DRAFT OF ONLINE NONIMMIGRANT US VISA APPLICATION (DS-160)

PLEASE DO NOT LEAVE ANY BLANK – PUT N/A WHERE APPLICABLE

Preferred DATE/DAY/TIME of appointment:

Subject to availability based on schedules online

PERSONAL INFORMATION
Full Name (First, Middle, Last):  
Other Names Used:  
Sex:  
Marital Status:  
Date and Place of Birth:  
Nationality:  
Other Nationalities:  
Are you a permanent resident of a country/region
other than your country/region of origin (nationality) above?
National Identification Number:  
U.S. Social Security Number:  
U.S. Taxpayer ID Number:  
Home Address:  
(City/Province/ZIP Code):
Mailing Address:
(City/Province/ZIP Code):
Upon Release of Passport (Please check):  PICK UP SM MOA (2GO)  Home Address  Mailing Address
Primary Phone Number:  
Mobile Phone Number:  
Work Phone Number:  
Have you used additional phone numbers in the last five years? If yes, please indicate
Email Address:
Did you use this email address to apply for US Visa before?
Have you used additional email addresses in the last five years?
Social Media Provider (Ex: Facebook, Instagram, Twitter etc.)
Social Media Identifier (Account name as shown in Social Media):
Passport Number:  
Place of Issue:  
Issuance Date:  
Expiration Date:  
Have you ever lost a passport or had one stolen?
(If Yes) Provide Passport No. and date lost/stolen:

TRAVEL INFORMATION
Purpose of trip to the US:
 
(Ex. Leisure, Business, Visit Relative, Study etc.)
Have you made specific travel plans?  
If YES – indicate dates/flight number/airport:  
Intended date of arrival in US:  
Intended length of stay:  
Address where you will stay in US:  
Hotel/Home Address (City/State/Postal Code)  
Telephone Number in the US:  
Person/Entity/Company/Organization paying for your trip:
 Telephone Number:  
Relationship to you:  
Address of Entity/Company/Organization:
 

Are there other Persons traveling with you?

If YES, list Full Names as shown in passport and Relationship to you:

 
Have you ever been in the US?  
Provide information on your last five (5)  
US visits (date arrived/length of stay)    
Do you or did you hold a US driver’s license?  
Have you ever been issued a US visa?  
Date Last Visa was Issued:  
Visa Number (Found at the bottom right of the
 
visa/eight digits/colored red):
Are you applying for the same type of visa?  
Are you applying in the same country where the
 
visa above is issued?
Is this country your principal country of residence?
Have you been ten-printed/have you provided all
 
your 10 finger prints to any US government?
Has your US Visa ever been lost or stolen?  
Has your US Visa ever been revoked or cancelled?  
Have you ever been REFUSED a U.S. visa, been refused admission to the United States
or withdrawn your application for admission at the port of entry?
(If yes, give exact dates and State Reason)
Has anyone ever filed an immigrant petition on your behalf
with the US Citizenship and Immigration Service?
(If yes, who and relationship to this person)

US CONTACT INFORMATION
Name of contact person in the US:  
Organization Name/Hotel in the US:  
Relationship to you:  
US Address of contact person/Organization with Postal Code:

Phone Number:  
Email Address:  

FAMILY INFORMATION
Father’s Full Name (First, Middle, Last):  
Date of Birth (mm/dd/yyyy)  
Is your father in the U.S?
If YES what is the Immigrant status (Citizen,  
Permanent Resident?
Mother’s Full Name (First, Middle, Last):  
Date of Birth (mm/dd/yyyy)  
Is your mother in the US?
If YES what is the Immigrant status (Citizen,  
Permanent Resident?
Do you have any immediate relatives, not including parents in the U.S.? (Spouse, Sibling, Child)
If YES, Full name/s, relationship and Immigrant status of relative in the US (Citizen, Permanent resident)
  
Do you have any other relative in the U.S.? If YES, Full name/s, relationship and Immigrant status
of relative in the US (Citizen, Permanent resident)
 
Spouse’s Full Name (First, Middle, Last) even if deceased:
Date (mm/dd/yyyy) and Place of Birth:  
Nationality:  
Address:  

WORK/EDUCATION/TRAINING INFORMATION
Primary Occupation:  
Present Employer/Business or School Name:
Start date with employer/business (mm/dd/yyyy)
Address (City/Province/ZIP Code)
 

Work Phone Number:  

Monthly Salary/Income in Local or PESO currency (DO NOT LEAVE BLANK):
Briefly describe your duties (DO NOT LEAVE BLANK):
 

Were you previously employed/Previous Business?

(If yes) Company/Employer Name:  
Complete Address:  
Telephone Number:  
Job Title:  
Supervisor’s Full Name:  
Employment Dates:
 
(Start-End) mm/dd/yyyy
Briefly describe your duties (DO NOT LEAVE BLANK):
 

SCHOOLS ATTENDED
HIGH SCHOOL (Name of School):  
Complete Address  
Dates of Attendance
 
(Start-End) mm/dd/yyyy
COLLEGE/VOCATIONAL INSTITUTION (Name of School):
Complete Address  
Course of Study  
Dates of Attendance (Start-End) mm/dd/yyyy  
Graduate School/Post Grad Education (Name of School):  
Complete Address
Course of Study
Dates of Attendance (Start-End) mm/dd/yyyy
Do you belong to a Clan or Tribe? (If Yes) What is the Name of Clan/Tribe?
Provide a list of all languages you speak:
List ALL the countries you have visited within the last FIVE (5) years:

 
SECURITY AND BACKGROUND INFORMATION (YES / NO)
If YES: (Please explain and provide complete dates)

Have you belonged to, contributed to, or worked for any professional, social, or charitable
organization?
Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or
chemical experience?
Have you ever served in the military?
Have you ever served in, been a member of, or been involved with a paramilitary unit, vigilante
unit, rebel group, guerrilla group, or insurgent organization?
Do you have a communicable disease of public health significance? (Communicable diseases of
public significance include chancroid, gonorrhea, granuloma inguinale, infectious leprosy,
lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, and other diseases as
determined by the Department of Health and Human Services.)
Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or
welfare of yourself or others?
Are you or have you ever been a drug abuser or addict?
Have you ever been arrested or convicted for any offense or crime, even though subject of a
pardon, amnesty, or other similar action?
Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled
substances?
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?
Have you ever been involved in, or do you seek to engage in, money laundering?
Have you ever committed or conspired to commit a human trafficking offense in the United States
or outside the United States?
Are you the spouse, son, or daughter of an individual who has committed or conspired to commit
a human trafficking offense in the United States or outside the United States and have you within
the last five years, knowingly benefited from the trafficking activities?
Have you knowingly aided, abetted, assisted or colluded with an individual who has committed or
conspired to commit a severe human trafficking offense in the United States or outside the United
States?
Do you seek to engage in espionage, sabotage, export control violations, or any 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 engaged
in terrorist activities?
Have you ever or do you intend to provide financial assistance or other support to terrorists or
terrorist organizations?
Are you a member or representative of a terrorist organization?
Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity,
including providing financial assistance or other support to terrorists or terrorist organizations, in
the last five years?
Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide?
Have you ever committed, ordered, incited, assisted, or otherwise participated in torture?
Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings,
political killings, or other acts of violence?
Have you ever engaged in the recruitment or the use of the child soldiers?
Have you, while serving as a government official, been responsible for or directly carried out, at
any time, particularly severe violations of religious freedom?
Are you a member of or affiliated with the Communist or other totalitarian party?
Have you ever disclosed or trafficked in confidential U.S. business information obtained in
connection with U.S. participation in the Chemical Weapons Convention?
Have you ever sought to obtain or assist 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?
Have you ever been removed or deported from any country?
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?
Have you voted in the United States in violation of any law or regulation?
Have you ever renounced United States citizenship for the purpose of avoiding taxation?