are such docs are checked or even
touched at the visa interview, but are being carried as a cautionary step. No
additional setsof photocopies is insisted upon necessary as one is advised to
carry the originals, if readily available.

From Visitor - As applicable From Host in USA – by e-mail – As applicable

1. Passport & Previous Passports 1. Current & Previous Passport/Visa

2. Last 6 Months’ Pay-Slips 2. Employment Proof like letters/Photo ID
3. Last 3 Yrs Form 16A, if avlblLast 3 Yrs IT Returns 3. Signed-Invitation add Mumbai Consulate with visitor’s dtls
4.Earlier Visa-Appln Rejection Dts/Fee-Slips 4. I-134 locally notarized, if host is sponsoring
5. Last 6 Months’ Very Recent Bank Stmts with Stamp 5. Any recent Utility bill in own name with local address
6. More…. like FDs, Recent D-mat Stmts, MF Holdings Stmts 6. Last Six Months’ Bank Stmts
7. Permission to travel abroad for Govt servants, IF avlbl 7. Local Doc-copies like Driving Licence/College ID
8. Work-place - Photo IDs 8. University Intimation regarding Admission/Convocation
9. 5cmx5cm Col Photos only for those under 12 Yrs of age. 9. Last 3 Yrs Tax Returns
10. Marriage Certificate 10. Conference/Business-Inv/Proof of Participation in Seminar
11. Husband/Father’s NOC to travel for Dependents 11. Covering letter from local employers if it is official trip
12. Proof of Profession-like Dr’s Practice-Regn-Cert etc 12. Green-Card or Visa Status-proof
13. Employment/Retirement/Ex-servicemen-Proof 13. OCI copy or LAST Cancelled Indian Passport copy of Host
14. Father/Guardian’s Financial Docs, if dependent 14. If avlbl, hotel or accommodation booking confirmation
15. Proof of business for those self-employed 15. If business trvl – business invite & related proof from USA

* When giving us this form, duly filled in, please attach Clear Xerox of OWN
Present/Earlier Passports & of anyone to travel together showing earlier or valid
visa copies, if any.
* While we, as your service provider, wouldstrive hard enough to handle your work
diligently, we cannot, in any manner, influence the Consular decision to grant or
refuse your visa.Decision on GRANTING or REFUSING visa to any applicant is the
ultimate decision of the Consular Officer.At our best, we could transparently assist
and guide you with appropriate presentation of your case, with a view to ruling out
many obvious groundsfor refusals, often overlooked thru ignorance or a hurried
submission.
*In most cases, a spot decision is taken by the end of the brief visa interview but
in some cases, the Consulate requires more time for a decision for a decision to be
taken AFTER administrative processing.
*When case is subjected to processing under Clause 221(g), applicant is required
to await a Consular-questionnaire through email a reply for which will need to be
sent through email based on which
* Visa Re-applications, if required, would mean full payment of fresh visa fee and
service charges, without exception. The Consular decision on such re-applications
too, usually have an equal chance of grant OR refusal, on an unbiased level.