USA VISA APPLICATION FORM

Personal, Address, Phone, and Passport Information

Name Provided (full

SANTOSH KUMAR THUNDIPARAMBIL VISWAMBHARAN
Name)
Surname THUNDIPARAMBIL VISWAMBHARAN
Given Name SANTOSH KUMAR
Other Names Used: NONE
Sex: MALE
Marital Status: MARRIED
Date of Birth: 23.03.1966
Place of Birth: PONJIKARA, KERALA
State Of Birth: KERALA
Country Of Birth: INDIA
Nationality: INDIAN
Other Nationalities: NONE
Home Address: VASANTHAM, ST.JUDE ROAD
THEVARA P.O , ERNAKULAM
City: KOCHI
State/Province: KERALA
Postal Zone/ZIP Code: 682013
Country: INDIA

Contact No:
09895076352
Email Address: Sk8205625@gmail.com
Passport Number: K 5992770
Passport Book Number: K 5992770
Country/Authority that Issued Passport: INDIA
City Where Issued: COCHIN
Country Where Issued: INDIA
Issuance Date: 18.03.2013
Expiration Date: 17.03.2023
Have you ever lost a passport or had one
NO
stolen?

Passport No & Explain :

Travel Information
▲ Have you ever been in the U.S.? YES
Previous U.S. Visits in the last 5 years:
Travel Date of Arrival (1) : 10.05.2014
Length of Stay: IN TRANSIT

Do you or did you hold a U.S. Driver's

NO
License?
▲ Have you ever been issued a U.S. Visa? YES
Date Last Visa was Issued: 21.03.2012
Visa Number: F1545560
Have you been ten-printed?
Has your U.S. Visa ever been lost or
NO
stolen?
Has your U.S. Visa ever been cancelled
NO
or revoked?

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 USA VISA APPLICATION FORM
Have you ever been refused a U.S. Visa, been
refused admission to the United States, or
NO
withdrawn your application for admission at
the point of entry?
Explain :

Family Information

Father's Surnames: THUNDIPARAMBIL KUTTY

Father's Given Names: VISWAMBHARAN
Father's Date of Birth: 10.01.1939
Is your father in the U.S.? NO
Mother's Surnames: VELLEPARAMBIL
Mother's Given Names: GANGA DEVI (LATE)
Mother's Date of Birth: 05.10.1944
Is your mother in the U.S.? NO
Do you have any immediate relatives, not
NO
including parents in the U.S.?
Do you have any other relatives in the United
NO
States?
Wife's Full Name: BOBBY SANTHOSH
Wife 's Date of Birth: 22.12.1972
Wife 's Nationality: INDIAN
Wife 's City of Birth: KOCHI
Wife 's Country of Birth: KERALA
Wife’s Address: VASANTHAM, ST.JUDE ROAD, THEVARA P.O , KOCHI-682013

Work / Education / Training Information

Occupation (Rank): MOTOR MAN

Month Salary in Local Currency: 95000 INR

WATCH KEEPING IN ENGINE ROOM

Briefly Describe your Duties:

▲ Were you previously employed? YES

Employer Name (1) : MSC CREWING SERVICES PVT LTD
Employer Address: MSC HOUSE,ANDHERI – KURLA ROAD, ANDHERI EAST

City: MUMBAI
State/Province: MAHARASHTRA
Postal Zone/Zip Code: 400059
Country: INDIA
Telephone Number: 00912267522555
Job Title: MOTOR MAN
Supervisor's Name:
Employment Date From: 21.04.2005
Employment Date To: PRESENT
Briefly describe your duties: WATCH KEEPING IN ENGINE ROOM
Employer Name (2) :
Employer Address:

City:

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 USA VISA APPLICATION FORM
State/Province:
Postal Zone/Zip Code:
Country:
Telephone Number:
Job Title:
Supervisor's Name:
Employment Date From:
Employment Date To:
Briefly describe your duties:
▲ Have you attended any educational
YES
institutions other than elementary schools?
Name of Institution (1) : UNIVAN MARITIME TRAINING ACADEMY
Address of Institution: 05-55, 4TH FLOOR, SOUTH BLOCK
GCDA COMMERCIAL COMPLEX, MARINE DRIVE
City: KOCHI
State/Province: KERALA
Postal Zone/ZIP Code: 682031
Country: INDIA
Course of Study: ELEMENTARY FIRST AID
Date of Attendance From: 12.06.2014
Date of Attendance To: 14.06.2014

Name of Institution (2) : UNIVAN MARITIME TRAINING ACADEMY

Address of Institution: 05-55, 4TH FLOOR, SOUTH BLOCK
GCDA COMMERCIAL COMPLEX, MARINE DRIVE
City: KOCHI
State/Province: KERALA
Postal Zone/ZIP Code: 682031
Country: INDIA
Course of Study: PERSONAL SURVIVAL TECHNIQUES
Date of Attendance From: 06.06.2014
Date of Attendance To:
Name of Institution (3) : UNIVAN MARITIME TRAINING ACADEMY
Address of Institution: 05-55, 4TH FLOOR, SOUTH BLOCK
GCDA COMMERCIAL COMPLEX, MARINE DRIVE
City: KOCHI
State/Province: KERALA
Postal Zone/ZIP Code: 682031
Country: INDIA
Course of Study: FIRE PREVENTION AND FIRE FIGHTING ACADEMY
Date of Attendance From: 05.06.2014
Date of Attendance To:

Name of Institution (4) : UNIVAN MARITIME TRAINING ACADEMY

Address of Institution: 05-55, 4TH FLOOR, SOUTH BLOCK
GCDA COMMERCIAL COMPLEX, MARINE DRIVE
City: KOCHI
State/Province: KERALA
Postal Zone/ZIP Code: 682031
Country: INDIA
Course of Study: PERSONAL SAFETY AND SOCIAL RESPONSIBILITY
Date of Attendance From: 27.05.2014

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 USA VISA APPLICATION FORM
Date of Attendance To: 28.05.2014
Do you belong to a clan or tribe? NO
▲ Have you traveled to any countries within
the last five years?
Country Visited (1) : JAPAN

Country Visited (2) : SINGAPORE

Country Visited (3) : SOUTH KOREA

Have you belonged to, contributed to, or

worked for any professional, social, or NO
charitable organization?

Do you have any specialized skills or training,

including firearms, explosives, nuclear, NO
biological, or chemical experience?
Have you ever served in the military? NO
Have you ever served in, been a member of,
or been involved with a paramilitary unit,
NO
vigilante unit, rebel group, guerrilla group, or
insurgent organization?

Security and Background Information

Do you have a communicable disease of

public health significance such as tuberculosis NO
(TB)?
Do you have a mental or physical disorder
that poses or is likely to pose a threat to the NO
safety or welfare of yourself or others?
Are you or have you ever been a drug abuser
NO
or addict?
Have you ever been arrested or convicted for
any offense or crime, even though subject of NO
a pardon, amnesty, or other similar action?
Have you ever violated, or engaged in a
conspiracy to violate, any law relating to NO
controlled substances?
Are you coming to the United States to
engage in prostitution or unlawful
commercialized vice or have you been NO
engaged in prostitution or procuring
prostitutes within the past 10 years?
Have you ever been involved in, or do you
NO
seek to engage in, money laundering?
Do you seek to engage in espionage,
sabotage, export control violations, or any
NO
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 NO
engaged in terrorist activities?
Have you ever or do you intend to provide
financial assistance or other support to NO
terrorists or terrorist organizations?
Are you a member or representative of a
NO
terrorist organization?

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 USA VISA APPLICATION FORM
Have you ever ordered, incited, committed,
assisted, or otherwise participated in NO
genocide?
Have you ever committed, ordered, incited,
NO
assisted, or otherwise participated in torture?
Have you committed, ordered, incited,
assisted, or otherwise participated in
NO
extrajudicial killings, political killings, or other
acts of violence?
Have you, while serving as a government
official, been responsible for or directly carried
NO
out, at any time, particularly severe violations
of religious freedom?

Have you ever been the subject of a removal

NO
or deportation hearing?
Have you ever sought to obtain or assist
others to obtain a visa, entry into the United
States, or any other United States NO
immigration benefit by fraud or willful
misrepresentation or other unlawful means?
Have you failed to attend a hearing on
removability or inadmissibility within the last NO
five years?
Have you ever been unlawfully present,
overstayed the amount of time granted by an
NO
immigration official or otherwise violated the
terms of a U.S. visa?

Have you ever withheld custody of a U.S.

citizen child outside the United States from a NO
person granted legal custody by a U.S. court?
Have you voted in the United States in
NO
violation of any law or regulation?
Have you ever renounced United States
citizenship for the purpose of avoiding NO
taxation?
Have you attended a public elementary school
on student (F) status or a public secondary
NO
school after November 30, 1996 without
reimbursing the school?