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Tata Consultancy Services Limited

Type of Visa Requested : Name (As per passport) H1B Individual L1B Blanket L1B

172816 BA Co. Name Onsite WON 1008208


(Please read instructions given in the last page before filling up this questionnaire)
Individual L1A Blanket L1A

Given Name

Surname (Family Name)

Male Female TCSL / BA Designation Date of Birth Sex

D D 10

YY 19 77
Date of Joining

M M 01


YY 20 06

Base Branch
Documents Sent By (Br anc h)





Do you have an observatio n page in your passport? If yes, please include a copy of the observatio n page


Social Security Number (if any) More Info.




NO Mumba Delhi Kolkata Chennai Hyderaba d

Others Please Specify

Complete Residential Address (in Home Country) Address: (Should be within the Jurisdiction of

Client Name & Project Site Address (More Info.) Client Name : Project Site Address (as per PRD): Corporate Headquarters One Boston Scientific Place City: Natick, State: MA United States Zip Code : 01760-1537 RM / AM :

Santosh Kumar Jha, D-1-12/4,DLF, Bhopura City/District: Sahibabad,GZB PIN: 201005 State: Uttar Pradesh Country : India


Present Contact No. +91-9810922019 Emp. E-mail ID:


E-mail IDs of stake holders 1 [Offshore/Onsite] to whom 2 processing status to be informed (More Info.) Degree / Name of University Specialization Place of University PG As Appearing in the Certificate (only Diplomas/Bachelors/Masters) B.E Shivaji University Electronics Maharashtra

Year of passing 2000

Relevant to Software (a) US Visa questionnaire Ver 6.6 -19.02.10

Not relevant to Software (b)

Total Experience (a+b) TCSL Internal

Work Experience

Prior to joining TCSL

04_ Years 03___Months

___ Years

___ Months


06__ Years

_01_ Months

In BA Organization

_10__ Years 04__ Months

All previous entry/exit dates to/from the United States. Include all kinds of travel (vacation, business etc.). Make sure that the project details and work location in CV are consistent with the below dates. If worked for more than one clients/locations during one visit, mention all the clients/locations. Visa Entry date Exit date from Client Name (s) City (ies) & State (s) Type into U.S. U.S. M D YY M D YY M D M D L1A 11 09 08 02 02 09 Electronic Arts Redwood City, CA L1A 11 15 09 12 05 09 Electronic Arts :: 2 :: US Salary ( TO BE FILLED IN BY FDFU) (USD per annum) Documents for all types of Petitions (also for Blanket Petitions) 1. Updated Resume 2. Project and Role Description (PRD) 3. Copy of Passport/previous US Visas 4. Copy of Degree/PG Certificate(s) Additional documents for H1B All semester Mark Sheets (with subject names and marks) 2. Experience Certificate(s) from previous employer(s), if any 3. Copy of earlier L1/H1 approvals ( If applicable) 1. Additional documents for Individual L1A/L1B Petitions 1. All semester Mark Sheets (with subject names and marks) 2. Latest Form 16 & payslip Redwood City, CA (Contd.. 2)

Details of Previous Petition(s) / Visa(s) 1. Please provide the details of previous petition(s), if any [check the petition(s) ]. Petition Type (Blanket/Individual/Ex tension) BLANKET Visa Type (L-1A, L-1B, H1B) L1-A Valid till (Check I-129 or I129S form in your petition documents) 23JUNE2011 Approved / Denied / Withdrawn (If denied, specify denied by whomUSCIS or US Consulate in India) APPROVED

2. Please provide the details of previous visa(s), if any [check your visa(s) from passport]. Visa Type (L1, H1, B1, H4, L2) L1 Visa Expiry Date 23JUNE2011 PED (Petition Expiry Date) 23JUNE2011 P# (Petition Number)

Signature of the associate : Santosh Jha 17/05/2011

Place: Delhi


US Visa questionnaire Ver 6.6 -19.02.10

TCSL Internal

INSTRUCTIONS: Ensure that the details filled in this questionnaire are matching with the details given in the CV,PRD and experience certificate Ensure that all the documents listed above are attached before submitting this questionnaire to your local FDFU

US Visa questionnaire Ver 6.6 -19.02.10

TCSL Internal


Social Security Number: Applicable only if you have traveled to USA before under L1 or H1 status. Type N.A. if not applicable Client Name and Project Site Address: Mention name of the client and location with the zip code where you will be working E-mail Ids of Stake Holders: E-mails will be sent to these addresses at each stage of processing your petition.

US Visa questionnaire Ver 6.6 -19.02.10

TCSL Internal