U.

S VISA APPLICATION FORM (FOR DS-160)

Basic Information

Full Name:
Date of Birth:
Place of Birth:
Home Address:

Tel. #:
Cell #:
Marital Status:
Facebook name
Email Address

Travel

Passport No.:
Place of Issuance:
Date Issued:
Expiration Date:

Have you ever been in the US? (If Yes, please provide your last 5 U.S. visit(s))

 When:
 For how long:

 When:
 For how long:

 When:
 For how long:

 When:
 For how long:

 When:
 For how long:

Have you ever been issued a US Visa? (If Yes, please answer the ff. questions below)

 When:
 Where:
 What type of Visa:

Have you ever been refused a US Visa?_____ (If Yes, please answer the ff. questions below)

 When:
 Where:
 What type of Visa:

List 15 (most recent) countries you have entered in the last five years:

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Education
School Name: fff
School Address:

_
Course: _____________________________________
Date of Attendance (mm-yyyy):

 From:
 To:

Family
Wife’s FULL MAIDEN Name: fff
Place of Birth:
Date of Birth:

Father’s Full Name:

Place of Birth:
Date of Birth:
Is your father in the U.S.?

Mother’s FULL MAIDEN Name:

Place of Birth:
Date of Birth:
Is your mother in the U.S.?

Do you have any other relatives in the U.S.? _____ (If yes, please answer the ff questions
below)

1. Relative’s Full Name:

Place of Birth:
Date of Birth:
Relative’s Status: (encircle your relative’s current status)

 U.S. Citizen
 Non-Immigrant
 Others/I don’t know

2. Relative’s Full Name:

Place of Birth:
Date of Birth:
Relative’s Status: (encircle your relative’s current status)

 U.S. Citizen
 Non-Immigrant
 Others/I don’t know

3. Relative’s Full Name:
Place of Birth:
Date of Birth:
Relative’s Status: (encircle your relative’s current status)

 U.S. Citizen
 Non-Immigrant
 Others/I don’t know
Work
Rank:
Assigned Vessel:
Duties and Responsibilities:

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Were you previously employed? (If yes, please answer ALL the questions below)

 Name of previous company/agency:

 Address:

 Tel./Fax No.:

 Job Title/Position:

 Supervisor’s Full Name:

 Employment Date:

 From:
 To:

 Duties and Responsibilities:

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US VISA PICTURE SPECIFICATIONS:

 2pcs x picture
 Dark Polo Shirt/ Uniform
 Colored Picture & in white background
 Reflects neutral facial expression ONLY
 No shadow
 Not pixilated
 No bear shadows, scratches, any marks or
spots seen on the applicant’s face
 Not edited
 Show both eyebrows and ears
 Taken within the last 6 months