INFORMATION REQUIRED FOR USA VISA APPLICATION

1. Full name on passport - please send a copy of the bio page of passport on wats app to
verify the information
______________________________________________________________________________

2. Any other name used. E.g. maiden name

______________________________________________________________________________
3. Date of birth
______________________________________________________________________________
4. City and Country of place of birth
______________________________________________________________________________
5. Male or female
______________________________________________________________________________
6. Marital status
______________________________________________________________________________
7. If divorced – name of divorced spouse, including maiden name of wife; date and place of
birth
______________________________________________________________________________
8. Dates of marriage
______________________________________________________________________________
9. Reason for divorce
______________________________________________________________________________
10. If widowed – name, place and date of birth of deceased spouse
______________________________________________________________________________
11. Do you have any other nationality?
______________________________________________________________________________
 12. Are you a permanent resident of any other country?
______________________________________________________________________________
13. National ID #
______________________________________________________________________________
14. USA Social security number if applicable
______________________________________________________________________________
15. USA Tax number if applicable –
______________________________________________________________________________
16. Home address
______________________________________________________________________________
17. Mailing address
______________________________________________________________________________
18. Primary, secondary and work numbers
_____________________________________________________________________________
19. Any other telephone numbers used for the last 5 years
______________________________________________________________________________
20. Email address
______________________________________________________________________________
21. Any email addresses for the last 5 years
______________________________________________________________________________
22. Any social media account/s and user name e.g Facebook, linkden, Instagram, Pinterest,
etc
______________________________________________________________________________
23. Passport number ( I have this)
______________________________________________________________________________
24. Issuance and expiration dates of passport ( I have this)
______________________________________________________________________________
25. Which city was passport issued
______________________________________________________________________________
 26. Have you ever lost a passport or visa or had one stolen– If yes, please give details
including date of lost
______________________________________________________________________________
27. Which police station a report made of the lost passport
______________________________________________________________________________
28. Were you ever deported or sent back. If yes, why were you deported or sent back
______________________________________________________________________________
29. Purpose of your trip
______________________________________________________________________________
______________________________________________________________________________
30. Intended date of arrival and length of stay
______________________________________________________________________________
31. Address in the USA
______________________________________________________________________________
32. Name of person or hotel, email address and telephone # of where you are staying in the
USA
_____________________________________________________________________________
______________________________________________________________________________
33. Relationship of person to you where you will be staying in the USA
______________________________________________________________________________
34. Is anyone travelling with you
______________________________________________________________________________
35. If yes, the name of the person/persons and relationship
______________________________________________________________________________
36. Have you ever been in the USA
______________________________________________________________________________
 37. If yes, the dates of visit/s and length of stay for the last 5 visits
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

38. Do you hold a US driver’s license? If yes, state of issuance and #

______________________________________________________________________________
39. Have you been refused a visa. If yes, date and reason for the refusal
______________________________________________________________________________
40. Have you ever been issued a USA visa, if yes – number (located in red on the lower right
hand corner of visa) and date of issuance (I have this information)
______________________________________________________________________________
41. Do you have any immediate family in the USA? If yes, Name and Status i.e. mother,
father, brothers, sisters or children
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
42. Do you have any relatives in the USA?
______________________________________________________________________________
43. Has anyone applied for a green card for you, if yes please give details
______________________________________________________________________________
______________________________________________________________________________
44. Names and dates of birth of parents including your mother’s maiden name
______________________________________________________________________________
______________________________________________________________________________
45. If your mother in the USA
______________________________________________________________________________
46. Is your father in the USA
______________________________________________________________________________
 47. If married – name, date and place of birth (city and country) of spouse, include maiden
name of wife
______________________________________________________________________________
______________________________________________________________________________
48. Do you all live at the same address, if not, the current address of spouse
______________________________________________________________________________
49. Who is paying for you trip – if someone else is, supply the following: -

 Name of person_____________________________________

 Relationship________________________________________

 Home address_______________________________________

 Telephone #________________________________________

 Email address_______________________________________

______________________________________________________________________________
______________________________________________________________________________

50. Work information for the last 5 years–(If present employment is not more than 5 years,
please include work information prior to present employment)
 Place and address of work;

_____________________________________________________________________

_____________________________________________________________________

 telephone #,__________________________________________________________

 job position; __________________________________________________________

  gross salary for the month,_______________________________________________

 start date of employment_______________________________________________

 End date of employment if applicable______________________________________

 Name of Supervisor____________________________________________________

 and brief description of

duties_______________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

51. All schools / secondary/tertiary/trade school/university, etc, information

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
52. List them in order as you attended school
 Names and addresses of school
 Dates attended schools
 Course of study at each school – e.g O Levels, A Levels, BA, MA, etc
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
 53. List of countries travelled for the last 5 years
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
54. What languages do you speak
______________________________________________________________________________
55. Do you belong to any social, professional or charitable organization
______________________________________________________________________________
56. Have you ever served in the military
______________________________________________________________________________
57. Do you have any specialized skills in firearms or biological, chemical training
______________________________________________________________________________
58. Are you a member of a vigilante group
______________________________________________________________________________
57. Do you have any sort of communicable diseases
______________________________________________________________________________
59. Any mental disorder
______________________________________________________________________________
60. Have you ever use drugs
______________________________________________________________________________
61. Have you ever been arrested
______________________________________________________________________________
61.Have you been involved in money laundering
______________________________________________________________________________
62. Are you coming to the USA for prostitution
______________________________________________________________________________
63. Have you or your parents ever committed human trafficking
______________________________________________________________________________
64. Do you seek to engage in human trafficking
______________________________________________________________________________
65. Have you ever engaged in sabotage or espionage
______________________________________________________________________________
66. Are you a member of the terrorist group
______________________________________________________________________________
67. Have you participated in torture or genocide
______________________________________________________________________________
68. Have you engage in the recruitment of child soldiers
______________________________________________________________________________
69. Are you a government official who was involved in political killings
______________________________________________________________________________
70. Have you ever been deported
______________________________________________________________________________
71. Have you ever assisted anyone in obtaining a visa illegally
______________________________________________________________________________
72. Have you ever overstayed in the USA
______________________________________________________________________________
73. Have you ever been deported from any country
______________________________________________________________________________
74. Have you ever withheld the custody of a USA child
______________________________________________________________________________
75. Have you ever voted in the USA
______________________________________________________________________________
76. Did you attend public school in the USA without reimbursing the school
______________________________________________________________________________
77. Have you denounce USA citizenship to prevent paying taxes
______________________________________________________________________________