PERSONAL INFORMATION

1. Residential address in Nepal:- swoyambhu, kimdole, 262 manjushree galli

2. Mob no:- 9851179878
3. Home Tel no:-97714881816
4. Work Tel no:-
5. Email address: Sudha.chitrakar@gmail.com
6. Social media reference as below
i) Facebook id Sudha chitrakar ii) Instagram
Others:
7. Have you ever lost a passport or had one stolen:- no

TRAVEL INFORMATION

1. Purpose of Trip in USA:- graduation of Son

2. Intended Date of arrival:- first week of June 2025
3. Intended length of stay in USA:- one month
4. Full Address of USA where you will stay with Tel /email/and relation or Hotel address:-
Knox university,

5. Person/company paying for your Trip with Address /Tel no. /email and Relation:-
self

6. Is another person travelling with you: ………………. IF yes provide following

If yes please provide Full Name /Relation or provide scan copy of passport

1. Pushpa chitrakar 2.

3. 4.

7. Have you been issued US visa before?.......no........ If yes please provide scan copy of visa
8. Date of Previous last 5 USA visit’s and length of stay:
i) ii)
 iii) iv)

v)

9. Have you been refused visa for any countries including USA before:-…….. IF yes Date of
refusal and reason

10.Has anyone file an immigration petition on your behalf with united states citizenship and
immigration services:-

FAMILY INFORMATION

Father full name:- Satya Narayan Chitrakar

Date of Birth (if known) :-

Mother full name:- Madhuri Chitrakar

Date of birth ( if known):-

Spouse full name:-Pushpa Chitrakar

City of birth Lalitpur

Date of Birth (dd/mm/yyyy):-21/04/19

11. Do you have any immediate relative (CHILDREN/PARENTS/SIBLINGS) in USA, if yes please
provide Full name and visa status in USA:-

1.suyash chitrakar

2.

12.PRESENT WORK INFORMATION

Employers name:- Angel Engineering Consultancy Pvt Ltd

Full address with Tel/email address:-

Monthly salary after tax in NPR:-

Start Date (DD/MM/YYYY):-

 Designation and Brief duties and responsibility (in two lines):-

13. PREVIOUS WORK INFORMATION

Previous office name:-

Full address with Tel/mob:-

Job title:-

Supervisor full name ( if known):-

Date of enrollment (DD/MM/YYYY):-

Date of end of job (DD/MM/YYYY):-

14. EDUCATION- (ONLY FOR APPLICANT below 60 years)

Highest education degree:-

Name of institution:-

Full address along with Tel/email and country

Course of study:-

Date of Join(DD/MM/YYYY):-

Date of completion (DD/MM/YYYY):-

15.list of language you can speak

1. 2. 3. 4 5

16. list of countries you have traveled in last 5 years .

1. 2. 3.

4. 5. 6.